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Mind, Body & Soul Inside February 2013

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February 2013


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CONTENTS

A publication of the Jewish Press, publishing since 1960

7 H&L Digest 8 Pain Medication Controversy 9 Medical Euthanasia Abroad

Moshe Klass

Senior Editor

Yaakov Kornreich

RAISING OUR CHILDREN

10 Kids and Cell Phones 11 About Lactose Intolerance 12 Right Brain/Left Brain Theory 13 Physical Exercise & Flu Prevention

WOMEN’S HEALTH

Ita Yankovich

Features Editor Aliza Levinger

Children Editor Editorial Staff Tova Ross Leah Rothstein

14 Choosing Where to Have

Your Baby 16 Egg Freezing 17 Hospitals Plan to Decrease Rates of C-Sections 18 Learn to be an Iron Chef

Learn how to protect yourself and boost your immunity.

18

Folic Acid

Heshy Korenblit

Advertising Sales

Learn the critical benefits of iron and folic acid for women and how to become an “Iron Chef ” by incorporating these nutrients into your diet.

Arthur Klass David Hoppenwasser

Advertising Coordinator Design

Alana White

20 The New Senior Lifestyle -

February 2013

5

COMMUNITY PROFILE

-23 Fit and Active 24 Caregiving and Technology 26 The Patient-Centric Approach to Healthcare 28 Changes in Medicaid System

have made it more and more difficult to get the necessary number of home attendant hours, even for people who really need the help. It’s critical to have someone familiar with the system to guide you through the process of obtaining home care services.

H&L TECH

GOLDEN YEARS

28 Changes in the Medicaid System

HEALTHY LIVING

Shaindy Urman

MEDICINE TODAY

Advertising Director

Cold and Flu Viruses Peak in February

GOLDEN YEARS

Dana Ledereich

13

WOMEN’S HEALTH

Associate Editor Rachel Wizenfeld Copy Editor

Widespread overuse and abuse of pain medication has led Mayor Bloomberg to institute a three-day supply limit in hospital emergency rooms.

RAISING OUR CHILDREN

Supplement Publisher

8

Pain Medication

ISSUES

ISSUES

INTRODUCTION

INTRODUCTION


INTRODUCTION

INTRODUCTION

Letters

CONTENTS

ISSUES

to the editor:

Hospital Closures

30

RAISING OUR CHILDREN

Due to Hurricane Sandy and a serious flu outbreak this winter have put strain on Brooklyn’s remaining hospitals. Now the proposed shutdown of Long Island College Hospital increases concern that wait times - already long - will increase for patients in need and emergency rooms will become even more crowded.

WOMEN’S HEALTH

38

GOLDEN YEARS

drinking red wine in moderation have long been documented. Now Israeli researchers are finding that the same antioxidants are also found in pomegranate juice, for potentially life-saving effects.

MEDICINE TODAY

ADDICTION RECOVERY

Crisis 31 Advances in Minimally Invasive Heart Procedures 32 Careers In Health - Nutritionist ✪ 33 Rare Genetic Cancer Risk Factors Raise Treatment Questions ✪ 34 The Avoidable Dangers of Daytime Sleepiness 36 FDA Monitor ✪ 37 The Search for an Alzheimer’s Cure

Over the last 18 months, people have been totally confused about the changes in home care. We at Revival have been able to guide our patients through these turbulent times. The effect to the Medicare patient has been basically no change. Patients that are dually eligible, which means they have both Medicare and Medicaid introduced to a new term, have a program referred to as an MLTC (Managed Long Term Care Plan). An MLTC will coordinate different services that was previously done through straight Medicaid. They will coordinate primarily the home health aides amount of hours allotted. Every case will be evaluated based on need. The MLTC is here to stay, so I recommend you work with the system so it will be able to assist you. There are a number of MLTC’s and the patient has the right to choose. Isaac Soskin Chief Executive Officer Revival Home Health Care

30 Post Sandy Emergency Room

47

Kids of Courage

Rofeh Cholim Cancer Society

762 Bedford Ave. Brooklyn, NY 11205 718.722.2002 • www.rccscancer.org An array of services for cancer-stricken patients in need, including the subsidizing of health insurance premiums, enabling them to obtain the best medical care.

Yad Ephraim

HEALTHY LIVING

5017 10th Ave, Brooklyn, NY, 11219 718.431.0404 • www.yadephraim.org Our volunteers visit patients in hospital rooms every day. They offer a listening ear, a warm meal, or sometimes, simply their presence to help pass the time more pleasantly.

732.905.2055 • lakewoodcourtyard.com A glatt kosher assisted and independent living community, located in the heart of the Lakewood community.

Under the guidance of Rabbi Yosef Y. Holtzman, chief Rabbi at SUNY Downstate Medical Center, Yad v’Ezer provides freshly cooked meals to families in temporary need.

Regency Home Health Care

5110 19th Avenue, Brooklyn, NY 11204 718.223.1520 Your family members will enjoy a community setting and quality of service that is second-to-none at our modern facility in the heart of Boro Park.

CHIROPRACTIC CARE Dr. Melinda Keller

5911 16th Ave. Brooklyn, NY 11204 718.234.6206 • www.brooklynspinecenter.com ng B’H! How can I Brooklyn Spine Center helps treat neck and back artum Depression?” pain, pediatric care, posture correction, pregnancy cupunture, we can help... care, stress relief etc.. Modern treatment done with -414-3831 old fashioned care. ,visit www.2ndNatureAcu.com

COMMUNITY PROFILE

vertise in arketplace Shaindy at 100 ext. 373 or wishpress.com

COMMUNITY SUPPORT Chai Lifeline

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48 H&L Showcase

COMMUNITY PROFILE

54 50 Chai Lifeline - Fighting Illness

DENTISTRY

Doueck Dental Trust Experience

with Love 51 Medical Profile 52 Community Provider Bulletin 53 Community Calendar 54 Health and Living Service -57 Marketplace 58 From the Doctor’s Desk ✪

563 Kings Highway Brooklyn, NY 1.800.SNORING • www.DoueckDental.com Sleep apnea is a serious disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea put themselves at risk for high blood pressure, stroke, heart failure, diabetes, depression, GERD. Dr. Doueck uses the latest in technology to diagnose and treat this disorder.

Joseph Lichter D.D.S

1420 Ave. P Brooklyn, NY 718.339.7878 • www.josephlichter.com Now in a new and expanded facility, laser, cosmetic and comprehensive dental work offered to all phases in family dentistry. Convenient appointments as well as emergency service and treatment available.

ELDER LAW Health & Living Marketplace 54

H&L TECH

46 Ipad Apps for Healthier Living ✪ 47 Choosing the Right Treadmill ✪

1410 East 10th Street, Brooklyn, NY 718.998.5400 Luxury senior retirement facility. Exciting & stimulating activities for Jewish seniors, morning and afternoon programs available.

can be an adventure, so be sure you know what to look for before making Lakewood Courtyard Yad v’Ezer 718.613.1818 theNJ investment. 52 Madison Avenue, Lakewood, 08701

Brooklyn, NY

Properties In the Pomegranate 40 French Paradox 42 Cupping Therapy ✪ 43 Unscrambling the Egg 44 Trim & Fit ✪ 45 Kosher in the Kitch ✪

Recovery through Torah

Choosing a Treadmill

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Recovery Road

ASSISTED LIVING

Healing

38 Doctors Discover Life-Saving

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HEALTHY LIVING

445 Central Ave, Suite 216, Cedarhurst, NY, 11516 516.612.8844 • www.kidsoc.org An innovative, all volunteer organization dedicated to improving the lives of sick children and their families. We offer year round programming as well as an annual ski weekend and a medically supervised Dream Trip to the West Coast, all at no cost to the parents.

Ateret Avot

H&L TECH

About Managed Long Term Care Plan

The Health Benefits of

th AND Living Service Marketplace

c., Dipl.

MEDICINE TODAY

Korsinsky & Klein LLP

2926 Avenue L, Brooklyn, NY 11210 718.312.3222 Specializing in Elder Law, Estate Planning, Medicaid Law, Probate, Wills & Trusts, & Guardianships

November 2012

✪ Featured Columns

6

SUBMISSION INFORMATION

Health & Living invites readers to submit letters to the editor. Letters will be selected for publication at the sole discretion of the editor, and may be edited for size and content. Submissions become the property of the Jewish Press. Please e-mail your letter to the editor to magazine@jewishpress.com. Health & Living, in its sole discretion, reserves the right to decline any submitted advertisement or to discontinue publication of any advertisement previously accepted. The acceptance of advertising by Health & Living does not constitute endorsement of the services, products, or information advertised. For subscription requests, advertising rates, general inquiries, calendar information and schedules contact Health & Living at 718.330.1100 ext. 352. You may also write to: Health & Living c/o The Jewish Press, 4915 16th Avenue, Brooklyn, NY 11204-1115 or e-mail magazine@jewishpress.com.

February 2013


Digest

?

H

? ?

Fact

Tip Wash Those Greens!

The number of people on Medicaid in NY in 2009, according to The Henry J. Kaiser Family Foundation, which tracks healthcare data in all 50 states. That’s 27% of the total state population, in comparison to 20% of the nation’s population who are on Medicaid. Under Obamacare’s Medicaid Expansion, more than 16 million people are expected to become newly eligible for Medicaid in January 2014, however some states, including California and Minnesota, are jumping on the expansion bandwagon early and have already begun to increase enrollment. Source: www.statehealthfacts.org

Congressman Paul Ryan, Chairman of the House Budget Committee and former Vice Presidential Candidate in an interview with the Milwaukee - Wisconsin Journal Sentinel.

Researchers in the American Journal of Therapeutics have discovered that a compound found in chicken soup – carnosine – helped the body’s immune system to fight the early stages of flu. Another study found that collagen obtained from chicken legs, which is emitted into chicken broth, reduced blood pressure in hypertensive rats within four hours of eating it. So cook up some matzo ball soup this Pesach – if not for tradition’s sake, then at least for the health benefits!

The NFL and G.E. are dedicating $50 million to a new initiative aimed to reduce the instances and affects of head injuries for football players, as reported by the New York Times. The fouryear initiative, which is expected to begin in March, will determine if some players are predisposed to head trauma, examine and detect the long-term effects of concussion, and improve equipment to protect the brain during play. Research shows that athletes who have repeated concussions are more likely to get long-term brain damage, including a condition known as chronic traumatic encephalopathy (CTE), a brain disease that mimics dementia.

February 2013

7

COMMUNITY PROFILE

Football Headcases to be Studied

H&L TECH

Chicken Soup for Your Health

HEALTHY LIVING

Newsworthy

Study

MEDICINE TODAY

The Affordable Care Act will collapse under its own weight... I really don’t believe that the system will be able to sustain... the numbers of people who will be dumped out of their employer [health insurance] plans into [the new individual health care insurance] exchanges.

GOLDEN YEARS

Quote

WOMEN’S HEALTH

Kashrus reasons aside, a new study in the March issue of Emerging Infectious Diseases estimates that more than half of all food-borne illnesses are caused by plant foods, which made more than 4.9 million people sick over a 10year period, and leafy Above is the Bug Checker XL Portable Light Board found at kosher-innovations.com. greens led the list, with 2.1 million people becoming ill after eating them.

RAISING OUR CHILDREN

5,208,135

???

ISSUES

By Elisheva Stein

INTRODUCTION

RAISING OUR CHILDREN ISSUES


INTRODUCTION ISSUES RAISING OUR CHILDREN WOMEN’S HEALTH GOLDEN YEARS MEDICINE TODAY HEALTHY LIVING

RAISING OUR CHILDREN ISSUES

? Should Painkiller Prescriptions be Limited? By Elisheva Stein By Leah Rothstein

H N

? ew York City Mayor Michael ? Bloomberg has announced a new policy to limit the amount of ??? pain medication provided in city hospital emergency rooms to a three-day supply. “Abuse of prescription painkillers in our city has increased alarmingly,” Mayor Bloomberg declared. His ban on prescribing a large quantity of painkillers is intended to address the burgeoning problem of teenagers and relatives of the patient with access abusing a patient’s leftover drugs. He cited another major concern, increasing violence by drug addicts. Drug robberies at pharmacies are getting increasingly dangerous, and innocent people have been killed. A drug robbery that turned violent in Medford, Long

Critics of the new policy say that it discriminates against poor patients who use the emergency room to get primary medical care, and who may not be able to get the painkillers they need in any other location.

Island in June 2011, left four people dead, including the pharmacists. With the new policy in place, prescriptions for narcotic painkillers like Percocet and Vicodin at city hospital emergency rooms will be limited to a three-day supply, and long-acting painkillers like extended-release oxycodone, fentanyl patches or methadone won’t be dispensed at all. Lost, stolen or destroyed prescriptions for these medications will not be refilled. The policy makes an exception for cancer patients and for palliative care. The new pain drug guidelines are only mandatory at public hospital emergency rooms; prescription painkillers will still be available at private hospitals. However, a number of private hospitals in the city have already announced that they will voluntarily adopt the new guidelines.

Another concern is that it will be harder for doctors in public hospitals to use their best judgment about how to treat their patients. But proponents respond that when patients demand painkillers, it’s hard for doctors to determine whether it’s for a genuine need or to feed an addiction. City hospitals had been giving patients on average of a week’s supply of painkillers, but the mayor’s panel of doctors considered this excessive for the majority of cases. “Most acute pain — from an ankle injury to a headache, whatever you’d like to pick — lasts two to three days,” Dr. Lewis Nelson of the NYU Langone Medical Center, a member of the prescription pill task force created by Mayor Bloomberg, told the NY Post. Prescription painkiller drug abuse is on the rise in the city- the reported use of prescription opioids grew 40% between 2002 and 2009. Overdoses are increasing toothere was a 30% rise in accidental painkiller overdoses between 2005

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H&L TECH

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COMMUNITY PROFILE

w w w. c h p n y c . o r g

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and 2010. According to the CDC, nearly three out of four prescription drug overdoses are of opioid drugs. Many, such as oxycodone, can be fatal when mixed with even small amounts of alcohol. Painkiller-related deaths in New York city reached 173 in 2010. “Make no mistake, these are dangerous drugs,” said Dr. Thomas Farley, the city health commissioner. “It’s best to think of them as heroin in pill form.” He added that three-quarters of prescriptionpainkiller addicts get access to their drugs from the unused supply of relatives. Dr. Russell Portenoy, long a famous advocate for the more widespread use of painkillers, has recanted his earlier claims that opioid drugs are safe and present low risks of addiction. In an interview with the Wall Street Journal, Dr. Portenoy said it was “quite scary” to think how the growth in opioid prescription, driven by advocates like himself, had contributed to soaring rates of addiction and overdose deaths. “Clearly, if I had an inkling of what I know now then, I wouldn’t have spoken in the way that I spoke.” He still believes that there is an important role for painkiller drugs when used appropriately, and doesn’t want to see a return to the way things were 25 years ago, when few doctors would prescribe opioid medications at all, even to patients who would clearly benefit tremendously. With so much potential for these drugs to help sufferers of severe pain, balanced against the dangers of addiction, the challenge is to find a way to equitably distribute painkiller drugs just to those who need them. The new threeday prescription limit may help keep excess painkilling drugs out of some family medicine cabinets where they don’t belong, but this step alone will not be sufficient to combat the city’s problem. Leah Rothstein is originally from Elizabeth, NJ and is a frequent contributor to the Jewish Press.

February 2013


? Creeping Medical Euthanasia in Britain

H N

Hopefully, with the help of Hashem, this critically important provision that Chayim Aruchim advocated for will be fully implemented! This is important not just for Orthodox Jews but for the rest of America as well. A focus upon providing information about potential medical treatments for those who care about the sanctity of life would ensure better health care for all Americans and protect us, with the help of Hashem, from the economic and bureaucratic pressures to institute such dangerous programs as the Liverpool Care Pathway.

GOLDEN YEARS

Barbara A. Olevitch, Ph.D., is a clinical psychologist living in St. Louis, Missouri and author of Life is a Treasure: The Jewish Way of Coping with Illness (Targum Press).

WOMEN’S HEALTH MEDICINE TODAY HEALTHY LIVING H&L TECH

9

COMMUNITY PROFILE

February 2013

prognosis of death within a year for such information, even if these palliative care approaches violate the religious beliefs of the doctor. Fortunately, in New York, Agudath Israel of America has started a program called Chayim Aruchim, whose mission is to ensure that end-of-life counseling is culturally sensitive. Representatives from Chayim Aruchim, led by Rabbi Shmuel Lefkowitz, met with New York legislators and successfully advocated for an amendment to the Palliative Care Information Act. This amendment, which was signed by the governor of New York on July 18, 2012, requires that patients with a terminal illness be informed about both palliative treatment, and “other appropriate treatment options should the patient wish to initiate or continue treatment.”

RAISING OUR CHILDREN

? ow that Obamacare has ? passed and President Obama has been reelected, ??? Americans are nervously watching health care developments in England with the idea that whatever is happening there could soon be happening here. Revelations published by the Daily Mail on October 25, 2012 indicated that in England, thirty million pounds have been given to health care organizations, or “trusts,” as financial incentives to put higher percentages of their patients on something called the Liverpool Care Pathway. It is a comprehensive set of instructions for medical personnel that was originally designed for terminal cancer patients but is now being applied to all kinds of patients. It includes withdrawing medical treatment and food and fluids and administering pain medication. On the average, patients placed on this regimen die within 29 hours, and it “is thought to be used in more than 100,000 cases a year,” according to the Daily Mail. This Pathway has been severely criticized, but it continues to be used. Wesley J. Smith, in an article in the National Review in October, 2009, quoted from an open letter published in the Daily Telegraph by palliative physicians and others saying that, “If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death.” Following the publication of this letter, there were testimonials from families who were happy with the Pathway as well as articles detailing personal stories about families who were outraged by the way their loved ones were treated on the Pathway. Recently, more reports about angry families have been published as well as more statements from those who defend the Pathway. The Telegraph reported on December 1, 2012, that half of the families whose loved ones were

put on the Liverpool Care Pathway may not have been informed of this. For example, the family of an 86-year-old man who was “begging for a drink” said, “We asked the doctors why he was taken off his drip and we were told he was on the Liverpool Care Pathway. We did not even know what it was. . . We kicked up a fuss and demanded he be put back on his medication and eventually they agreed about 20 hours later.” To be sure, there are those who are demanding an inquiry and changes in the law to require the consent of the families, but in the meantime, the Liverpool Care Pathway is still being used. Why does the Pathway continue to be viewed as justifiable in spite of these heartrending complaints? The answer is that it is claimed to be an example of excellence in endof-life care, and the rewards given to institutions that put a large percentage of their patients on the Liverpool Care Pathway are being called rewards for “excellence.” While palliative medicine does have expertise in pain-control techniques, whether it is right or wrong to use these techniques in a particular case is a religious decision. Rav Yaakov Weiner, addressing the Conference of Synagogue Rabbanim at the Agudah Convention in 2010, made an important distinction about the basis of a doctor’s medical decision. Does it really come from his medical knowledge or does it come, rather, from his hashkafa? If it is based upon his hashkafa, and if it is in conflict with the Torah’s hashkafa, then we should not listen to it. Here in America, there are also those who are claiming that palliative techniques that hasten death are not only acceptable, but desirable, and that all patients should be informed about them. In California and New York, legislation has been passed requiring medical doctors - under the threat of fines and even jail sentences - to offer information about palliative care or to refer all patients with a

ISSUES

By Elisheva Stein By Barbara A. Olevitch, PhD

INTRODUCTION

RAISING OUR CHILDREN ISSUES


INTRODUCTION ISSUES

RAISING OUR CHILDREN

Should You Give Your Child a Cell Phone? - Pros and Cons By Ita Yankovich

COMMUNITY PROFILE

H&L TECH

HEALTHY LIVING

MEDICINE TODAY

GOLDEN YEARS

WOMEN’S HEALTH

RAISING OUR CHILDREN

T

he latest horrific shootings that have been taking place in schools, malls and movie theaters have once again stirred up the debate over whether kids should carry cell phones. Some parents view the cell phone as a lifeline connecting them to their kids, while others maintain that the device only opens the door for other forms of danger to their children. According to the Pew Research Center, 75% of kids 12-17 have a cell. The Kaiser Family Foundation reports that 31% of 8-10 year olds own a cell, 69% of 11-14 year olds, and 85% of 15-18 year olds. But according to the American Academy of Pediatrics, there’s really no “right” age to own a cell phone. Whether or not your child is old enough or actually needs a cell phone is something each parent will have to decide for him or herself. It is a decision that varies from family to family and from child to child.

Reasons Kids Should Carry Cell phones

Security - Cell phones equipped with a GPS tracking chip enable parents to know where their children are all the time. Other phones come with a panic button, which automatically dials 911 in case of emergency. Parents give their kids cell phones so they can call them if they ever feel like they are in danger, if their ride didn’t show up, if they feel ill, etc. It is an open line of communication. Health - If you or your child

has a pressing medical issue, a cell phone might be necessary to communicate information on medication, sensitivities etc. Len Saunders, public school teacher in the NYC area, believes that a cell phone is often necessary, for example, in a case where a child has a severe peanut allergy and the parents always need to have instant access to communicate with him or her. Work - If you are a working parent, or even if you own your own business, there might be a sudden change in schedules that will require you to speak with your child (such as a change in pick-up time, not being home, etc.)

possible damage to the eyes and ears from overuse. Kids can get into accidents while crossing or walking in the street because they are distracted by their cell phones. Cell phones can also be a breeding ground for germs. Privacy - Owning a cell phone can make your child a target for unknown callers, advertisements and hackers. It can also be hard to control your child’s social

Reasons Kids Should Not Carry Cell phones

Security - Read any police blotter and you will notice how many children are attacked and robbed for their cell phones. It may make them a target for muggers. Consider that with a cell phone, your child will simply have another way to communicate with the outside world that you will have little supervision over. Most of today’s cell phones offer internet access which is much harder to filter and control compared to your home computer. Kids in most situations are never alone. They usually will have access to a phone if they need to contact you either through a pay phone or by borrowing a cell phone or landline belonging to a friend or an adult. Health- -Possible health hazards through exposure to low power microwave radiation, as well as

At a Glance

Is Your Child Ready for a Cell Phone?  Does he/she have a real need for it or is it simply a want?  Is he/she able to use it only when necessary and remain undistracted while crossing the street and in face-to-face social settings  Does he/she demonstrate responsibility? Is he/she likely to quickly lose it or be able to keep track of the phone even when busy or distracted?  Does he/she know what to do about calls or texts from strangers?  Does the device have internet capabilities? Is access restricted in any way? In either case, is he/she old enough and mature enough to use it responsibly?

will rewire themselves and be conditioned to behave in that way. Young brains are not yet fully developed and therefore I do not believe it is worth the risk.” So how do you know when your child is ready for a cell phone? A child should only have a cell phone if there is a clear need for it: for instance, if your child is engaged in an afterschool activity and you need to be in touch. In addition, children should demonstrate responsibility. Can they contribute to the monthly payments out of their allowance? Can they take care of the phone and not lose or damage it? Can they follow rules and not exceed their allotted minutes?

Conclusion

life once they have a phone. You cannot monitor every communication they have on the phone. Sherianna Boyle is a former school psychologist, parent educator, and the author of several books on child safety. She believes that a cell phone that was initially purchased for safety often turns into a device that promotes distractibility, poor face-to-face communication, social rudeness, and an addiction to the feeling of always being electronically hooked up to others. “Think of phones as training a muscle, only it is the muscles of the brain,” she explained. “If you train someone early enough to be dependent and detached from the world around them, their brains

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Most professionals like Mitchell Weiss, finance executive and professor and author, believe that parents need to advocate for more direction and balance—“don’t let these kids stare at a personal screen all day.” If you feel that your child is ready for a cell phone, consider:  Purchasing a pre-paid plan with a limited number of minutes so that you won’t end up with a high bill with a lot of extra charges.  Parental control - you should have the power to turn off or limit web access and text messaging, and restrict who can call and whom your child can call.  Allowing your child access to the phone only in certain situations such as when they are hanging out with friends, in an outside venue, attending an afterschool program, or other times when he/she might not be near a regular phone.  Explaining that owning a cell phone is a responsibility and a privilege. While it can be also used for friendly chatting, its major purpose is for serious communication. Also, explain the dangers of driving while talking or texting on a cell phone, cyber bullying, cell phone etiquette, and following rules for cell phone use at school. Ita Yankovich is a freelance writer/re-

porter. She also teaches English and Literature at Kingsborough and Touro College.

February 2013


The Lowdown on Lactose Intolerance

L

HEALTHY LIVING

We fixed that.

MEDICINE TODAY

Speedy diagnosis and expert treatment are crucial when dealing with a stroke. Should you ever experience one, you’ll get the fastest, most qualified care possible at New York Methodist Hospital. The latest drugs,and the most sophisticated technology are tools used by our highly trained neurosurgeons to remove blood clots and reverse stroke effects up to twelve hours from the onset of symptoms. Permanent damage can often be prevented and a full recovery is possible.

GOLDEN YEARS

New York Methodist is one of the only hospitals in Brooklyn with the latest technology to treat and reverse strokes.

Dr. Tuvia Marciano is a pediatric gastroenterologist in Long Island, New York. He is available by appointment at 516.663.4600. Most insurances are accepted.

WOMEN’S HEALTH

“When I had my stroke, I was afraid life would never be the same.“

approximately 25 grams of lactose (equivalent to two glasses of milk) and measuring the amount of expressed hydrogen gas in your breath. If you suffer from lactose intolerance, the malabsorbed lactose will enter the colon and be fermented by bacteria into simple sugars and hydrogen gas. The hydrogen gas will be absorbed into the blood stream and exhaled. Lactose intolerance is not an allergy. Management requires patients to take a lactase enzyme replacement, but dairy avoidance is not an absolute necessity. Most patients are able to tolerate some amount of lactose without symptoms.

RAISING OUR CHILDREN

of two simple sugars, glucose and intolerance. This occurs after a galactose. In the small bowel, lac- gastrointestinal illness, in which actose intolerance affects ap- tose is broken down into simple the villious tips of the small bowel proximately 50 million Amer- sugars by an enzyme called lac- are damaged, resulting in diminicans. The most common symp- tase. When lactose is not ab- ished lactase activity. Many times toms are bloating, diarrhea, and sorbed in the small intestine, it it will be necessary to change the excessive gas. It is found in 100% will pull a large amount of fluid baby to a lactose-free formula or of American Indians and Asians into the bowel. The lactose will go on a dairy-free diet following and it affects 60 - 80 % of African then enter the colon where bac- a gastrointestinal illness, for this Americans and Ashkenazi Jews. teria will digest the sugar by fer- reason. A large number of people believe mentation. This produces a large Irritable Bowel Syndrome (IBS) they are lactose intolerant and amount of hydrogen gas and sim- is often confused with lactose are not. Many people with lac- ple sugars. The sugars are then intolerance. The symptoms are tose intolerance will still be able digested into short-chain fatty often similar, and up to 25% of to tolerate some amount of lac- acids, which will cause the diar- patients with IBS will suffer from tose, and almost all will tolerate rhea produced by lactose malab- lactose intolerance as well. Many a minimum of 12 ounces of milk. sorption to be acidic. Babies with disease states may result in lactose A diagnosis can be made either lactose malabsorption will there- intolerance. These include Celiac by a breath test or a biopsy of the fore often develop a severe diaper Disease and Inflammatory Bowel Disease. small intestine. Treatment is by rash, resembling a burn. avoidance of lactose or by enzyme Congenital lactose intolerance Diagnosis of lactose intolerance is extremely rare. Most babies is often done by lactose breath supplementation. Lactose, which is the sugar in who have difficulty with lactose hydrogen testing. This is done in NYM-Stroke_JewishPress 2/22/13 _Layout 2/1/13 12:29lactose PM Page 1 milk, is a disaccharideH&L made up8.625x5.625 suffer from a 1temporary your doctor’s office by drinking

ISSUES

By Tuvia Marciano, DO

INTRODUCTION

RAISING OUR CHILDREN

Emergency Department

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February 2013

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506 Sixth Street, Brooklyn www.nym.org ER Pedestrian Entrance corner of Seventh Avenue and Sixth Street


INTRODUCTION ISSUES RAISING OUR CHILDREN WOMEN’S HEALTH GOLDEN YEARS MEDICINE TODAY HEALTHY LIVING H&L TECH COMMUNITY PROFILE

RAISING OUR CHILDREN

Your Child’s Brain - Which Side is Dominant? By Chaya (Ilene) Klass, MS, OTR/L

“M

y sister is an artist and I can’t draw even a simple stick figure.” “My friend is a math genius and I can barely add two numbers together.” “My father can find his way around town with no problem and I get lost with my GPS.” Have you ever heard people making comments such as these? Have you ever wondered why your child excels in some areas and not in others? Is the answer to all this as simple as determining if your child is right or left brained? The study of right and left sides of the brain began as early as the 1860’s by Dr. Pierre Paul Broca and continues through today. Many theories have arisen as to why humans excel in some areas and not others. These theories attempt to explain why some individuals learn to play piano without being taught and draw beautiful paintings without art lessons, while others are good with numbers and logic puzzles. One major theory hypothesizes that each side of the brain is responsible for different functions and processes information differently. It is further believed that individuals have a preference for processing information on one side of the brain, which determines how we function, think, behave, and what we excel at. The right brain is thought to be the spontaneous, intuitive and creative side of the brain. Rightbrained people “think out of the

box” and follow their instincts, rather than relying on logical reasoning. They often have good musicality, are imaginative, creative, and artistic. They are more visual and look at the whole picture rather than the details. They also recognize patterns and have good spatial awareness, which makes them good at facial recognition. They

also exhibit good visual memory skills, attach images to memories, and make visual associations between objects, pictures, and things. When communicating, rightbrained individuals rely less on words and more on gestures. They are more perceptive and use pragmatics of language to understand others, rather than on the spoken word. They also tend to be less organized than left-brained people. Left-brained individuals are more practical and follow logical thinking to solve problems rather than their intuition. They deal with facts, details, logic and reasoning to analyze situations for a ratio-

Right brain skills: Left brain skills:  Practical  Logical  Analytic  Literal-thinking  Sequential

 Intuitive  Creative  Pattern recognition  Spatial awareness  See the big picture

At a Glance

While it is important to help children learn in the manner they process and absorb information and ideas best, it is also imperative that parents and educators help them “stretch their thinking” and perform well in both right and left brain capacities. While it is important to analyze situations and think logically, it’s also important to be emotionally aware. And while spontaneity creates excitement and fun in everyday living, it is critical to also develop impulse control.

nal outcome. They prefer subjects such as reading, writing, math, and science. Because of their sequential ability, they learn new educational concepts easily and have a broad amount of stored knowledge. They are detail-oriented, organized, easily form strategies, and seek out knowledge. They don’t take risks and go through life “playing it safe.” They rely on verbal words for commun i c at i o n , speak in a precise manner with few gestures, and rely on what is said - not implied. To further understand the left vs. right brain concept, we must have a basic understanding of how the brain works. The human brain is the most complex organ in the human body and is responsible for our thoughts, feelings and behavior. Each part of the brain controls specific functions, and if damaged those parts cause deficits in their areas of function. For instance, a brain injury to the cerebellum, which controls balance, will cause difficulty walking and running. It is important to remember that each side of the brain controls the opposite side of the body. The question that begs to be asked is, does an artistic person use only the right side of the brain while a math genius only uses the left? The answer is no. Both sides of the brain are in constant communication with each other. An associate professor, Michael Saling from the University of Melbourne, states that, “Every single cognitive function has right and left hemisphere components.” Though both sides are in constant communication and are processing information, one side of the brain is more dominant in each individual,

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which accounts for us being right or left-handed. This also explains why one individual can have one or more right-brain features, while at the same time being left-brain dominant and vice versa. Though both sides of the brain are being utilized, one side is typically more dominant. There are also some individuals that are referred to as “whole-brained” and display both right and left brain characteristics. So what do parents, educators and therapists gain from understanding the right vs. left brain theory? Pediatric neurologist Henry Hasson, MD, quoted the famous King Solomon proverb: “’Teach a child according to his way.’ Modern biology reflects the Bible’s teachings. Every brain is different and every child needs to be taught in a way that is most conducive to his learning. As science continues to learn the intricacies of the brain, we can get closer and closer to understanding the best way to apply that proverb to each and every child,” Dr. Hasson said. By understanding how a child processes information and recognizing a child’s strengths and weaknesses, we can determine what type of learning will facilitate an optimal outcome. For example, a right-brained child will likely learn better with hands-on, multi-sensory learning, group discussions, and using singsongs to memorize facts. Left-brained children may utilize graphic organizers, step-by-step logistical instructions, or research and analysis. Additionally, we can gently guide and encourage them to choose a career that’s a good fit for their way of thinking and processing. For example, a left-brained child might choose a career in biological research or law, whereas a right-brained individual would not. By helping our children identify their learning types, we can help them learn well and choose the right path to succeed. Chaya (Ilene) Klass, MS, OTR/L, is an occupational therapist who works for the NYC Department of Education and treats children in the community. She can be reached at ileneklass@aol.com.

February 2013


Physical Exercise and Flu Prevention

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Dana Ledereich, MA, OT/L is a pedi-

GOLDEN YEARS

atric occupational therapist with a private practice in Brooklyn. She evaluates and treats children age birth-13 years with sensory processing issues, poor handwriting, developmental concerns and neurological issues. She is available to lecture and to mentor new therapists, and can be reached at 718.252.2939.

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COMMUNITY PROFILE

February 2013

and supermarkets, they are still vulnerable for catching cold and flu viruses. Interestingly, the incidence of cold and flu goes up in the wintertime in warmer climates as well. Researchers attribute this to crowded stores as well as to more time spent together for holidays. Wintertime also brings less exposure to sunlight. Sunlight is the body’s best source of vitamin D, which boosts the immune system. Because the winter days are shorter and people are indoors more, there is less opportunity for reaping the immunological benefit of sunlight. Also, when people do venture outdoors, they tend to be covered up against the cold and as such the skin does not have an opportunity to absorb sunlight. The result is lower levels of vitamin D in the winter, leaving one’s immune system with less support from that vitamin. The cold weather that drives people indoors also contributes to decreased physical activity. People are more sedentary in the cold weather, and have a harder time motivating themselves to go outdoors to exercise or even to drive to a gym. This is unfortunate because physical exercise has been shown to boost the immune system. In fact, people who exercise regularly are 40% less likely to catch the flu. It is theorized that exercise helps to better circulate

active on a regular basis during the winter. If it’s too cold to go to the park, take them to places where they can be active indoors such as swimming pools, ice skating rinks and gymnasiums. Regular physical activity is important for maintaining their immune health. Important Note: Physical exercise does not decrease the duration of the flu once it has been contracted. Someone already suffering from the flu should not exercise. Instead, he or she should take the time to rest in bed to allow the body to recover.

RAISING OUR CHILDREN

inter is here and with it comes a whole host of viruses that are somehow less prevalent in the warmer seasons. Poor winter, it’s saddled with the nickname of “cold and flu season.” In a typical year, February marks the peak of the flu season after which incidences of flu begin to decrease. This year, however, the CDC describes flu activity as particularly high and says that they cannot predict when it will reach its peak. They’ve geared up for a long and strong flu season, and recommend staying vigilant to protect against cold and flu, even though winter may seem to be nearing its end. Colds and flu are both viruses that are spread either through direct contact with an infected person or by airborne transmission. There is usually an incubation period of 10-12 days, so a person may be a carrier or infectious for a particular virus without even knowing it. It’s difficult to find accurate statistics to back up the claim that people suffer from more colds in the wintertime, since colds often go unreported. Most people do not go to the doctor for a common cold but instead manage it on their own with over-the-counter medication. There do tend to be more missed workdays in the winter due to a cold. However there are better statistics for tracking the flu. While people do get the flu in the summertime, the incidence of influenza increases in the fall, peaks in the winter and begins to decrease in the spring. Reported cases of colds and flu tend to peak in February and begin to decrease in March. Several theories have been suggested to explain why cold and flu seem to increase in the winter. People tend to spend more time indoors during the wintertime simply because it’s cold outside. Not only are they indoors, but they tend to huddle together. The close proximity facilitates the spread of germs. Coupled with this is the fact that most heated indoor

one’s white blood cells throughout the body. The white blood cells are responsible for maintaining our immunity in response to a foreign invader such as a virus, and exercising allows them to more quickly and effectively defend the body. What’s the best way to prevent the flu? First and foremost, the American Medical Association recommends receiving an annual flu shot. It also recommends eating a healthy diet and drinking plenty of fluids. Frequent hand washing is important to prevent exposure to the virus through physical contact with contaminated surfaces, such as door knobs or handrails on subways or in stores and shopping malls. It’s also important to maintain regular exercise routines, even in the winter. This is especially hard for children, but it is important to find ways to keep them physically

areas have low humidity, which creates an environment in which viruses thrive. Even people living alone are not immune; as long as they travel on crowded busses and subways, or shop in crowded malls

ISSUES

By Dana Ledereich, MA, OT/L

INTRODUCTION

RAISING OUR CHILDREN


INTRODUCTION ISSUES

WOMEN’S HEALTH

Choosing Where to Have Your Baby By Rachel Wizenfeld

COMMUNITY PROFILE

H&L TECH

HEALTHY LIVING

MEDICINE TODAY

GOLDEN YEARS

WOMEN’S HEALTH

RAISING OUR CHILDREN

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aving a baby today is all about making decisions. Which doctor to go to. Which hospital to deliver at. What are your health concerns. Do you want to go natural. Do you want convenience. Where is your insurance accepted. Which hospital has the best reputation. Etc., etc., etc. Living in New York, with over a dozen major, top-quality hospitals within driving distance, the umbrella of choices becomes that much larger. In contrast to smaller cities where expectant parents are limited to two or three respected hospitals, New York offers a wealth of top doctors, hospitals, and other health resources. So whether it’s you or a loved one who is expecting to give birth in the near future, let this article serve as a starting point for your research in making this most important decision. As any new mom can attest (this reporter included!), the quality of your birth environment and experience has a critical impact on your emotional wellbeing and early bonding with your newborn. So take your time, do your research and make the choice that’s best for you.

How to Choose a Hospital and Healthcare Provider

Madeline Jaffe, a parent-family education manager and childbirth educator at St. Luke’s-Roosevelt Hospital Center said the first step is for a women to actually plumb the depths of her own psychology and figure out what her personal needs are and what type of healthcare consumer she is. “While some people may want to go to a provider that’s very directive, where the healthcare consumer feels that this individual is highly trained with years of experience and ‘who am I to question them’ others may prefer a more natural and holistic attitude, where they feel, ‘if something’s not broken, don’t fix it.’” Those people should have a different healthcare

provider, one who is not quick to do interventions but will let things take a natural course, Jaffe said. “Some people are in love with 21st century technology and embrace all the bells and whistles, and some hospitals in the city have a reputation for being more high-

courses, ranging from childbirth classes to parenting classes?  Do they have lactation consultants 24/7 or only a few times a week?  Does the hospital provide for rooming-in, allowing the baby to stay with the mother immediately

tech. They’ll have doctors on staff who will not necessarily embrace a more natural approach, and they may push epidurals, push testing, they may be quicker to induce rather than take a wait and see attitude.” The most important thing, Jaffe said, is to have a partnership with your physician or midwife and discuss your needs and expectations so you can chart your course. Services to Look

after birth, which is good for bonding and early development?  Do they have 24-hour OB anesthesia, allowing you to get pain relief whenever necessary? Sara Chana Silverstein, a doula and lactation consultant who practices in LA and NY, recommended finding a hospital that is registered as “baby-friendly.” This means a new mother has the option of

“rooming-in” and having the baby stay with her, as opposed to staying in the nursery, as well as the opportunity to breastfeed on the birthing table, among other things. “You can call a hospital to find out if they are registered,” she said. Silverstein also recommended finding out if they have lactation consultants on call – a lot of hospitals advertise lactation consultants, but once you’re at the hospital you may find out they only come in twice a week for a half-day, which may not be when you need them. “People should always take a tour to see the facility,” Silverstein suggested. She said that often in the big hospitals in NY where hundreds of babies are delivered each month, it can feel like giving birth in a factory – “you tend to be like a number. “New York hospitals are very, very crowded. The nurses tend to be very frustrated due to the intense workload, so many people giving birth in such small areas, and so many different demands coming from physicians, midwives and then women coming in with their doulas,” Silverstein said. But while a smaller hospital may boast a more personalized, homey experience, they may not offer as high a level of NICU services or medical expertise as a larger hospital. Obviously, women should know whether or not they’re high risk and choose a hospital with physicians who are knowledgeable in their area of risk, Jaffe noted. Jaffe also said that while there’s

The Heavy Hitters - Hospitals in New York with the Most Live Births in 2011

For in a Hospital

When evaluating a hospital, Jaffe recommends looking at the kinds of services the hospital provides:  Do both midwives and physicians deliver?  What level of Neonatal Intensive Care Unit (NICU) do they have? (Expectant parents should look for a level 3 which provides for all situations.) What sort of NICU services do they provide?  Do they have a maternal/fetal health medicine department and offer genetic testing and counseling?  Do they offer a variety of

Maimonides (Brooklyn): 7,968 live births; 6,094 natural, 1,828 cesarean (23.1%) St. Luke’s Roosevelt Hospital Center: 6,637 live births; 4,735 natural, 1,746 cesarean (26.9%) Mount Sinai: 6,232 live births; 4,030 natural, 2,049 cesarean (33.7%) NY Presbyterian – Cornell: 5,698 live births; 3,537 natural, 1,994 cesarean (36.1%) NY Methodist Hospital: 5,422 live births; 3,385 natural, 2,006 cesarean (37.2%)

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NYU: 4,654 live births; 3,289 natural, 1,260 cesarean (27.7%) Columbia Presbyterian: 4,508 live births; 2,681 natural, 1,698 cesarean (38.8%) Lenox Hill: 4,183 live births; 2,510 natural, 1,571 cesarean (38.5%) Beth Israel: 3,956 live births; 2,820 natural, 953 cesarean (25.3%) Data collected by the NY State Department of Health, available online at http://hospitals.nyhealth.gov/maternity.php.

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February 2013

MEDICINE TODAY

Maimonides Medical Center in Brooklyn boasts the biggest baby business in New York State, delivering nearly 8,000 babies each year. It also has one of the lowest rates of delivery by cesarean section, 23.1% as of 2011. This may be partially due to their openness to midwives; nearly 20% of women at Maimonides delivered with a midwife in 2011, while in 2007, 13% of women delivered with a midwife, suggesting that this number is on the rise. Maimonides is also the only hospital in New York City that provides volunteer doulas on a nearly roundthe-clock basis. Operated by N’shei C.A.R.E.S. (Community Awareness Responsibility Education & Support), a division of Agudah Women of America, these doulas provide parents with nonmedical services such as advice during labor on breathing, positioning, relaxation techniques, as well as massage and other natural pain management. Maimonides has a strong commitment to encouraging breastfeeding; 90% of babies born there in 2011 were fed at least some breast milk. The birthing center at Maimonides includes 11 labor and delivery suites, as well as four additional rooms for the care of high-risk women. New moms can choose from 24-hour a day rooming-in as well as daytime-only rooming-in with their babies. Thanks to their state of the art NICU, quality support services and top-notch doctors, surgeons and specialists, the New York State Department of Health gave Maimonides the status of Regional Perinatal Center, making them the referral center for the South Brooklyn community.

publications and is the founder of PopWriter.net.

GOLDEN YEARS

Maimonides: New York’s Birthing Leader

Rachel Wizenfeld edits and writes for many Jewish

WOMEN’S HEALTH

Because of the rising C-section rate in New York - most major NY hospitals are tending towards a rate of 30% or more, in contrast to a rate of 15% previously recommended by the World Health Organization, (they officially withdrew their recommendation in 2010, saying that “there is no empirical evidence for an optimum percentage,”) along with other reasons – including crowded hospitals, routine interventions and impersonal medical care, many women are opting for more natural methods, such as birthing centers or home births, or at the very least, having doulas accompany them to hospital births. According to Silverstein, who has worked as a doula in all the major hospitals in NYC, “the

ter, Silverstein cautioned that expectant mothers should be in good health. “If someone were obese or diabetic, I wouldn’t want them in a birthing center, or if they have a history of high blood pressure or another kind of medical history. Usually people who decide to give birth in a birthing center know they have to be in good health.” Women should also be confident in their pain management, as she said there are usually no epidurals available in birthing centers, though there may be other pain management options. Even more women are opting for home births, which Silverstein asserts is the safest way to deliver in New York. She estimates that her neighborhood in Crown Heights has one of the highest rates of home birth in the country – “not because people are hippy and alternative, but because it’s really the safest place to give birth in New York.” It’s also one of the least expensive methods for insurers, and NY State law requires all insurers to cover at least one midwife care option. Medicaid also covers home births. Silverstein also encouraged people to discard their outdated stereotypes of unhygienic home births. “Home birth midwives are all RN licensed midwives; they can resuscitate babies; they bring oxygen and they bring IVs,” she said.

RAISING OUR CHILDREN

Doulas, birthing centers and home birth

doctors are so busy and overwhelmed that to get them to give you the attention you need, you have to be in crisis.” In addition, she said that nurses, especially in NY, are going to be very quick to do what’s best for them – not necessarily what’s best for you. She gave an example of one client she worked with who was admitted to a hospital to give birth, and the nurses were about to treat her for group B strep, a condition Silverstein asserted her client did not have. The nurses showed Silverstein the woman’s name in their computer as having the condition. Silverstein demanded they run another test, and it turned out the woman did not have group B strep – there was another woman in the hospital directory with the same name – and Silverstein’s client was about to have an unnecessary procedure. “These things happen all the time in New York,” said Silverstein. Hospitals often have many protocols about interventions, including induction and augmenting of labor, monitoring of the baby’s heart rate, episiotomies, using forceps and vacuums to ease delivery and more. Natural birth advocates attest that these are often done unnecessarily for women with low-risk pregnancies and that they also introduce many risks for the mother and baby. Because of this, Silverstein contends that home birth is the safest way to give birth in New York – and if a woman opts for a hospital, she should make sure to have a doula or an assertive friend or family member accompany her. Many OB/GYN practices frequented by Jewish women in the NY-area who have Medicaid are huge, meaning that you rarely see the same doctor twice. According to Silverstein, this means a woman’s chances of creating a meaningful relationship with her healthcare provider, in which he or she is focused and understanding of your expectations for birth, is lessened. In contrast, choosing a practice with a midwife – who is usually more accessible and less time-crunched than a doctor – and selecting a birthing center can create a more personalized experience which is respectful of a woman’s emotional needs during pregnancy and delivery. This also diminishes the use of interventions. Birthing centers offer a comforting, calming environment with Jacuzzis, tubs and home-style furnishings, and usually allow an entire family or group of people to accompany the laboring woman, in contrast to one or two extra people usually permitted in a hospital delivery room. Several hospitals, including St. Luke’s – Roosevelt and NY Methodist Hospital, have birthing centers connected to the hospital – which gives a woman immediate access to hospital-level care should she require it - but there are few options for freestanding birthing centers as many have recently closed due to funding issues, according to Jaffe. The Brooklyn Birthing Center is still operating, however, and is well regarded by parents and healthcare professionals alike. In order to deliver safely in a birthing cen-

ISSUES

a tremendous commitment in New York City to diversity, “you want to see if that’s practiced.” Expectant parents can get a sense from the classes or conversations with their healthcare provider if they are open to different ethnicities and religious groups. “My own personal experience, being an observant Jew and knowing the issues that concern observant Jews, made me more sensitive to the Muslim women who come to classes with their own particular religious requirements.”

INTRODUCTION

WOMEN’S HEALTH


INTRODUCTION ISSUES

WOMEN’S HEALTH

Egg Freezing Improves IVF Fertility By Joshua U. Klein, MD

COMMUNITY PROFILE

H&L TECH

HEALTHY LIVING

MEDICINE TODAY

GOLDEN YEARS

WOMEN’S HEALTH

RAISING OUR CHILDREN

A

s an orthodox fertility specialist, people often ask what sparked my interest in pursuing this field. My decision to specialize in reproductive medicine was motivated by many factors: the relative “newness” of the field, the ongoing and exciting scientific advances in embryology and genetics, the routinely high success rates and happy outcomes we are privileged to help achieve, amongst others. But particularly during this time of the year, when we read the parshiyos describing the fertility struggles of our Avos and Imahos, I am reminded that the most important reason I chose this field is also the most fundamental: Jewish culture revolves around building families and transmitting the Mesorah to the next generation. There is something very powerfully “Jewish” about spending your professional life helping couples dealing with infertility. In that context, I think it is important to help increase awareness and understanding of a revolutionary new technology with special importance to the observant community: oocyte cryopreservation, or “egg freezing,” as it is more commonly known. While many biological components need to be functioning properly for a pregnancy to be achieved, the single most important factor, by far, is the age of the woman attempting to conceive. The chance of having trouble conceiving increases from less than 10% for women in their early 20’s, to 60% or higher for women in their 40’s. It is important to note that even advanced fertility treatments, such as in vitro fertilization (IVF), cannot adequately compensate for the negative effects of female aging: in 2010 in the United States, women younger than 35 had almost a 50% chance of pregnancy with one IVF attempt, while women 43 and older had only a 9% chance of pregnancy – and more than half of those pregnancies ended in miscarriage. The reason female age is such a powerful determinant of fertility is that unlike men, who continuously create new sperm cells throughout their adult lives, women are born with a limited supply of eggs, and those same eggs are then used throughout their reproductive lives. Like the rest of our bodies, egg cells are not shielded from deleterious effects of aging. Specifically, there is deterioration with age of the integrity of the microscopic genetic material (DNA) inside the eggs, which leads to an increasing likelihood that the egg released in any given month will either be incapable of being fertilized normally or will result in an unhealthy pregnancy (which usually ends in miscarriage). In the past few decades, multiple societal and economic forces have contributed to the fact

that the average age at which women have their first child has increased dramatically. For example, in 1970, only 1% of first-time mothers were 35 or older; in 2006 almost 10% were older

than 35. While the statistics are likely quite different within the observant Jewish community, there is little doubt that there are also increasing numbers of observant women who, voluntarily or not, remain single and/or defer childbearing until their 30’s or even 40’s. Until quite recently, observant women in this position had no effective options to preserve their fertility. While non-Jewish/non-observant women have used donor sperm to conceive without a spouse, halachic considerations often left religious women with no options other than aggressively searching for a mate and hoping to find a partner before their biological clock runs out. The recent advances in oocyte cryopreservation, aka “egg freezing,” have the potential to dramatically relieve the social and biological pressure that such women currently experience. The concept of egg freezing is simple: if eggs can be obtained and cryopreserved while a woman is still young and fertile, they can remain frozen indefinitely until a suitable match is found and/ or the woman is ready to conceive. Importantly, there is an overwhelming amount of scientific research that has proven that a woman can successfully conceive using “young” eggs (traditionally obtained from a young egg donor) well into their late 40’s and even 50’s. By freezing her eggs while she is still young and fertile, a woman can almost literally put a temporary hold on her biological clock, extending her fertile years by a decade or more, providing precious additional time to find a spouse and prepare to start a family without worrying about the rapid decline in fertility that normally occurs during that time. While egg freezing has been attempted since the 1990’s or earlier, technical and biological challenges precluded its effective use until the past few years. Very recently, however, a newer approach to egg freezing, called “vitrification,”

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has dramatically increased the success of the technique. As with any new medical technology, fertility specialists have been cautious about offering the technology to a wide audience of patients until studies have demonstrated its safety and efficacy. In just the past couple of years, several such studies (comparing IVF results using “non-frozen” with frozen eggs) have been published, and they have consistently demonstrated that results with frozen eggs have been equivalent (or better). In light of these studies, this past month, the American Society for Reproductive Medicine (the leading society of fertility specialists in the US) has removed the “experimental” label from egg freezing. While holding enormous potential for many women, egg freezing is not without its drawbacks. A woman pursuing egg freezing must undergo daily injections of fertility medications, in addition to multiple blood tests and ultrasound examinations, for at least 10-12 days, as well as a minor surgical procedure to obtain the eggs. In addition, egg freezing is expensive, usually in the range of $10,000 or more, and only a few laboratories around the country have had much successful experience thus far. Also, medical insurance will almost never cover much, if any, of these costs. Finally, while there have already been many healthy babies born worldwide from frozen eggs, there are still some theoretical concerns about the long-term health of these children. Despite these downsides, there is no doubt that effective egg freezing will be a real “game-changer” for single women in their late 20’s and 30’s who are not yet ready or able to start a family. Many rabbinic authorities, including Rabbi Menachem Burstein of the Puah Institue, not only allow egg freezing; they actually strongly encourage single women in their 30’s to consider freezing their eggs. Egg freezing will not be the right choice for everyone, but if my own sister or daughter were in that position, I would certainly encourage her to at least consider pursuing this option. Joshua U. Klein, MD is the medical director at Reproductive Medicine Associates of New York (RMA of NY) – Brooklyn Office. He is also the assistant clinical professor of OB/ GYN at Mt. Sinai School of Medicine and SUNY-Downstate.

February 2013


Hospital Incentives to Reduce Unnecessary C-Sections

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WOMEN’S HEALTH GOLDEN YEARS

bies born after 37 weeks are no longer considered premature, growing research shows that babies born

the Medicaid payments hospitals received for uncomplicated C-sections, shaving $1,000 from the $7-10,000 hospitals get from such surgeries, and saved $3 million a year by utilizing that “disincentive.” The state then added an incentive by creating a $10 million reward to be shared by various hospitals that displayed significant improvements on five patient-health measures, including reducing optional early birth plans. Hospitals began requiring doctors to give a medical reason for every delivery before 39 weeks, and also educated staff about the risks of delivering babies from 3739 weeks. These efforts bought down rates of unnecessary Csections in the state by 77 percent. Other states are now looking into similar measures.

RAISING OUR CHILDREN

an you guess the most common surgery in the United States? The answer is C-sections, the rates of which have risen steadily every year since 1996 and accounted for 33 percent of all births in the U.S. in 2009. The World Health organization said previously that the ideal rate for a country is about 15 percent. Yet doctors often perform C-sections to get a baby to arrive on schedule, and because it’s convenient for them and for many expectant parents. However, elective C-sections are generally not in the best interest – health-wise – for mothers or babies. From 1990 to 2009, the percentage of babies in the U.S. delivered at 37 and 38 weeks increased from 19 percent to 27 percent. While ba-

before 40 weeks are still more vulnerable for health problems. These complications, such as NICU (Newborn Intensive Care Unit) stays, tax the health system. Even if a baby is totally healthy from a Csection, the surgery itself is expensive and can cost up to 60 percent more than a vaginal delivery. C-sections are sometimes medically necessary, for instance, if the baby is in a breech position or the baby is more than two weeks overdue. But often in the U.S. they are performed unnecessarily. Hospitals and insurers can cut costs by reducing elective birth interventions, while simultaneously improving health outcomes for more mothers and newborns. The state of Washington led a two-year effort to discourage unnecessary surgeries, and reduced

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By Tova Ross

INTRODUCTION

WOMEN’S HEALTH

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INTRODUCTION ISSUES

WOMEN’S HEALTH

Learn to be an Iron Chef By Amy Dubitsky

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ooking shows are all the rage. In the past, only culinary experts knew specialty techniques such as deglazing a pan or caramelizing. Now the average American learns a lot about professional cooking by having access to top ranking chefs’ kitchens via television or internet. Unfortunately, these shows usually focus on taste alone, and not necessarily on teaching people to eat what is good for them, – like iron and folic acid, two nutrients that are extremely important to women’s dietary needs. Folic acid is critical for women of childbearing age as it has been proven to help prevent major birth defects. Jack Friedman, nutritionist for Maxi Health Research said, “Women should take folic acid from day one of their pregnancy and even before.” Most prenatal vitamins contain folic acid, and Friedman recommends specifically combining folic acid with vitamin B12 to enhance its absorption and performance. According to the womenshealth.gov website, pregnant women need 400 to 800 mcg of folic acid daily, and nursing mothers need 500 mcg. Women in certain risk categories may need larger supplements and everyone should consult with their physician to find out how much they need. Folic acid is found in legumes, whole grains, citrus fruits and some vegetables, but is actually better absorbed by the body in its man-made form called, “folate,” which is added to many processed foods such as cereal, bread, and pasta. However, even if a woman eats a lot of these foods, it is still unlikely that she would get the recommended amount of folic acid without a vitamin supplement. Unlike folic acid, iron is a nutrient that is best absorbed by consuming iron-rich foods. The recommended daily allowance (RDA) for women aged 19-50 is 15 mg per day, but goes up to 27 mg per day for a pregnant woman and down to

9 mg per day for a nursing mother. Friedman suggests that the further along a woman is in her pregnancy the more iron she will need, and that all women in their childbearing years may need extra iron due

mend daily value.) Not a liver person? Beef, turkey and tuna are also good choices to add to your menu. Many boxed cereals and instant oatmeal varieties are iron fortified and certain varieties contain the

easily search nutrient information for over 8,000 foods – viewable at http://ndb.nal.usda.gov. To jumpstart your iron today, try this easy salad: Combine fresh spinach, shredded carrots,

to blood loss. According to the US RDA, women 51 and over need 8 mg per day. People who don’t get enough iron can develop iron deficiency anemia, which according to the National Institute of Health can cause people to feel tired and weak, decrease work performance and immunity, and can cause difficulty in maintaining body temperature. People who have Celiac or Crohn’s disease may have difficulty absorbing iron and may need a supplement. Several smaller dose supplements are usually better absorbed in the body than one larger dose. Too much iron is also dangerous, especially for children - they can die from iron toxicity if they ingest too much. Consult with your physician to make sure you know how much iron you should be taking, and be sure to keep your supplements, along with any medications, tightly closed and away from children. So how can you become an iron chef? Chicken and beef liver contain high amounts of iron (11 mg per 3 oz. serving of a pan-fried chicken liver – 61% of the recom-

full daily value in one ¾ cup serving. Check the label’s nutritional information to see how much iron is contained in your favorite cereal. Beans, tofu, spinach and raisins also contain iron. A great resource for ensuring you get enough iron (as well as other nutrients) is the USDA National Nutrient Database, where you can

chopped apple, chopped pear, tangerine – peeled and sectioned, raisins and pecans. Use amounts and proportions according to your taste and quantity needed. Top with a sweet vinaigrette dressing. La’briut! Amy Dubitsky is a freelance writer living in Phoenix, AZ.

Folate and folic acid help prevent Neural Tube Defects (NTD) - a condition which covers a range of brain and spinal chord disorders including opening of the spine, known as spina bifida, to failures in brain development, called anencephaly. 130 babies born in New York State each year are affected by NTD. Nationwide, the rate is about 4,000 pregnancies per year. Reduced risk of heart disease, stroke, and possibly even some kinds of cancer are other potential benefits of taking folic acid supplements. Unless under the supervision of a qualified physician, it is important to limit folic acid intake to less than 1 mg per day, since high doses may disguise the presence of vitamin B12 deficiencies, Iron is necessary for the formation of proteins, particularly those that transport oxygen throughout the body. Vitamin C aids the body’s iron absorption so eating cantaloupe, mango, citrus fruits, pineapple, and berries not only raises the body’s level of vitamin C but is beneficial to iron levels as well. In contrast, commercial black teas contain substances that disrupt iron absorption. Children and adolescents face an increased risk of iron deficiency due to inconsistent eating habits and rapid growth. Source: NYS Department of Health website: www.health.ny,gov

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The Jury is Still Out on Experimental Prenatal Blood Tests

GOLDEN YEARS

extra copy of chromosome 18 or 13 causes lesser-known and less common conditions called Edwards syndrome and Patau syndrome. All three conditions are linked to serious developmental and psychical problems. Standard first-trimester screening, consisting of a blood test to check levels of pregnancy-associated proteins and hormones in the mother’s blood and an ultrasound to check for extra fluid under the skin of the back of the fetus’s neck, can detect about 90 percent of Down syndrome cases and more than 90 percent of trisomies 18 and 13. However, there’s a false-positive rate of about 5 percent, and only CVS and amniocentesis can provide definitive answers.

WOMEN’S HEALTH

er the tests as of yet. Prices for the tests can cost nearly $2,000. Still, many women who fear the miscarriage risks associated with the more established – but more invasive – CVS and amniocentesis prenatal testing are choosing to have these alternative tests, which extract fragments of fetal DNA from the mother’s blood sample and are checked for increased amounts of material from chromosomes 21, 18, and 13, a sign that the fetus carries three instead of the normal two copies of these chromosomes. An extra copy of chromosome 21 causes Down syndrome, while an

RAISING OUR CHILDREN

hree versions of a new prenatal test that requires only a sample of the mother’s blood to check for Down syndrome have recently come on the market, reports Kaiser Health News. The tests can be performed as early as 10 weeks into a pregnancy and tens of thousands of women have already used them, according to the companies that sell and market the tests. However, questions have been raised about the accuracy of the technology behind the tests, as they are not subject to FDA regulation. Because of these questions, no major insurance company has agreed to cov-

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The New Senior Lifestyle - Fit and Active By Yaakov Kornreich y 2015, 46 million Americans will be over the age of 65. As members of the baby boomer generation pass the traditional retirement age, our standards for aging are steadily changing. A generation ago, the age of 40 was widely considered to be the start of middle age. In 1932, American psychologist Walter Pitkin published a self-help book titled “Life Begins at Forty,” a concept which he proclaimed, “is the revolutionary outcome of our New Era. Today it is half a truth. Tomorrow it will be an axiom.” Pitkin was referring to the fact that the longevity which we take for granted today is a relatively recent phenomenon. It was not until the start of the 20th century that the state of medical knowledge ad-

The Turbaned Torpedo at age 100

dicting that the trend would continue, and that as time went on and we learned more about how to pre-

serve our health, we would be able to remain fit and active far longer. A few years later in 1935, when the federal government inaugurated the Social Security program, 65 was established as a reasonable age at which point American workers would be ready for retirement. It was thought that by that point the wear and tear of daily living had taken such a toll on their health and bodies that many would no longer be able to carry out their responsibilities in their workplace. In other words, during that era, by age 65 most people had become “old,” both physically and mentally, and were being forced by the “infirmities of age” to give up the active pursuits of their younger years. But over the past 80 years, with the further progress of medical science, those aging standards have become obsolete. In today’s

daily exercise as part of their recuperation from lifesaving medical procedures. For example, walking is a mandatory part of the rehabilitation process after open-heart surgery. Cardiac bypass patients are encouraged to get up and walk within three days of the surgery. When they go home, they are told to get up and walk around for five or ten minutes every hour, and to gradually increase the length of their walks as their stamina returns. The walking strengthens their heart, lowers their blood pressure and builds up their muscle tone. Many of these patients, to their surprise, discover that they enjoy these long walks and find them relaxing, and continue with them voluntarily long after they have fully recovered from surgery. Recovering cardiac surgery patients are also quickly started on

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vanced to the point that the average life expectancy in Western societies was able to reach 40. He was pre-

Exercise classes at Ateret Avot in Brooklyn, NY. Photo Credit - Menachem Adelman

culture, the attitude is that “60 is the new 40.” Many of those now reaching the traditional retirement age of 65 no longer consider themselves to be old, and are unwilling to give up their active lifestyles. Furthermore, there is a growing recognition that remaining physically active is one of the best ways for older people to maintain and protect their health, adding not only to their longevity, but also to the quality of their lives as they age. Many seniors who have been sedentary throughout their adult lives have been introduced to mild

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low-impact exercises using light weights. The physical benefits from regular, moderate exercise are well documented. They include improved appetite and digestion, weight loss, more restful sleep, and relief from many of the normal bodily aches and pains that come with aging. There are also psychological benefits from becoming more physically active, such as reduced depression, anxiety and stress, and often an overall improvement in mood and outlook. For others, remaining fit and acKornreich Continues on Next Page ➙

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Some of these programs, including the trainer-led exercise groups, are also open to seniors living in the surrounding community who wish to participate in the Ateret Avot Social Club. They are invited to sign up to come in for a few hours of activities and then return home. There are many gyms and Jewish community centers throughout the New York area which offer reduced rate memberships for senior citizens, as well as special exercise classes designed to accommodate participants with physical limitations. In addition, there are senior citizens centers in New York City which offer various types of physical fitness activities and classes for free, or in return for a voluntary contribution. According to Ellie Kastel, the

RAISING OUR CHILDREN

tive in their senior years is a conscious lifestyle choice. Many members of the baby boom generation who made vigorous exercise and activities like jogging an integral part of their daily lives have refused to give these activities up as they have gotten older, and are using some of the recent advances in sports medicine to enable them to continue. By the hundreds of thousands, they are routinely replacing their worn-out knees and hip joints so that they can keep playing tennis with their friends, or running along the jogging paths in local parks each morning. As a result, it is no longer uncommon for even quite elderly people who have remained physically fit to continue their participation in the most active of sports. For example, the 2012 New York City Marathon had 88 participants who were 75 or older. One of them was Joseph Pascarella of Brooklyn, who has run in 25 NYC marathons and is now 78. He finished the 26.2-mile-long course in 5 hours and 36 minutes. Joy Johnson, of Duluth, Minnesota, who is now 84, has run in 24 NYC marathons. She finished the race this November in 7 hours and 44 minutes. The oldest marathon runner in the world is Fauja Singh, an Indian-born British citizen. Singh is a Sikh, and was dubbed the “Turbaned Tornado” by the British media after he took up the sport at the age of 89. Running in the Toronto Waterfront Marathon in 2003, he set the current world record for marathoners over the age 90 by completing the course in 5 hours and 40 minutes, at the age of 92. Citing old age, Singh recently announced that he will retire from competition after running in the Hong Kong Marathon on February 24, five weeks before his 102nd birthday. However, Singh says that he will continue to run at least four hours each day in order to “inspire the masses.” Obviously, these elderly marathon runners are in very good

Even some of the men at Ateret Avot who spend most of their time sitting and learning Torah every day are motivated to join in the exercise groups because they understand they need it to protect their health, which is also a part of their religious obligations. One of the residents, Lillian Bernstein, who has been at Ateret Avot for five years, says she looks forward to the half hour exercise sessions every Tuesday and Thursday which make her feel “more invigorated, alive and awake.” She believes that the exercises have given her more stamina and reduced the aches and pains in her knees and waist. She particularly enjoys exercising to soft Jewish simcha music, and using isotonic exercises while sitting in a chair which build up muscles that she doesn’t often use in her upper body and arms.

overall physical condition, but even seniors who are not as healthy or physically fit can and do safely enjoy and benefit from much less strenuous regular exercise. Alan Magill, the program director at the Ateret Avot assisted living facility in Midwood, Brooklyn, says that its daily moderate exercise programs are among the most popular activities for residents, most of whom are in their 80’s and 90’s. In addition to a daily morning program of gentle stretching, Ateret Avot brings in a professional trainer twice a week to lead more focused half-hour exercise sessions, conducted separately for men and women. The exercises are designed to help the seniors avoid the danger of injury due to falls by working to maintain their sense of balance, build up their muscle tone and strength, and improve their hand-eye coordination. Some of the exercises are specifically designed to enable more physicallylimited residents to participate while seated in a chair. Other planned daily activities for residents are also designed to get them moving, sometimes in conjunction with Jewish musical entertainment. The group dynamics from joint participation yield additional benefits to the residents by strengthening their sense of community and shared experiences. According to Magill, “they serve as social outlets, encouraging the seniors to come out of their shells. It encourages them to participate. These seniors think they know what they can do, but once they get involved, they often discover that they can do more than they think they can. “There is also an element of mind over matter. When elderly people exercise, it releases endorphins in their brains which make them feel better. Once they start exercising regularly, their stamina improves and many of their minor aches and pains start going away. This, in turn, leads to a better overall attitude simply because they are enjoying their life more.”

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INTRODUCTION ISSUES RAISING OUR CHILDREN WOMEN’S HEALTH

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executive director at the Boro Park Y, 500 seniors participate in all of the Y’s activities, and not just those which were designed specifically for senior citizens. Age is no limitation. She has one member who is 103 and comes to the Y regularly, twice a week, to use the swimming pool. Some of the older participants come to the Y accompanied by their home health aids. The Y’s facilities include a gym, two pools, an exercise room, a sauna and a steam room. In addition to swimming and professionallyled exercise classes, the Y brings in specialists to speak on health topics of interest to seniors, such as cardiologists, neurologists and registered nurses. The Y’s senior center also offers a series of six lectures on nutrition. When a senior comes to the Y for

the first time, Kastel tries to help them make the best choice among its various classes and activities. For example, she will advise someone who has not been regularly exercising before not to “jump into the Zumba class,” before building up their strength and endurance by participating in some of the Y’s less physically demanding activities. For those who are less agile, the Y offers “the circle,” a group which does chair exercises. Kastel says that the social aspect of the exercise group is important to keep seniors coming back to participate on a regular basis. She finds that the most effective mode of advertising in the community is word of mouth, and that many of her first-time people say that they are joining the Y because “my friend is coming.” She also says that, “65 is no lon-

ger considered old. Many of the Y’s senior members are still working full-time jobs during the day and come in to use the facilities at night. Our people at that age are still young and active.” The Boro Park Y offers a reduced senior membership rate of $310 a year ($430 for couples). But there is another way that some people over 65 can participate in its ac-

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Advantage participants need to check the benefits offered by the specific plan they have chosen. Those who are now enrolled in traditional Medicare, or whose current Medicare Advantage plan does not include Silver Sneakers, can switch to a Medicare Advantage plan that does offer it during the annual Medicare enrollment period.

Seniors exercising at Ateret Avot in Brooklyn, NY. Photo Credit - Menachem Adelman

tivities and use its facilities with no out-of-pocket cost: through their Medicare benefits. Those seniors who receive their Medicare benefits through the privately administered Medicare Advantage system have the option of choosing a plan which offers free gym membership through the “Silver Sneakers” program. Participants receive a Silver Sneakers membership card from their Medicare Advantage provider. The card gives them free access to the facilities at the Boro Park Y. Many other gyms and private fitness centers throughout New York City and the rest of the country also participate in the Silver Sneakers program. However, not all Medicare Advantage plans provide Silver Sneakers membership. Medicare

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AKastel recommends paid Y membership, even for those who have the Silver Sneakers benefit, simply because of human nature. Being required to pay for access to an exercise facility helps to motivate people to use it more regularly than if it is available for free, and more frequent use results in getting more health benefits from it. There are other easy ways for seniors to get into the regular exercise habit. Those living in retirement communities should check out their community room. It probably contains one or more Ninetendo Wii video game setups. These will enable them to play surprisingly accurate simulations of active sports, such as tennis or bowling, without requirKornreich Continues on Next Page ➙

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Designing a Senior Fitness Program

HEALTHY LIVING H&L TECH

Yaakov Kornreich has been working as an Anglo-Jewish journalist for more than 40 years, and writes regularly on a wide range of both Jewish and secular topics. He is the Senior Editor of two supplements published by The Jewish Press, “Health and Living” and “Building Blocks”, and a co-author of the book “Young Israel at 100” published earlier this year.

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2007 by the prototypical Jewish comedian, Jackie Mason, at the age of 76. In the video, Mason delivers a monologue on his views on health and exercise while walking, albeit at a slow pace, on a treadmill, apparently in his home. So, all you readers over the age of 65: what are you waiting for? If you belong to a Medicare Advantage plan, check to see if it offers you a free Silver Sneakers membership. Make an excuse to visit your children, and then ask your grandchildren to show you how to use a Wii or an X-Box with Kinect. Or get on the Internet, go to YouTube and let Jackie Mason talk you into it. (Of course if you are reading this on Shabbos, please wait until after Havdallah.) No more excuses. See you in the gym!

ing them to run around a tennis court or pick up a heavy bowling ball. While seniors won’t get the same health benefits they would from playing the actual sports, the upper body movements necessary to control the video games are physically beneficial. Because of the popularity of this use for the Wii, Nintendo now offers a variety of accessories for the game system to simulate other sports and exercises. Microsoft has also responded by adding the Kinect accessory to its X-box 360 video game. Like the Wii, Kinect allows the user to control the game console through gestures and body movements. There is also a version of the Kinect available for use with games played on a Windows PC. Since the Kinect was introduced in late 2010, 18 million of the devices have been sold. Despite all of these options, there are some people who still have trouble accepting the concept of older Jews committing themselves to regular daily exercise. To them, somehow, it just doesn’t seem to fit the Jewish stereotype. Those skeptics may want to check out a sixminute video on YouTube made in

the spine. Balance is improved through calisthenic exercises such as sit-ups, and by activities such as tai chi, dance, and yoga classes.  Relaxation after a workout allows the heartbeat to return to its resting rate, and it allows the body to clear itself of toxins and waste products. Relaxation can also alleviate symptoms of stress. Some exercises, such as yoga, tai chi and pilates, can be a form of relaxation. The same is true for some stretching exercises combined with post-workout breathing exercises. The guidebook recommends that every senior fitness program should include aerobic fitness, muscular fitness, flexibility and balance exercises three times per week. Relaxation exercises should be included every day.

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It is improved through stretching exercises involving all the major muscle groups in the arms, back, hips, thighs, and calves. Stretches should be held for approximately 10 to 20 seconds. The best time to stretch is after a workout, or after a 5-10 minute warm up. Stretching is an integral part of activities such as dance, tai chi, or yoga classes. Flexibility helps to alleviate stiffness, prevent injuries, improve coordination and relieve stress.  Problems with balance or stability are a major cause for falls and broken bones in older adults. Balance can deteriorate with age, injury and illness. It is best developed together with muscular fitness and flexibility, and by strengthening the body’s “core muscles” in the abdomen, lower back and pelvis, which work together to support

WOMEN’S HEALTH

healthy weight and blood pressure. Aerobic exercises include light jogging, brisk walking, aerobics classes, dance classes, and any physical activity that keeps the heart rate elevated for at least 10 minutes.  Muscular fitness involves both muscular strength and endurance. Endurance can be effectively developed through aerobic exercises that actively engage various muscle groups. Exercises for muscular fitness include lifting moderate weights, working with stretch-bands, calisthenics, and yoga classes. These stimulate the growth of bone and muscle and increase metabolism. This facilitates activities of daily living and protects against injuries.  Flexibility is the ability to move muscles or joints through a full and normal range of motion.

RAISING OUR CHILDREN

he New York City Department for the Aging, in cooperation with Asphalt Green, has published, “Creating an Effective Senior Center Fitness Program: A Guidebook.” It recommends that every senior fitness program emphasize five key components:  Aerobic Fitness  Muscular Fitness  Flexibility  Balance  Relaxation  Aerobic fitness is achieved by brisk physical exercise activity that requires the heart and lungs to work harder to meet the body’s increased oxygen demands. It strengthens the heart, improves the circulation of oxygen through the blood, builds lung capacity, and helps individuals to maintain

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New Horizons in Caregiving, Seniors and Technology By Harriet Blank, LCSW, OHEL Director of Geriatric Services

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oday, seniors are the fastest growing segment of our population. Everyone wants to grow older with dignity, respect and independence. Aging in place has become both a buzzword and mantra for families. Caregivers, often the lifeline of seniors, can now access various forms of technology and new devices that can assist them in caring for their senior in a more efficient way. Even the seniors themselves are learning, using and accessing new technology and computers. A term used for caregivers and seniors years ago-- “techno peasants”--- will soon be obsolete. Seniors are being encouraged by their children and grandchildren to learn computer skills and are quickly filling up lo-

cal classes. Caregivers and seniors alike are learning to adapt to the new technology. Caregivers want to allow their family members to live as independently as possible. We want our parents to feel that their dignity and wishes are respected. Children want to fulfill the mitzvah of kibud av veEm (honoring one’s parents) but we want to insure that our parents will also be safe. Our parents are living longer and children, specifically daughters, who work are no longer available 24/7 to physically be with their parents. It is no surprise, therefore, that the business of technological monitoring is emerging and growing quickly. There are many new companies to choose from, though as a word of caution, one should check references and ask around before choosing a technology provider.

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AGING PARENTS? Without Warning you can suddenly face meeting the medical and psychological needs of your parents.

Stress & Conflict can quickly manifest if unmanaged, and can lead to a crisis.

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INTRODUCING THE

OHEL Family Caregiver Help Line & Support Program Trained professionals help identify affordable alternatives and ensure your peace of mind

347-695-9713 helpline@ohelfamily.org • ohelfamily.org/helpline

Today, living independently requires more than good health and mazal. Living independently can be more successful when there are a variety of supports that include new technological resources.

of older adults use some form of monitoring system, and 42% have expressed interest. Among caregivers who were polled, 17% stated that they use these devices and 37% expressed interest. The costs

One of these resources is care and health monitoring. Families can be at work, in their own homes or any remote location, and be plugged in to their family members, allowing them to monitor their loved one’s home environment and situation. Monitoring can be done through PCs and smartphones. This can offer both families and older adults a greater feeling of security even when they are miles apart. These devices include PERS (personal emergency alarm systems). For example, many of us have seen the TV advertisement which depicts an elderly person falling and calling out, “Help, I have fallen and can’t get up!” This new device, as well as more sophisticated and advanced systems, can monitor medication and ensure safety in the home environment. This is good news for our loved ones! Falls for seniors are the number one culprit for decline and hospitalization, while 40% of nursing home admissions are due to side effects from falls. Hearing loss also accounts for changes in status. Monitoring systems enable the older adult and their families to prevent more dramatic declines. In addition, monitoring devices can also serve as a “nanny cam,” in order to observe the aide who is home alone with a frail loved one. This allows families to constantly observe what is going on in the home. According to the AARP, 11%

for these devises vary and are NOT always covered by insurance. There must be a family discussion to determine if a monitoring system is worth the cost it may entail. While the factors to be discussed include finances, one must also consider peace of mind, home care needs and quality of life issues. Since insurance coverage for home care has diminished, families will need to rely on private pay and alternative resources as the older adult’s needs increases. Computers and new technologies can be significantly helpful to seniors in other ways. Most families no longer live together in the same small community. Lives have become busy and scheduled. We communicate via email, text and Skype. Bubbies and Zaides want to and can stay in touch with families via these methods. Using the computer provides the senior with an entrée to a whole new world. Computer use can help alleviate the loneliness and isolation that an older adult might feel. Multi-generations can now communicate together and maintain family ties and values. Another helpful use of technology is the ability to set up banking and other financial transactions as well as shopping and maintaining independence in daily activities. Seniors can now “surf the web” for activities they enjoy. This is vital as a person ages and is more home-

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INTRODUCTION

Home Air Conditioning: Not Just a Luxury Anymore

tored with privacy and kavod, but also with assurance that someone on the “other side“ knows when to sound the alarm button. It helps a person remain in control of his or her environment when that might be difficult due to physical and cognitive changes. While we continue to learn from our elders and encourage the generations to grow together, we can also ensure that the older adult can learn and enjoy what technology has to offer. Let’s discard the stereotype that elders are too old to learn something new. Our loved ones can learn and reap the benefits of new and helpful technologies!

HEALTHY LIVING H&L TECH

Harriet Blank, LCSW is the Director of OHEL Geriatric Services. With over 20 years of experience in geriatrics and health care in both community and longterm care settings, Harriet has helped ensure the optimum welfare for thousands of seniors and provided peace of mind for their families.

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MEDICINE TODAY

bound. Technology allows seniors to attend senior centers, shiurim, siddur plays and other activities while sitting in the comfort of their armchair. Technology provides the freedom to overcome physical barriers and develop systems that are user friendly for people of all ages and abilities. My mentor promised she would never learn how to use a computer. But in the last years of her life, she set up email accounts and blogs with family members who lived throughout the country. When she was sick and in a hospice, family and friends were able to communicate love and wishes and still feel close to her. Embracing technology allows families to promote their personal goals and values. Adult children are able to keep parents independent and safe. The older adult’s medical condition can be moni-

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WOMEN’S HEALTH

The chances of dying on an extremely hot day fell 80 percent over the past half-century, attributed to the installation of air conditioners in American homes. Very few homes had air conditioning before 1960. By 2004, 85 percent of American homes had at least one air conditioner. A team of researchers from Tulane University, Carnegie Mellon University, the National Bureau of Economic Research and the Massachusetts Institute of Technology

looked at U.S. mortality records going all the way back to 1900. They examined patterns in heat-related deaths between 1900 and 2004 and found that days where temperatures rose above 90 degrees Fahrenheit accounted for about 600 premature deaths annually between 1960 and 2004 period, one-sixth as many as would have occurred under conditions before 1960. The findings suggest that the spread of air conditions in the developing world could play a key role in preventing future deaths from heat related to climate change. In India, for example, only a small percentage of the nation’s population possesses home air conditioners. On average, India has 33 days each year where the temperature rises above 90 degrees Fahrenheit. This number could increase to 100 days by the end of the century, according to calculations based on expected climate change. Ironically, the increase of home air conditioners will likely increase the world’s carbon output, and thus, the problem of higher temperatures, since many units will be powered by fossil fuels.

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efore summer arrives comes some good news for seniors with air conditioners: a new study has found that home air conditioning has gone a long way toward reducing American deaths in the past half-century, reports The Washington Post.

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The Patient-Centric Approach to Healthcare By Mutty Burstein

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ne of President Obama’s key successes of his first term was the Patient Protection and Affordable Care Act, commonly known as Obama Care. It will be a few years until the law is totally implemented, but many changes have already begun. The Affordable Care Act includes a number of policies to help physicians, hospitals, and other caregivers improve the safety and quality of patient care, and to try to help make health care more affordable. By focusing on the needs of patients and linking payments to successful outcomes, it hopes it can improve the health of individuals and slow down the growth of medical costs. It is often observed, unfortunately, that Americans have more interest in the well-being of their automobiles and pets than in their own health. The challenges of encouraging patients to manage diet, lifestyle, and chronic conditions are well documented, as are the costs of chronic illness. The threats these challenges pose to health reform should not be discounted. Many doctors will tell you that preventive care has been an elusive concept, due to resistance from insurers on coverage and patient apathy. Any attempt to change the status quo would have to include patient involvement. Health care has been evolving away from a “disease-centered

model” and toward a “patientcentered model.” In the older, disease-centered model, physicians make almost all treatment decisions based largely on clinical experience and data from various medical tests. In a patientcentered model, patients become active participants in their own care. They receive services designed to focus

ready, stakeholders such as insurance companies and HMOs are forming new partnerships with providers of services, and are organizing, or have already established, new care strategies along these lines. Hospitals and healthcare systems are moving their focus away from revenue streams aimed at inpatient services to establishi n g

on their individual needs and preferences, in addition to advice and counsel from health professionals, and are involved, to some extent, in making decisions about care. New healthcare models are emerging in response to pressures to contain costs while safeguarding quality. Typically, they feature multiple providers and caregivers, are based on outcomes and aim to deliver patient-centric care. Al-

patientcentered, quality-based initiatives that reduce hospital stays which, in turn, reduce hospital-acquired infections. Driven, in part, by mandates within the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) have taken steps toward incentivizing providers to reduce hospitalization costs. Some steps include: penalizing facilities with high readmission

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rates for certain conditions, denying additional payments for certain hospital-acquired conditions, and establishing primary patientcentric care models that reward quality and savings. Home care providers are a key component in reducing hospital readmissions. With proper care and monitoring of the patient in the home, some emergency hospital readmissions can be prevented. The actions undertaken by the CMS will impact geriatric care in particular. Teams which care for the geriatric population will need to be retrained to focus on patient-centric needs. They will need to take a step back and look at the whole person. H o m e care providers, do c tors, nurses and therapists, will have to begin to become more proactive in catching developing situations before there is a need to go to the hospital. Collaborative care becomes a team-based, proactive care management. Collaborative care lets providers get closer to where healthcare really happens: in the home and the community. This requires a team approach and the ability to understand how tools such as social media and the internet can play a role in helping older adults selfmanage their health and stay out of the hospital. One of the models evolving out of this new collaborative care concept is the Managed Long Term Care (MLTC) model. Managed long-term care plans pro-

February 2013


more about the welfare of the patient and patients assuming responsibility for their part. If either party isn’t willing to play their role, then there’s no chance

be subjected to all the germs that inevitably linger during a hospitalization. By following a patient-centric approach, every segment of the health care sys-

costly hospitalizations; providers improve the quality and safety of their clinical practice; and industry reduces its financial burden to provide health insurance subsidies to employees.

the healthcare system can ever be improved. For seniors, keeping them at home should help them stay healthier, as they won’t

tem will benefit: patient health improves; payers reduce costs and premiums by becoming more efficient and preventing

WOMEN’S HEALTH GOLDEN YEARS

“Home care providers are a key component in reducing hospital readmissions. With proper care and monitoring of the patient in the home, some emergency hospital readmissions can be prevented.”

Outreach Manager of the Patient Relations Department at Americare CSS, a Certified Home Health Agency. The Americare Companies, founded in 1982, provide high quality home care services in the N.Y. metro area, including the 5 boroughs, Long Island, and Westchester, Rockland, Orange, Dutchess, Putnam, Sullivan, and Ulster counties. Americare integrates compassionate patient care with family needs and is ready to serve 24/7 with registered nurses, home health aides, PT’s, OT’s, speech therapists, and social workers. In addition to all the regular aspects of home care, Americare has a special license to work with patients with behavioral health issues and patients with dementia, Alzheimer’s, and/ or depression, as well as the developmentally disabled. Mutty can be reached at 917.287.1636 or mburstein@americareny.com for any questions regarding health care or eligibility for Medicare, Medicaid, and managed care.

RAISING OUR CHILDREN

Mutty Burstein is the Education

ISSUES

vide long-term care services like home care, adult day care, nursing home care, ancillary and ambulatory services (including dentistry, and medical equipment), and are reimbursed through Medicaid. MLTC’s help people who are chronically ill or have disabilities and who need health and long-term care services to stay in their homes and communities as long as possible. The MLTC plan arranges and pays for a large selection of health, social services and home care. It provides choice and flexibility in obtaining needed services from one place. Most managed longterm care plan enrollees must be at least age 65. Simply put, no health care system today or tomorrow is going to work without the patient taking his or her place as an active team member in the health care process. The concept of “patient-centric” is a two-way street, with the system thinking

INTRODUCTION

GOLDEN YEARS

MEDICINE TODAY HEALTHY LIVING H&L TECH

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COMMUNITY PROFILE

February 2013


INTRODUCTION ISSUES

GOLDEN YEARS

Changes in Medicaid System Make Getting Home Care Help Harder By Eli Stolberg

COMMUNITY PROFILE

H&L TECH

HEALTHY LIVING

MEDICINE TODAY

GOLDEN YEARS

WOMEN’S HEALTH

RAISING OUR CHILDREN

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ne of the biggest issues for families when pursuing home care with Medicaid coverage for a loved one is with regard to how many hours a day of home attendant services they will receive. It used to be relatively easy for someone who needed a high number of hours or even round the clock care to get the help they needed. Unfortunately, due to changes in the Medicaid system, it has become more and more difficult to get a high number of home attendant hours even for people who really need the help. Now more than ever, it can be extremely valuable to have someone who has intimate knowledge of the home care system to guide you through the process of obtaining services.

‘requires a higher level of care’. The other factor keeping services down is that the govern-

provided down. In fact, once a patient requires more than a certain amount of services, they are actu-

The Challenge

The primary reasons for the change in availability in services is a change in how providers are reimbursed and the forced induction of all longterm home care recipients into Managed Long Term Care plans (MLTCs). Many providers used to be paid directly in proportion to the services they provided -- the more services that they provided, the more they got paid. Under those terms, providers were more than happy to authorize whatever services were necessary. Now those providers are paid a fixed amount per episode and more services provided do not necessarily translate into more money for the provider. Under this system, if a provider gives more than a certain amount of services, they will lose money. As a result of this change in reimbursement, there are fewer services available for the people who need the most help. In some instances, providers will not even accept a patient who needs a great amount of help, saying the patient

24 hour care. They may not tell a patient that, but they are telling us that and telling us not to refer them patients that require 24 hour care. Another MLTC we work with will accept patients that require 24 hour care but will not accept dementia patients. Trying to obtain services from a provider which has a policy not to accept a case like yours can result in much aggravation and precious time wasted. Another factor that can affect the processing of your case is that many of the MLTCs are relatively new and have not instituted protocols or just don’t have the staff in place to handle given situations. One area where this can make a big difference is when a client requires the submission of a Medicaid application in addition to an assessment for services. The difference in processing time start to finish between varying agencies can literally be months.

Find Someone Who Can Guide You

ment is now forcing all patients requiring long-term home care to join MLTCs. These plans receive monthly premiums similar to any insurance company. They do not get paid more or less based on how many services they provide, and are therefore greatly incentivized to keep the amount of services

ally losing money on that patient.

Not All Companies are the Same

Each provider and MLTC has its own policies for what kind of clients they will accept and how tight they are on services. For example, some of the MLTCs we work with will not accept patients that require

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When looking to obtain home care services for a loved one, it can be extremely valuable to work with someone who knows today’s system and can match your loved one with an appropriate agency for their needs. It is important to note that today’s home care system is still developing. As such, a company’s policies can change, and what was true one month ago may no longer be true today. Don’t rely on what you heard in the past. Find someone who is actively involved in home care and who can give you current information. Eli Stolberg is the director of Homecare Planning Solutions, which provides free assistance with Medicaid applications, pooled income trusts, long-term care insurance claims, and private pay arrangements for people who would like to receive home care. He is available between 9:00 am and 5:00 pm and can be reached at 718.838.3838.

February 2013


Link Between Age-Related Hearing Loss & Genetic Marker

Aspirin Shown to Lessen Cognitive Decline in Older Women With Heart Disease

H&L TECH

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COMMUNITY PROFILE

February 2013

jects showed an average decline of -0.05 on the MMSE, compared to -0.95 for non-users, over a fiveyear period. Other memory and cognitive tests showed similar patterns for the aspirin - taking patients, but the results were not statistically significant. Simon Ridley, Head of Research at Alzheimer’s Research UK, reiterated that, “the results provide interesting insight into the importance of cardiovascular health on cognition, but we would urge people not to selfmedicate with aspirin to try to stave off dementia.” The positive results were only indicated for high-risk cardiovascular patients, not for dementia patients in general. Further research is needed to study risk factors and effective prevention for cognitive decline in senior patients.

HEALTHY LIVING

t’s well known in studies that low-dose aspirin can help prevent cardiovascular disease. Now, it seems that low doses of aspirin may also have a neuroprotective effect for elderly women with a high risk of heart disease. The results of the five-year study were published in October in the journal BMJ Open. Anne BorjessonHanson and colleagues from the University of Gothenburg (Sweden) studied 681 women, at a mean age of 75 years, who were at high risk of a cardiovascular event. Subjects of the study took the MMSE (Mini Mental State Examination), which is commonly used to test cognitive and thinking skills and used in the UK to diagnose dementia. In the Swedish study, 18.9% of the women were already on a lowdose aspirin regimen. These sub-

MEDICINE TODAY

I

GOLDEN YEARS

The gene is responsible for producing a protein called glutamate receptor metabotropic 7. In the cochlea, or inner ear, this protein plays an important role in converting sounds into a format that can be processed by the nervous system and sent to the brain. The gene is also linked to speech processing ability. The discovery encourages younger people to be tested for this gene at an earlier time so that if they find that they have this genetic marker, they can take steps now to preserve and protect their hearing, like avoiding loud noises and medicine known to damage hearing, and to wear ear protection when needed.

WOMEN’S HEALTH

estrogen helps protect auditory function. “This gene is the first genetic biomarker for human agerelated hearing loss, meaning if you had certain configurations of this gene you would know that you are probably going to lose your hearing faster than someone who might have another configuration,” said Robert Frisina Jr., co-author of the study and founder of the Global Center for Hearing & Speech Research. The causes of age related hearing loss are both genetic and environmental, so even if someone has the genetic predisposition to lose their hearing, they can still take steps to improve their quality of hearing.

RAISING OUR CHILDREN

esearchers at the Rochester Institute of Technology have identified a gene that serves as a marker for age-related hearing loss. The discovery, published by the journal Hearing Research, could have a significant impact on improving senior quality of life and psychological well-being. Presbycusis, or age-related hearing loss, is the cumulative effect of aging on hearing. The condition affects an estimated 30 million Americans with hearing impairments that cause difficulties in communication and daily life for many seniors. Men and women are not affected equally men’s hearing tends to decline faster and earlier than women’s, and it is believed that

ISSUES

R

INTRODUCTION

GOLDEN YEARS


INTRODUCTION ISSUES RAISING OUR CHILDREN WOMEN’S HEALTH GOLDEN YEARS MEDICINE TODAY HEALTHY LIVING H&L TECH COMMUNITY PROFILE

MEDICINE TODAY

Health & Living continues after the Mind, Body and Soul section…

Brooklyn’s Post-Sandy Hospital Crisis May Soon Worsen By Yaakov Kornreich

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ver since the end of October, when extensive flood damage caused by Hurricane Sandy forced the closure of Coney Island Hospital in Brooklyn, and the NYU Langone Center and Bellevue hospitals in Manhattan, Brooklyn’s remaining hospitals have been struggling to deal with a serious overflow of emergency room patients. City, state and federal officials have responded by committing more than $50 billion dollars to Sandy recovery projects, but repairs to the ERs and other critical facilities at damaged city hospitals are still far from complete. Meanwhile, this winter’s flu outbreak, one of the most serious in recent years, has put additional pressure on Brooklyn emergency room facilities and medical personnel.

Now SUNY’s Downstate Medical Center has announced plans to shut down its Long Island College Hospital, which has been serving

emergency room at Maimonides Hospital in Boro Park, patients on stretchers were stacked threedeep at each treatment station,

the Cobble Hill section of Brooklyn for 150 years. It is not clear when LICH would close its doors, but if it happens soon, it is sure to increase the pressure on Brooklyn’s remaining hospitals. During a visit by this reporter several weeks ago to the large

leaving hardly enough room for doctors and nurses to walk between them. Some patients in less serious condition had to wait for hours before they were treated by the overworked doctors on duty. If patients needed to be admitted to the hospital, they sometimes had to wait for more hours in the ER or a hospital hallway before a bed in a regular room opened up. The crush of ER patients never seemed to stop. In the middle of the night, the crowding at Maimonides worsened when patients began to arrive who had originally gone to Kings County Hospital for treatment, but were turned away because its ER was already at maximum capacity. Longtime Maimonides staff members said they had never seen its facilities so taxed for such an extended period of time. Yet, despite the pressure from working long hours under difficult conditions, many of the hospital’s workers rose to the challenge and went to extraordinary lengths to try to meet their patients’ needs. There is little near-term relief in sight. NYU hospital partially re-opened last month, but its emergency room remains closed until reconstruction is completed. Bellevue has just fully reopened its emergency room and other facilities to patients in critical condition, including its level one trauma care center. The emergency room at Coney Island hospital has only partially reopened, and many of its

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other facilities are still out of commission. Because of the emergency rooms and many private physicians’ offices which were knocked out of action by Hurricane Sandy, freestanding urgent care facilities in the region have reported a surge in walk-in traffic. For example, Samuel Fisch, the CEO of MedRite Urgent care, which is located just a few blocks from NYU hospital in Manhattan, reported a 50% increase in patients in the aftermath of the storm. “We got in many more staff to accommodate the influx of patients so we can continue to serve the community with the same compassionate care that MedRite is known for,” he said. The problems which threaten to close LICH have nothing to do with Hurricane Sandy. The hospital had been losing money for the past 17 years before it was taken over two years ago by Downstate, which had hoped to save it through improvements in its management, but according to Downstate President John Williams, the rescue failed, in large part because of a tendency by local residents to go to Manhattan hospitals for treatment, which resulted in LICH having one of the lowest hospital bed utilization rates in New York City. The continuing financial losses threatened to bankrupt Downstate’s entire operation, including its medical school, school of nursing and school of public health at its main campus in East Flatbush. As a result, SUNY Downstate’s Board of Trustees voted unanimously this month to close down LICH, subject to approval by the State Department of Health. If LICH is closed, the wait by Brooklyn patients for beds and treatment at other local hospitals is likely to grow even longer. Yaakov Kornreich has been working as

an Anglo-Jewish journalist for more than 40 years, and writes regularly on a wide range of both Jewish and secular topics. He is the Senior Editor of two supplements published by The Jewish Press, “Health and Living” and “Building Blocks”, and a co-author of the book “Young Israel at 100” published earlier this year.

February 2013


MIND, BODY & SOUL

February 2013 A Publication of

In Collaboration With:

A Mental Health Magazine

YOUR MIND MATTERS


& MIND, BODY SOUL

MIND, BODY SOUL &

Touro College Graduate School of Psychology Offers Master’s Degree Program In Industrial/ Organizational Psychology

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o you want a job in what is projected to be one of the ‘Hot Jobs” through the next decade? Well, the Graduate School of Psychology of Touro College and University System is providing a new and dynamic option for potential students by offering a Master of Science degree in Industrial/ Organizational Psychology (I/O), a growing field that has been projected to hold promise for future job seekers through 2018 according to statistics from the Department of Labor. The Graduate School of Psychology of Touro College and University System is offering a Master of Science degree in Industrial/Organizational Psychology (I/O), a field expected to hold promise for job seekers in the next decade. The field of I/O is a varied one that dates back at least 100 years. During World War I, prediction of work performance was needed as new troops were assigned to duty. After the war, the field grew along with the nation’s industrial base. Today, I/O encompasses the scientific study of employees, workplaces and organizations, and I/O psychologists contribute to the success of organizations by improving employee performance, satisfaction

Happenings:

Awareness in Mental Health Through Ezer Mizion Services

M

ental health is a field that is shrouded in mystery. How can one determine if a loved one is suffering from a mental health issue or if they are simply exhibiting a character flaw? For the family dealing with what may be a mental health issue, the fear of stigma prevents them from seeking advice and so patient and family sink further into the whirlpool of the unknown. In an attempt to lift the fog enveloping the world of mental health, Ezer Mizion’s Mental Health Division includes the promotion of mental health awareness by means of a public lecture series initiated in collaboration with Pa’amonei Tikvah - a non-profit organization dealing with mental health issues and the Bnei Brak municipality. Ezer Mizion’s Mental Health Division offers a variety of psychological support services and rehabilitative programs for those afflicted by psychological disorders, emotional issues and mental illnesses. These services include: Rehabilitative em ployment centers that provide mentally handicapped

and well-being. I/O psychologists work as professors, researchers and consultants, among other roles. The program is appropriate for students wishing to work in a wide range of professional arenas, including organizational consultants, human resource professionals, psychologists, educators, school administrators and anyone who wants to enhance their professional capabilities and career options. Students are required to complete 12 courses exploring issues of psychology in the workplace, including assessment, consulting, motivation and organizational design. Students are also required to complete a capstone field experience. The new program complements existing Master of Science programs including school psychology, mental health counseling and school counseling. Courses will be offered at the Graduate School of Psychology at Touro’s midtown Manhattan campus at 43 West 23rd Street. For additional information, please contact Jenny Ilina at 212-242-4668, ext. 6007, jenny.ilina@touro.edu or Dr. Yair Maman at 212-242-4668, ext. 6008, yair.maman@touro.edu or visit www.touro.edu/dgsp/programs.asp

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people with basic vocational training and employment, and ease their integration into free market employment. A 24-hour crisis hotline for non-medical emergencies, including mental health crises such as suicide attempts or severe manic episodes. A psychological referral team that recommends appropriate psychologists, psychiatrists and counselors. A network of psy-

chiatrists & psychologists throughout Israel who

provide their services at a discount to patients referred by Ezer Mizion. A Big Brother/ Sister Program that pairs individuals suffering from mental illnesses with trained mentors who provide companionship, offer assistance with basic daily function, and teach the skills necessary for independent living. In addition, counseling services and support groups are made available to the families of the mentally ill at no cost. For further info: www.ezermizion.org

February 2013


& MIND, BODY SOUL

CONTENTS February 2013

Letter from Dear Readers,

On February 17 -18 Nefesh Inter-

Once again the Jewish Press and national sponsored its 16th AnNefesh International, a Network nual International Conference here of Orthodox Jewish Mental Health in New York. The conference was atProfessionals, are engaged in a col- tended by virtually hundreds of frum

2 4

Mind, Body & Soul Happenings

5

Can All Hurts in Marriage Be Forgiven?

6 7

Goodness of Fit

‘Anxiety’ Clarified By Benyamin Halpern, MSW LSW CSAC-T By Dvorah Levy, LCSW By Chaya Tauber, LCSW

Executive Functioning: The Keys to Independence

By Dr. Shuli Sandler

8

Boundaries: Vessels for Healing By Lili Grun, LCSW and Rabbi Richard Louis Price, M.D.

laborative effort entitled “Mind, mental health professionals from 10 Psychotherapy

By Ilana Rosen, LCSW-R

Body and Soul”. We offer you a pot- around the globe. The opportunity 11 If I Am Not For Myself, pourri of articles on a broad spec- to engage in dialogue, to confer on

Who Will Be For Me?

By Nancy Zwiebach, MA, PD

trum of mental health subjects. We the most challenging issues of the 12 Offering Rewards

By Rosalind Levine, PhD

hope they expand your thinking and day and to share new and innovative 13 Protecting Our Children expose you to ideas which may well ideas and techniques were the hallprovide food for thought.

marks of the conference. The stellar

By Rabbi Raffi Bilek, LSW

14

Talking To Children About Death By Dr. Norman N. Blumenthal, PhD

Over the past many years, the frum array of presenters on cutting edge 15 Psychlogical Treatment & the Haredi Community

By Seymour Hoffman

community has gained a considerable subjects drew immense interest. We 16 Self-Esteem and True Identity By Yehuda Lieberman, LCSW-R, QCSW, DCSW degree of sophistication regarding were privileged to immerse ourselves mental health as it pertains to the

in the wisdom of experts in the field 17 Breeding For Succeeding

By Ilana Orange, LMSW

way in which we live, the relation- of mental health who have imbued 18 Better Late than Never By Pamela Siller, M.D. ships we cultivate, how we raise our their lives with Torah scholarship 19 Holiday Blues By Dr. Michael J. Salamon families, and how we face life cycle and learning. Nefesh International events. Subjects which were unspo- is dedicated to promoting underken years ago are now part of an es- standing of the human spirit and the sential dialogue. This is for the bet- human heart.

& MIND, BODY SOUL Is a publication of the Jewish Press Published since 1960 and in collaboration with Nefesh International

ter since issues that remained in If you wish further information or the darkness plagued us no less by discreet referrals please contact us virtue of the silence, but as we have at www.Nefesh.Org. developed the courage to face challenging issues, it has actually made us stronger and more resilient. The authors in this selection reflect a keen depth and breadth of knowledge which you will assuredly

Bivrachah,

Phyllis Mayer, LCSW Phyllis Mayer, LCSW executive board member of Nefesh, executive board member of the Task Force on Children & Families At Risk in the Frum Community, Private Practice in Brooklyn & Staten Island. She can be reached at mayerphyllis@gmail.com or 917.306.3298

find enlightening. February 2013

SUPPLEMENT COORDINATOR Chaim Sender, LCSW • Alice Tusk, LMSW ARTICLE COORDINATOR Phyllis Mayer, LCSW SENIOR EDITOR Ita Yankovich EDITORIAL BOARD Phyllis Mayer, LCSW • Chaim Sender, LCSW Rabbi Simcha Feuerman, LCSW-R Nathan A. Solomon, Ph.D. • Lisa Twerski, LCSW AD COORDINATOR Shaindy Urman DESIGNER Alana White • lanala8@gmail.com

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& MIND, BODY SOUL

‘Anxiety’ Clarified By Benyamin Halpern, MSW LSW CSAC-T

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e all hear the buzzword “anxiety,” along with statistics like those stating that one out of three people will battle anxiety in their lifetime. What is anxiety? What causes it, and how does one overcome it? And what is the Torah’s prospective? Almost every normal person will experience anxiety and/or its related conditions during their lifetime to some degree. A third of the population will experience anxiety to the degree that it affects their daily living and productivity. Anxiety ranks as the number one diagnosis in emergency rooms across the United States, and the primary medication used to treat anxiety is the most prescribed medication in America. Anxiety suffers complain of feelings of agitation that is described as a black cloud over their heads at all times. Others experience a feeling of impending doom. Some common symptoms that accompany anxiety in general are intense inner nervousness and fear, tightness of throat, shortness of breath, dry mouth, heart palpitations, uncontrollable, obsessive scary thoughts, sleep problems, nausea, chest discomfort, dizziness, feeling of unreality, numbness or tingling in the extremities, hot flashes and chills, shortness of breath, and muscle tension. Very commonly, the sufferer will avoid public places or situations that may evoke the feeling of anxiety, thereby making their world smaller and smaller. Another common form of anxiety is the experience of intrusive, persistent, irrational, thoughts or impulses. In an effort to minimize or cope with these nagging thoughts, the sufferer engages in repetitive behaviors and rituals to control their anxiety. Anxiety is one of the most painful psychological conditions that one can experience, but fortunately also the most curable. The most effective way to treat anxiety today is CBT (Cognitive Behavioral Therapy), the science of systematically changing one’s thought patterns and behaviors to more positive ones that don’t produce anxiety.

CBT has an 85-99 percent success rate, based on various studies done for different forms of anxiety. In other words, a sufferer from anxiety can look forward to at the least

Either way, we are living in fantasy, because we can only control the precious present moment, and we are not living in it. When the yetzer has us living in the past or future,

an 85 percent reduction in symptoms and in many cases more relief from the debilitating effects that anxiety can have on the sufferer. The Torah says in the third Parsha of Shema “Velo susuru achrei levavchem vechrei eineichem asher atem zonim achrayhem”– “You should not follow the distractions of your heart and eyes that you pull towards.” This posuk describes the yetzer harah’s tactics to keep us from staying on track with our life’s work in this world. The yetzer distracts us from the only thing we have any power to control or affect, and that’s our precious present moment. One of the yetzer’s tactics is to create emotions of fear, causing us to live in the future, or feelings of guilt that have us living in the past.

it robs us from experiencing simcha and menuchas hanafesh in our lives. To avoid this pitfall, we need to learn how to stay in the present moment, and to control our focus in order to stay on track and keep moving in the direction we want to go. The skills to accomplish this can be learned rather quickly, in most cases, within weeks. Many successful interventions are based on the concept of modeling. The brain is neutral. It can be used for good or ill will. If you were to interview 10,000 anxiety sufferers, you would find that they all think in similar patterns; interviewing 10,000 people who don’t suffer from anxiety, would show that they too have common patterns. It is therefore pertinent to learn and model the way non-anx-

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iety sufferers think for you to overcome your problem with anxiety. I would like to share some skills that you can put to work right away if you suffer from anxiety, and see rapid improvement. Most people complain that they are unhappy with their current situation. I compare this to getting into a taxi, and when the driver asks where you want to go, you answer, “Not here!” You will then find yourself driving for hours while the meter is rolling, and still not be anywhere because you never gave him a clear destination. But it you have the address you’re headed to, the driver can get you there in a reasonable time. Ask yourself, “If I got up tomorrow morning and my anxiety was gone, how would my life be better?” You need to create clear images as to where you want to go. Come up with ten ways your life would be better. For example, if one of your reasons is that you will be able to get up and enjoy the process of getting ready for the day, you need to see, in your mind’s eye, a clear image of getting up tomorrow morning and feeling great. How does it feel? How do you like it? How does your face look? How are others responding? The more real you make it by incorporating all of five senses into your mental imagery, the quicker you will see the results. You will find that you will start moving toward the ten mental images you’ve created. Do this exercise daily; spending about one minute on each image. In just ten minutes a day, you will be giving your brain a clear message of where you want to go. Chazal say that every outcome lays in the intention that comes initially. With this exercise you will be affecting the direction in which your mind is headed, thereby also setting the direction that your thoughts will follow throughout the day. Benyamin

Halpern, MSW LSW CSAC-T, has developed a Torah-based program that teaches the skills necessary to overcome anxiety. He sees clients in Lakewood, Monsey and Brooklyn, or via phone or Skype. For more information on the Staying on Track TM program to overcome anxiety call 732.730.3900, or email info@fearanxietystress.com.

February 2013


& MIND, BODY SOUL

Can All Hurts in Marriage Be Forgiven? By Dvorah Levy, LCSW

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ur spouses have the ability to hurt us in a way that very few others can. How we understand these particular hurts and the process of working through them is key to getting to forgiveness. Can all hurts be forgiven in marriage? The answer is “yes” but it requires a process that takes work, understanding and patience. The insight and understanding gained when working on repairing a deep hurt often bring couples closer together. In my psychotherapy practice, couples often will describe hurts they experienced by their partner. Their descriptions are vivid and emotional. Through the course of exploration I learn that many of these hurts often have occurred 5, 10, 15 or more, years ago. The question begs asking: If every year on Yom Kippur we are taught to ask for forgiveness and grant forgiveness, what kind of hurts are these that they just don’t go away? The hurts that stay with us are generally those that threaten our sense of secure attachment to our partner. We are hardwired to want human connection. The foundation for positive attachment comes from feeling secure that our partner accepts us and is there for us when we need him or her. Our sense of calm and wellbeing comes from this secure attachment. When the message we receive from our partner is that we are unimportant and our needs do not matter, we experience an “attachment injury.” These are typically the types of hurts that are hard to work through and forgive because they create a sense of insecurity in the relationship. There are times when we feel more vulnerable and our attachment needs are higher than usual, such as after a birth or miscarriage, death of a parent/friend, sudden loss of a job and/or the diagnosis or treatment of a serious illness. These are the times when couples can easily miss each other in terms of seeing the others needs and subsequently, attachment injuries are created. When our partner is not emotionally or

February 2013

physically there for us when we need him or her to be, it hurts. Ignoring or burying relationship injuries does not work; unresolved traumas do not heal by themselves. Rather, the opposite is true. Hurt feelings generally lead us to protect ourselves, often by creating emotional distance. Our survival instincts scream out not to leave ourselves unprotected by trusting and risking emotional engagement. All hurts can be forgiven, but it’s a process not dissimilar to the Rambam’s four steps for tshuvaHakarat hachet, Vidui, Charata al haavar and Kabbalah laatid. These steps can be applied to healing attachment injuries in relationships as follows: Hakarat hachet is associated with awareness of why my partner is hurt. I need to take my partner’s hurt seriously. Rather than dismiss my partner as being irrational or “making a mountain out of a molehill.” I need to ask questions until the meaning of the incident becomes clear. “What is the nature of the attachment injury for my partner?” is a question I will keep in the forefront of my mind. The insight I carry is that I must have done something to make my partner feel he or she was unimportant to me or that I was not there for him or her. Once we are aware of our partner’s hurt we can articulate our understanding in the context of attachment. “I understand that I let you down by doing … and that you thought I didn’t care about you.” This step correlates with the Vidui process, articulating an understanding of the hurt we caused. Charata al haavar, or empathy/ remorse, is when we take ownership of how we inflicted this injury on our partner and express regret and remorse, not with a “Look, OK, I’m sorry,” – that sounds impersonal or defensive. Rather, we show our partner that his or her pain has an impact on us. Saying things like “I pulled away and in doing so let you down,” “I didn’t see your pain and how you needed me,” “I didn’t know what to do,” goes a long way in helping our partner believe that we are really

sorry. Caring and feeling our partner’s pain, verbalizing that his or her hurt and anger are legitimate, owning up to what we did that was so hurtful, and feeling dismayed by our behavior are the ways we express Charata. Kabbalah laatid reflects a commitment to be more sensitive and aware in the future. Providing reassurance at this juncture is very important. When we construct a new story that explains how the injuring event came to be and are aware of how our actions eroded trust and connection and sent us into a cycle of hurt and distancing, when we make a commitment to avoid repeating the hurtful actions or words in the future, then our partner can begin to trust again and healing occurs. Sometimes safeguards are required to be implemented in order to remove temptation and enhance our partner’s sense of security. Let’s take the opportunity to

check in with our partners by asking, “Are there any hurts that you are carrying from previous years, something I may have done that you are finding hard to forgive?” And if so, apply the following steps: Gain awareness of the hurt created by asking questions & looking through the lens of attachment. Articulate awareness of the hurt within the framework of attachment. Empathize and feel remorse. Express commitment and reassurance that with sensitivity, awareness and possible safeguards, the hurtful event will not happen again. Dvorah Levy, LCSW, is a psychothera-

pist in private practice working with individuals and couples and specializing in relationship issues: marriage, parenting and dating. She maintains offices in Hewlett and Flatbush. Dvorah is trained in Emotionally Focused Couple and Gestalt therapies. She can be reached at 516.660.7157.

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Goodness of Fit By Chaya Tauber, LCSW

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here is a secret many parents harbor and are afraid to admit- liking one child more than another. When this was brought up during a parenting group, one parent immediately responded, “I love all my children equally.” While this response sounds like the correct thing to say, it is usually untrue. It may be the age or stage the child is in that appeals more to a parent. It may be the child’s personality. Some parents prefer an active, energetic child while others prefer a more passive, laid back child. Some parents find it easier to connect with a child who has a similar personality to their own or the opposite. Sometimes when a child has a different personality than his parents, a clash occurs. The parent and child have a hard time understanding each other from the other’s perspective and a power struggle will begin. The term for this phenomenon is “goodness of fit.” Goodness of fit refers to the ability of parent and child to get along with each other given their temperaments. As an illustration of the parent/child relationship it is helpful to think about a dance between two people. If one partner pulls to the right the other follows and the dance is smooth; however, if one partner pulls to the right and the other pulls to the left, a stalemate is reached and movement stops. Parent and child need to figure out how to maintain a smooth relationship. The parent/child dyad is not an equal partnership. The parent has the advantage of being an adult with life experience, having developed reasoning skills, being stronger and smarter, and hopefully is emotionally stable most of the time (see sidebar). The child has yet to mature developmentally, physically, emotionally, and socially. If parents begin to get a sense that they are having difficulty connecting to one or more of their children it can be helpful to take a careful look at themselves and their child. To develop an understanding of the parent/child dyad parents can create a list for themselves in private. Some parents find

it helpful to complete this activity in the presence of a therapist. The list can include the parents’ and child’s good and bad qualities,

reaching a resolution. Gaining insight into the parent/ child personalities and preferences will greatly enhance the under-

benefit from more outdoor play. A child who prefers to read, will benefit from more couch time. A child who is fast paced, needs many

which activities each enjoys, and a description of their personality. The differences should be easy to spot when comparing the two lists. Since the parent is the more advanced partner in this relationship, it is his/her duty to take the lead in

standing a parent needs to help the relationship be healthier. Parents can make different allowances for each child with acceptable limits, so they can foster each child’s needs and personalities. A child who prefers more physical activity, will

activities available. A child who is slow paced, needs extra time to complete tasks. A chatty child may enjoy long conversations with his parents while another would prefer more silent, cuddling time. While it sounds like you need a unique set of rules for each child, it really is more of an accommodation of the child’s needs. The fundamental rules in the household remain uniform such as, no hurting others, safety rules, and cleaning up after oneself. Chores can be designated based upon skill level. Planning ahead and keeping the needs of each child in mind will allow the parent to meet the child’s individual needs. A child whose needs are met will be satisfied with himself and quite lovable in his own way.

THE ANXIOUS/DEPRESSED PARENT

Many adults suffer from disorders such as anxiety and depression. Some recognize they have a problem and seek help. Others will struggle with, hide, or deny their disorder and live their whole life in pain. If a parent raising a child has a clinical disorder which interferes with their ability to raise their child in a healthy way, their responsibility to ensure they receive treatment increases dramatically. Parents naturally want to provide the best opportunities for their children to succeed. The most important opportunity for a child to be successful and develop into a healthy adult is to have an emotionally stable parent. While there is stigma attached to seeking help, treatment and recovery will always outweigh the stigma. To help one recognize if there is a need for treatment, here is a list of symptoms to look out for: Irritability Loss of appetite/Increased appetite Disturbed sleeping patterns Fatigue Muscle tension Difficulty concentrating and completing tasks Feeling sad, empty, worthless, or helpless Thoughts of hurting oneself or others Unexplained aches and pain

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Chaya Tauber, LCSW is the founder and supervisor of the Parent Support Program at Integrated Treatment Services and is employed as a Mental Health Consultant for Head Start. She maintains a private practice and directs Parent Support Groups. She received postgraduate training in the treatment of adolescents at the Postgraduate Center for Mental Health, a psychoanalytic institute, and is bilingual (Yiddish-speaking). She can be reached at 347.701.9185 or chayatauber@ yahoo.com.

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Executive Functioning: The Keys to Independence By Dr. Shuli Sandler

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y son takes an hour to get up in the morning…” “My daughter’s backpack is a disaster!” “Yitzchak can’t sit still in class. He’s always so fidgety.” “Batya doesn’t raise her hand in class. She always calls out.” “Laurie doesn’t study for her Chumash test unless I am hovering over her.” “Zachary doesn’t do his homework unless I sit with him, and half the time he forgets to hand it in anyway.” “I don’t know how my 18 year old is ever going to move out and be independent. I do everything for him!” What do these comments have in common? All the children in these scenarios suffer from deficits in Executive Functioning. Executive functions are the regulatory functions of the brain that direct cognitive activities, emotions, and behaviors. Our executive functions clearly impact our day-to-day functioning in a multitude of ways and help us with skills such as prioritizing, focusing, managing time, and organizing. Many school-age children struggle with weaknesses in executive functioning. They may be bright and highly intelligent, but their poor executive functioning inhibits the true expression of their intelligence. Deficits in executive functioning are manifest as part of other psychiatric diagnoses such as Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorders such as Asperger’s Syndrome. Executive functions are mediated by the prefrontal cortex of the brain; however, it is likely that input is received and processed in other parts of the brain. In a typically developing child, in the early stages of development, parents and teachers serve as models of executive functioning. Through setting guidelines and enumerating concrete steps, they provide a template the child can use as he or she develops his or her own executive functioning. For example, when a

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parent asks a five-year-old child to “clean up,” the parent will typically have to specify what that entails and break it down for the child (put your laundry in the hamper, put the Legos back in the bin, etc.), but for a ten-year-old, the directive, “clean up,” may be sufficient

and any changes in routine may result in inflexibility or meltdowns. As a child gets older, there may be difficulty juggling increased demands at school with different subjects and more complicated assignments. Writing down and keeping track of these assignments

to know what that entails based on the modeling the parent has done over the years, combined with the maturational development of the child’s brain. In the child with executive dysfunction, this process has become interrupted and the child continues to need support and guidance, in contrast to sameage peers. Difficulties in executive functioning impact children differently at different stages. In school-age children, it may manifest with difficulties in everyday routines, such as getting ready for school or bedtime. At school, a teacher may have to repeat directives and the child may have difficulty staying on task or completing an assignment. Homework can be a nightmare for the child and his or her parents,

becomes critical. The peer group becomes increasingly important and the child with executive dysfunction may struggle socially as well. Completing chores at home may result in a battle as the child may refuse tasks due to an inability to break down information into manageable chunks. This time also confronts students with challenges such as planning for college and making plans for the future, which require a lot of executive functions as well. Parents often react in two ways. Some parents become their child’s Blackberry by taking on full responsibility for their child’s life. They keep track of all their child’s assignments, exams, papers, social life, and room, with the child taking no responsibility. Other

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parents struggle with their own executive functioning difficulties, so the child is left to “sink or swim;” they usually sink. In either model, parents often become understandably resentful at their child’s lack of independence in basic everyday functioning. To remediate these difficulties, a two-pronged approach is best. We want to improve the specific area of difficulty, both by strengthening the weak area and by compensating with other areas of strength. Modifications are often helpful as well. Each child has his or her own “list” of areas of difficulty that is unique. Through a careful assessment, a list of the child’s difficulties can be broken down with a specific plan for each area of difficulty. Teachers, parents, and a therapist can work together to tailor a specific approach to a child’s unique needs and modify the environment to improve the difficulties. Some examples may be helpful. A child who has difficulty getting up on his own may be put on a behavior system whereby he gets rewarded for getting up on his own, or with minimal help. A child who has difficulty organizing her backpack can be put on a color-coded system where each subject is a different color. A checklist of subjects is printed out and she checks off each assignment as she places it in the folder. A child who cannot sit still in class may benefit from short breaks, preferential seating, or rewards for sitting still. In this way, a child’s environment serves to reinforce their independence and executive functioning to increase the likelihood of success. When dealing with more complex executive dysfunction, or in cases where behavior problems are significantly impacting the child’s success, enlisting the help of a child therapist trained in working with executive dysfunction can be effective in creating an effective plan for success. Dr. Shuli Sandler is clinical psychologist

in private practice, with offices in midtown Manhattan and Teaneck, NJ. She works with children, adolescents, and adults. She can be reached at shulisandlerpsyd@ gmail.com.


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Boundaries: Vessels for Healing By Lili Grun, LCSW and Rabbi Richard Louis Price, M.D.

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he theme of boundaries is woven throughout Jewish culture. This theme is apparent in the first human action. Adam delineated between human and animal, and created a boundary of identity for each animal through naming. Avraham was called haIvri (“the one from the other side”) because he distinguished himself from others, standing one side of a spiritual divide and speaking a different language. Boundaries in space and time are found in our most important texts. Most notable, the boundary between Shabbat and chol. In addition to the spiritual benefits, having a day of rest allows us to be more effective. We post our most holy text, the Shema, on the boundaries of our home. Concepts like hevdel, hefsek, eruv, mechitzah, aveira guide our daily life, drawing defining boundaries: parent-child, husbandwife, teacher-student, employer-employee. Lines you draw between yourself and others create a solid sense of who you are, and your role in different settings. They give you the opportunity to communicate firmly what you believe, are willing to accept and expect to be treated. Boundaries serve the important job of protecting you, bringing a sense of order and predictability, especially if people in your life change their demands frequently, or act manipulatively. Many boundaries for everyday life are already outlined to us by the Torah and Gemara; we have only to fine-tune. Boundaries benefit those with whom we interact, allowing us to fulfill the mitzvah of “Love Thy Neighbor as Thyself.” They give others a feel for who you are…a healthy closeness, making for simpler relationships with less drama. Many of our depressed, anxious

feelings stem from feeling helpless. This limits our ability to contribute to relationships.

what subjects we feel comfortable discussing. Refusing to accept demanding or needy behavior is an example of an emotional boundary. Not accepting accusatory or “pinning” behavior (e.g. getting pinned with “you don’t like me”) is a way of maintaining the emotional boundary between yourself and one whose emotional world is like a watercolor painting that runs all over.

Types of Boundaries

Physical boundaries are the amount of physical personal space you feel comfortable having between you and another. The laws of negiah and tznius help us with this. This can be communicated in words (expressing to a person that they are too close and you don’t feel comfortable) or with body language, (moving). We communicate physical boundaries to children so they are not vulnerable to inappropriate touching. Requesting privacy

Flexibility and Boundaries

Limits can be flexible. What is important is not to be so flexible that people get an inconsistent message. On the other hand, when boundaries are very rigid, people may view you as uncaring. You may lose out on the benefits of closeness with others. If you are doing this, you may want to explore your “if…then…” thinking. It may go something like, “If I let people get close, then I risk rejection.” Fear may be limiting you. You may choose to make temporary exceptions to personal limits. For example, your friend is having financial problems and asks if she could borrow the gown you had made last year for your sister’s wedding. You may ordinarily tell her you don’t feel comfortable lending it. But because this is an exceptional circumstance, you say yes. The key to setting aside a boundary is that you feel in control of this choice and able to handle the consequences. The laws of tzedakah give us room to tighten boundaries as needed. We treat a stranger’s request for tzedakah differently at a time when our close friend cannot pay his rent.

is a physical boundary. A person violating a physical boundary may do so forcefully (abuse), or subtly, such as sitting so close as to touch you. Who touches you and how must be your choice. Too much distance or absence of touch from a loved one may also be a physical boundary issue. Perhaps that person has withdrawn for reasons you need to discuss in a respectful, loving way. Setting emotional boundaries requires respecting your own feelings. This will help you respect those of others. They are set when we draw the line firmly and respectfully on listening to another’s problems, when we agree to listen only when one uses an appropriate tone, when we make clear

How do I set Boundaries?

Nourishing ingredients that make us strong enough to set boundaries include self- worth, self-trust, self-care and an ability to listen to that inner voice of loving kindness (which means turn-

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ing down the volume on the selfjudging voice). Boundaries grow from a belief that what you want, need, dislike are important. A first step is asking yourself questions, like: What feels both good and appropriate? What feels bad/overwhelming? Do boundaries need to be firmed up with specific people? What will I say no to? What limitsetting will help me be a better Jew? You will not be able to simply draw up your own personal “bill of rights” standing on one foot. Setting limits requires getting to know yourself. Or, it may happen the other way; you experience what “violated” feels like and then “get” where that boundary line is for you. A big challenge in setting boundaries is using them for the purpose of self-care rather than for controlling or changing another. Set limits on your behavior, such as deciding not to answer certain questions. This way, you feel in control. You are not relying on the other person changing.

Communicating boundaries

Briefly, specifically describe the situation that made you uncomfortable. Avoid accusations or drama. Describe how you felt (not how the person “made you feel”). Do not read the person’s mind (i.e. don’t tell them why they did what they did). For example: “Yesterday you called me. I said I have meetings all day and cannot speak until tomorrow. You called me six more times. I felt uncomfortable. If I say I cannot speak today, please respect that.” Other easy formulas include: “I prefer,” “I do not feel comfortable with,” “I am unable to.”

How do I know if my Boundaries are not firm?

If you don’t have solid answers to the questions above, this may be a sign you have not set limits. Without strong boundaries, you are likely feeling uncomfortable. You may have taken on responsibilities that don’t feel like your own. You may feel emotions that originally were felt by the other person (are you feeling someone else’s anxiety, perfectionism?) Reviewing the way you respond to others, you may see

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no consistency, which may indicate that you are being swayed by their needs rather than a sense of your own boundaries.

Factors that May Get in the Way of Setting Proper Limits

Moshe Rabeinu took the wise advice of Yitro to answer only certain types of shailos. This decision was as much about self-care as it was about efficiency. Those who have difficulty with self-care may have a hard time setting limits. Boundaries are rooted in beliefs about what we deserve. Those who feel undeserving will have boundaries that reflect this. Importantly, boundaries grow from a sense of identity; knowing what suits you. People with weak identities may have weak boundaries. Those with identities that exist only as a reflection of someone else’s behavior (“I am good only when I am praised”) may have boundaries that insure they only get praise. Holding on to a familiar but inappropriate identi-

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ty from your formative years, such as “caretaker” may lead to boundaries that prevent you from being anything else (like “friend” or

setting or maintaining limits is difficult, the support of a therapist may be helpful. An answer to the age old question of ‘why do thera-

“Lines you draw between yourself and others create a solid sense of who you are, and your role in different settings. They give you the opportunity to communicate firmly what you believe, are willing to accept and expect to be treated. ” pists insist on boundaries?’ is because much of our work is in the areas of self-care and limit-setting. Modeling these skills is an integral part of helping others. The special nature of the Jewish community is that we are all interconnected, opening our homes,

“boss”). We sometimes set boundaries that ensure we experience the opposite of what we experienced previously. One who experienced abandonment may have boundaries that ensure (sometimes inappropriate) closeness to others. If

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giving of ourselves and supporting each other. Creating and maintaining personal limits allows us to balance the middos of chesed and gevurah. Properly bounding and restraining ourselves reaps many more benefits than unbridled giving. Boundary-setting should not be a source of guilt. To the contrary, this self-care allows us to refresh our energies so we can give of ourselves more effectively. The result is a beautiful coexistence with those we care about. Lili Grun, LCSW is a graduate of Columbia University School of Social Work. She presents nationally on topics in psychiatric research and psychotherapy practice. She practices social work in Monsey, NY. Rabbi Richard Louis Price, M.D. is a Yale and Columbia University trained Diplomate of The AmericanBoard of Psychiatry & Neurology, Assistant Clinical Professor of Weill Cornell Medical College/NewYork-Presbyterian Hospital, Medical Director of Bikur Cholim of Rockland County and has a privatepsychotherapy and psychopharmacology practice in Monsey, New York where he resides with his wife and four children.


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Psychotherapy: The Good, The Bad, and The Dangerous By Ilana Rosen, LCSW-R

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n the course of our 120 years there will be, G-d willing, many wonderful times. However, since we are here to grow, we may also face stress, loss, and hardships. Some of us might experience abuse, neglect, poverty, or financial strain. Others might face challenges in marriage or parenting, mental illness, or medical illness. Accidents, war, crimes, or “acts of nature” may undermine our sense of safety. No one will escape the pain of losing a loved one. At such times, competent psychotherapy can help us cope. But what is psychotherapy? It is not a “schmooze”; it is not advice or a friendship, and it is never, a romantic relationship. Therapy is a professional relationship practiced within carefully protected, supportive, and safe boundaries. Like other “helping professions,” such as medicine, therapy is both an art and a science designed to help clients meet their goals for healing and living. There are many “modalities” of therapy: Some shape thoughts and behaviors to create internal and external health; some use the mind / body connection to bring harmony to the system; others help clients explore their internal world so they may make informed choices in their lives. Some modalities build healthy communication between spouses or educate parents. Others are geared for crisis, trauma, or life threatening conditions. Thanks to tremendous strides in research and the field of neuro (brain) science, we now understand more about why some modalities are safe and effective, while others are best abandoned for better options. All modalities require great technical skill as well as sensitivity by the therapist. Good therapy can be a life saver, but bad “therapy” can cause deep emotional scars or wreak havoc in lives and relationships. Bad treatment can drain financial resources and undermine emotional growth. When it comes to physicians we want the “top.” The same applies to mental health practitioners. Do your research: Don’t be afraid to ask questions. Reputable therapists will talk to you about their training, supervision, and professional experience. Here are some guidelines for interviewing a potential therapist: (see sidebar) If you are in therapy that feels uncomfortable, stop and seek consultation from a specialist. RELIEF 718.431.9501, and NEFESH 201.384.0084, can help you assess whether something is amiss in your treatment. Therapy can be wonderful and healing. You owe it to yourself to seek the best possible provider, so be an educated consumer. Ask questions, seek referrals, use reputable referral agencies, and above all, listen to your inner voice.

A therapist should:

Be educated and trained at an accredited institution Regularly attend professional workshops and trainings to sharpen skills Keep up with the current literature on effective therapies Have expertise with your particular issues Be open to seeking rabbinic guidance Assure confidentiality Be willing to strictly obey the laws of yichud (seclusion) Respect the client’s religious and cultural sensitivities Provide paperwork as needed Create a sense of safety to work through issues, at the client’s pace Be emotionally present, patient, and persistent Be kind, calm, empathetic, insightful, and really, REALLY listen Be supervised by a more experienced practitioner, or have regular peer supervision Adhere to professional standards, i.e., be on time for appointments, return phone calls, and work in a professional setting Encourage or insist that parents wait for their child in an adjacent waiting room, or join the session, but not leave the premises Explain the rules of therapy and confidentiality to adult and child clients; explain they may repeat anything said to whomever they choose

Unfortunately, not all therapists are good and trustworthy. Here are some “red flags” that cross the line into being inappropriate or abusive.

A Therapist should not:

Be often excessively late, miss, or cancel appointments Be casual about the length of sessions. Adults consistently 45 min to 1 hour, children 30-50min, and up to 90 min for Eye Movement Desensitization and Reprocessing (EMDR) Meet with you outside of the office unless there is a clear medical necessity Answer non-emergency calls during sessions Eat, talk on the phone, or text during sessions Fall asleep Discuss other clients with you by name or with identifying details Discuss you with anyone other than a supervisor, or use your name publicly Fail to refer you elsewhere when the problems you are facing are beyond the scope of his/her expertise Talk excessively about his/her personal life Fail to keep track of what you have discussed and where you are in your healing process Fail to help you set and attain goals in a reasonable time frame

A Therapist should NEVER:

Lock the doors or make your exit difficult See you at late or odd hours when no one is around Discourage a child’s parents from remaining on the premises Take the child off the office premises Tell you, “you are more special than other people/clients” Shop, eat out, or run personal errands with you Ask for personal favors Push you to disclose information before you are ready Touch you or your child in any way that makes you uncomfortable or violates Jewish Law Fail to respect the laws of yichud (seclusion), or exhibit un- tzniusdig (immodest) behavior Conduct “therapy” in a bedroom Yell, insult, become angry, or impatient Contact your relatives or friends without your permission Threaten to tell anyone and that you ar e troubled or a liar if you reveal what is taking place between you and the “therapist” Insist that your problem is a lack of emunah (faith) Pressure you to remain in the “therapy” Ask for gifts or loans Encourage you or your child to stop, or start, taking medication without a full evaluation by a competent physician Insist that you or your child come multiple times a week for many hours Charge above the maximum rate for someone with their degree of education and experience Pressure you to remain in, or return to, a situation in which you or your children are at risk of physical harm Use treatment techniques that make you feel uncomfortable or unsafe without a clear therapeutic purpose backed by research.

Ilana Rosen, LCSW-R has been a practicing psychotherapist for over 15 years.She specializes in the treatment of trauma,

abuse, medical issues, and bereavement. Mrs. Rosen is certified in Internal Family Systems and EMDR, and maintains a private practice in Monsey, NY.

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“If I Am Not For Myself, Who Will Be For Me?” By Nancy Zwiebach, MA, PD

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hese words, commonly quoted within the Jewish world, carry great meaning. As a Self Esteem Facilitator and psychotherapist, it is my goal to help people understand that caring for oneself is a mandate and that, like the instructions given by flight attendants on airplanes, you must care for yourself first if you are going to do your best in caring for others. Anyone who is a parent experiences, along with the joys and pleasures, some frustration, disappointment, anger, and even exasperation. This happens when we are parenting the “average” child with “average” needs, so you can only imagine what is going on with the parents of a “special needs” child. Needless to say, it can be overwhelming, leaving one feeling drained, depleted and maybe even defeated. So, how can these parents “be” for themselves - maintaining a feeling of self-worth and self-renewalwhile fulfilling their responsibilities to their children? I’d like to share a story offered by a woman participating in a process group I was facilitating for a group of special needs parents. The theme of the group was “why aren’t I getting what I want out of life?” This woman said she had been at a desperate point, and told her husband she didn’t think she could go on. It wasn’t just dealing with all the children and their needs, there were additional life issues pulling at her, and she was just too overwhelmed. Her husband asked, “if you could do one thing, whatever you want, what would it be?” She said what she wanted was impossible - they lived in Chicago, it was the middle of the winter, and she had no time to do it. “Well, what is it?”, he asked. “I’d like to learn how to scuba dive.” Soon after, for their anniversary, he presented her with a gift certificate for scuba diving lessons given by an instructor in Chicago. Included was his promise to be at home with the children when she took her lessons. There are several key factors at play here, but the first and most salient one is knowing what you want. In fact, one of the first concepts I try to introduce to the peo-

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ple I work with in my psychotherapy practice is to ask themselves, “what do I want?” It is amazing that this idea is so infrequently considered. It is instilled in us to do what someone else wants or needs us to do. So, if you are a parent feeling somewhat overwhelmed and needing some relief, first think about what it is you want. What it is you’d like to do that would help you feel

as long as possible adds to the richness of the experience. So, who’s going to watch the kids while you’re doing this? If a spouse is not available, think hard -- perhaps another family member or a neighbor. There is the option of paying for a babysitter/caretaker, but if that is not a possibility, often high school students are seeking “chesed” or community service hours. Organi-

you’re getting away and nourishing your own soul? It doesn’t have to be as exotic as scuba diving. I knew someone who would always feel replenished by taking a long, quiet bath, with the requirement that everyone would forget she was in the house. It could be taking a walk, perusing a mall, having a cappuccino with a friend or by yourself. The main feature should be a sense of self - “this is for me”.... and “I deserve it - I’m worth it”. Another piece that could be important is finding a support group. It could be a group specifically formed for people with a common situation (i.e., “Parents of Autistic Children”, “Parents of Developmentally Disabled Children”, etc.) which is the best idea if you are looking for concrete suggestions and advice. If you just want a place where you can express yourself freely with the guarantee of confidentiality, then a general on-going group would work as well. Being in a group, feeling safe and connected, has a way of helping people evolve, acquire the ability to set boundaries, and achieve their goals. While, eventually, all of these changes in yourself should have a positive impact on the others in your life, the time spent at the group, and traveling back and forth is your time to express yourself and to be with your thoughts and feelings. Keeping the cell phone off for

zations might offer respite services, or perhaps you could “swap” time with another person who is also looking for some time off. Music is a great spirit lifter and tension reliever. Make sure to have some CD’s available so if things are feeling really difficult, you can play them. Affirmations and visualizations are very powerful tools to help people change their mood, attitude, and approach to the situation itself. Affirmations are strong, positive statements that are made in the present tense, as if what you want is already happening. Develop 5 -10 such statements and repeat them to yourself whenever time may arise (usually showering, driving, or preparing dinner work well. A good way to start would be the following four generic affirmations: I am competent I am creative I deserve respect I own this day Visualizations are an intentional effort to create a scenario in your mind for a specific purpose. The purpose might be to help your calm down. If so, think about situations in which you feel relaxed and peaceful. It could be a luxurious bath, being at the beach, or walking in a green field of wild flowers. Make the visualization as specific as possible, and, with it, of course, recognize how relaxed you are and how good you feel. This

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can be done any place you can be alone for a few minutes-- even, if necessary, in the bathroom. These little two minute vacations can really help restore a sense of peace and the ability to go on. You can also use these to prepare for a challenging situation. Again, make them as specific as possible and see yourself being as exactly as you wish to be. Each time you do this, it’s a rehearsal for the actual event. According to David Katz, M.D., one of the best and easiest ways to manage stress is deep breathing. Not only does deep breathing reduce muscle and emotional tension, it can also temporarily lower blood pressure and heart rate, delivering a quick rush of additional oxygen to cells. There’s even some evidence that suggest it can reduce food cravings, improve sleep quality and boost energy levels. Sit in a comfortable chair, feet flat on the floor, close your eyes and breathe deeply, letting all the air out on expiration. It’s best to do this for 3 to 5 minutes twice a day. The bottom line is that caretakers have to accept and believe that they are worthy and that they are not only entitled, but obligated to take care of themselves. Thus, they can allow themselves to do what needs to be done. You also must accept that all of your feelings are legitimate, including anger, resentment, fears, etc. They are all part of the human condition and are involved in being a whole person. In accepting that fact, you accept yourself and come to recognize that you, as you are right now, are exactly enough. Nancy Silberman Zwiebach, MA,

PD is a Certified Self Esteem Facilitator. Trained and certified by Jack Canfield, of the “Chicken Soup for the Soul” series, she has done seminars for professional and business groups, educators, students, and parents, as well as for general audiences. A Certified School Psychologist and former Assistant Director of the Early Childhood Department at the JCC on the Palisades, Nancy is a graduate of the Center for the Advancement of Group Studies. She has published numerous articles on Parenting and authors a column, “Ask the Psychologist” for Spirit Magazine. Currently working for Bergen County Special Services and Jewish Education for Special Children, Nancy has a private psychotherapy practice in Paramus, New Jersey.


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Offering Rewards By Rosalind Levine, PhD

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here is a donkey in the middle of the road. A man wants to pass and so he yells at the donkey, telling it to move but the donkey does not budge. So he gets behind the animal, takes a stick and hits the donkey. Again, it does not budge. So the man tries to push the donkey and kicks it. No movement. He then goes to the other end and offers the donkey some grass and, lo and behold, the donkey follows the man and moves off the road. This can serve as a lesson in how to get children to cooperate. If we want children to do what is expected of them, they need an incentive. When there is something in it for them, children are more willing to do things that, while they are important to their parents, are not so meaningful to them. Conversely, children do not respond well to threats and yelling and pushing from their parents. They resent the repeated demands and what they perceive as control. In such situations, children may become oppositional, not unlike the donkey, and there is resultant conflict and tension between children and parents. There is a ‘dance’ that occurs when parents yell at and push their children. The more a parent engages in such behaviors, the more the child will refuse to comply. The parent will end up feeling frustrated and angry and will likely make threats and yell louder. This only breeds resentment, anger and a sense of not being understood on the part of the child, leading to even more resistance. And so the dance goes. But when parents change their steps to provide rewards, the children’s steps will in turn change. Imagine if the morning routine, homework routine, and going to bed routine, were all opportunities to earn rewards. Would children not demonstrate good midos if such actions were praised or otherwise rewarded? This new system would yield a reduction in yelling as well as an expectation of winning rewards. Gone would be the conflict that was perpetuated by the old dance. The parents’ role is

to offer the good things that their children will appreciate so as to motivate their children. Now, the family can work together as a team toward common goals. Motivating children gets them to learn to cooperate and leads to shalom bayis. Rewards need to match the deed, so that for little but significant cooperation they merit small but

Thus, when children fail to reach targeted behaviors, they are not rewarded and also not punished, but are encouraged to try so that the next time they can earn their rewards. In this way there is no attention given to what is not being done or what is being done wrong and only positive behaviors are addressed. It is incumbent on parents

In such a situation, there are more likely to be clashes as children may stand up for their needs. For example, a mother yelling at her children to clean up because SHE is running late and is stressed, is very different from a mother calmly rallying her children to do their tasks to get the house ready. The difference is subtle but very important

significant rewards. While we often think of material rewards, what is most appreciated by children young and old is attention and time with parents. Offering to play a game, read a book, learn or cook together or go out to the park or for ice cream are wonderful rewards that motivate children to do what we want. The fringe benefit of such rewards is that the parentchild bond can be strengthened. To put a reward system into practice requires follow through and commitment on the part of parents. Parents need to be vigilant, watching to see if children’s behaviors merit rewards. A system of rewards puts an emphasis on the positive.

to be firm and only give rewards when they are earned. Schools often use systems of rewards, employing behavior charts, where students get checks for reaching targeted behaviors. After a certain number of checks the individual and/or the class will be entitled to their reward. There are those who say that children should listen to parents as a matter of respect, without the need for rewarding them. When children feel that parental authority is backed by caring and love they are more likely to accept rules. Some parents set severe rules and impose them in a harsh and rigid way, often serving their own needs.

because in the latter example there is a sense of understanding and caring and love that is conveyed from the mother to her children. From the viewpoint of offering rewards, the mother’s approval and appreciation is a strong motivator for children to cooperate . The act of rewarding can go a long way in shaping the behavior of others. It provides the ‘grass’ that will lead people in our lives to where we want them to move.

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Dr. Levine, PhD is a Senior Staff Psychologist at Maimonides Medical Center, in the Child and Adolescent Outpatient Clinic. She also has a private practice in Boro Park and in Manhattan. She can be contacted at DrLevinePsychologist@gmail.com.

February 2013


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Protecting Our Children By Rabbi Raffi Bilek, LSW

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he Talmud teaches us that a man is obligated to teach his son Torah, find him a bride, teach him a trade, and according to some even to teach him how to swim (Kiddushin 29a). In short, parents are required to give their children the tools needed to lead successful lives. We cannot raise our children without teaching them what they need to know to support themselves, nor can we rear them without offering spiritual guidance and instilling them with values and morals. We live in a different era today. Yet the Sages’ words are far from irrelevant; indeed, we must even go beyond their instructions. Don’t we teach our children to stay away from drugs? Not to get in a car with someone who’s been drinking? Not to text and drive? Our children need to hear these lessons from us in order to be safe in today’s world. Today there is another subject that needs to be broached with equal gravity. Research tells us that 1 in 4 girls and 1 in 7 boys will be sexually abused by the time they are 18 years old. The problem is epidemic. While no studies have been conducted on the Jewish community, experts in the field assert that the rates are no less among our own people, regardless of affiliation, race, or socioeconomic status. There are important steps we can and must take to protect our children from sexual abuse. Here are some of the basics.  Let your children know that they can talk to you about anything. This is the number one lesson that underlies the rest. The truth is that we cannot be around our children 24/7, and we cannot protect them from everything and everyone. Yet children who know that they can discuss anything at all with their parents have an enormous advantage, because in the case, G-d forbid, that they are touched inappropriately, they know they have somewhere to turn for safety. They know that they do not have to keep the abuse a secret. Children who do not have that se-

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curity are likely to suffer abuse for longer in silence and secrecy – for months and even years. One study found that the traumatic impact of sexual abuse was related to the length of time it was kept secret more than to any other factor. Children are afraid of losing their parents’ love; they must be assured that this is impossible. They must

parts at some point, and these words should be used in the home from time to time. There are two reasons for this: one is because if they are using your family’s nicknames for their private parts, they may not be able to communicate to anyone else (such as a teacher or camp counselor) that someone else has touched them there. The

also be assured that disclosing sensitive information will not cause you to become angry, uncomfortable, or hysterical. Children do not want to cause pain to their parents and will usually clam up if they sense that will be the result. This means that not only do you have to inform them, in advance, that this won’t happen, but you have to act on it as well – so when Johnny comes home one day and tells you he was kicked out of class, or beat someone up, or totaled the car – you must react appropriately to the situation without losing your temper, and you must convey to him at the same time that you love him nonetheless.  Talk to your children about sex and their bodies. This process begins as early as 2 or 3 years old, when you talk to your toddlers about their bodies. We are happy to talk to our kids about their fingers and toes; how often do we name their private parts for them? From an early age they need to be given words for these body parts. Children who do not have those words do not even have a way of expressing that something has happened to them if it ever does. Some experts allow for the use of cutesy names for private parts; I believe that while they can be used most of the time, children must also be taught the proper names for their private

second and more important reason is that they will ultimately find out the real names for these parts anyway; and if it is not from their parents, they will come to understand that “we don’t talk about these things with mom and dad.” That is the very worst message you can send them. As children age, you can explain to them that certain parts (those that are covered by their bathing suit) are private, meaning that nobody else should be looking at or touching them, and they should not look at or touch anyone else’s. Explain also the difference between “good touch,” “bad touch” and “confusing touch.” Good touches make us feel good, like hugs and handshakes. Bad touches make us feel sad or scared, like pushes and punches. Confusing touches make us feel confused or embarrassed. Bad touches and confusing touches should both be shared with you right away. Eventually, in their pre-teen/ early teen years, you will teach your children about sex and intimacy more directly. There are many helpful books on the market, including Jewish ones, to help you conduct these conversations.  Make clear to your children that their body belongs to them. When I have presented this material to children in Jewish day schools and I ask who their bodies

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belong to, inevitably some of them respond with “Hashem!” That is true, I tell them, but He gave it to YOU to take care of – so your body belongs to you! Children must know that they are in control of their bodies and their personal space. You should teach them that they have the right to say no to anyone who wants to touch or get too close to them. This is more difficult than you might originally think, because moments after you have this discussion with them, Aunt Gertrude is going to stop by for a surprise visit and want to kiss your cute little kiddies. Do your children want to be kissed? Do they want to kiss Aunt Gertrude? They must be allowed to decide for themselves, and you should support them. Aunt Gertrude may be offended, but she will get over it (especially if you explain to her the reason for your position). Your children should choose whether they will hug Grandpa or not. Your children should choose whether they will hug you or not. Similarly, if you are having a good time of tickling them (which is something I heartily endorse), if one of them shouts “Stop!” – even if s/he laughing – it is imperative that you stop immediately and say, “I am stopping because you said to stop.” Children who learn that they are allowed to determine who touches them and when are in a much better position to act on that knowledge if, G-d forbid, someone should try to touch them in more inappropriate ways. Much ink has been spilled on child sexual abuse prevention, and the number of Jewish books on the subject is growing. I encourage you to begin the process now, however old your children are, of teaching them what they need to know to stay safe from sexual abuse. Certainly this is no less important to the long-term success of our children than teaching them a trade. Rabbi Raffi Bilek, LSW maintains a

private counseling practice online at www. frumcounselor.com and sees clients across the globe. He is also a speaker on issues related to domestic violence and sexual abuse in the Jewish community.


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The Inevitable and Inescapable Truth: Talking To Children About Death By Dr. Norman N. Blumenthal, PhD

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errorist attack in Toulouse…. Gunman kills children in Newtown, Connecticut…Bombs continue to fall in Southern Israel…Child abducted in Brooklyn… The news abounds with frightening and catastrophic events from which it is increasingly hard to insulate our children. Should we continue to try to protect our children from an awareness of such misfortune? If we have to resign ourselves to their finding out, how do we help them process such information without causing undue distress and worry?

teachers and child care professionals from the most parochial and segregated communities reflect a savviness and awareness among children that is unprecedented. Our role as parents and teachers is no longer that of the provider of information or the primary protector of what our children are exposed to. For better or worse,

The New Culture of Childhood

Until recent times, childhood was characterized by innocence and naiveté. The adult world largely controlled what information children were made aware of. If deemed too scary, parents and teachers could decide to insulate children from an awareness of that which is potentially destabilizing. Even if a child needed to be told, the adults filtered the information and couched it in terms that ensured the preservation of safety and sensibility. With the onset of the internet and its easily accessible information and graphic imagery, children are now more directly exposed to many of the painful realities of life without the intermediary role of an adult who can control or contain that cognitive and visual assault. As a result, the whole culture of childhood has changed. Not only do children find out all news and events, no matter how horrific, but they feel entitled to know as well. It is no longer in their psyche that there are occurrences and situations in life that only adults are privy too. They find out and demand to know as well. This change has even permeated communities that are more stringent in the accessibility to television and the computer. It is no secret that prevailing tendencies and influences of society infiltrate even the most pristine and segregated communities. Feedback from

we have been relegated to a more secondary role of clarifying that which our children have seen or heard and rectifying misconceptions. Even when we are the initial source of information, we are oftentimes in the begrudging position of having to share more facts and details than we’d prefer on the basis of an awareness that our children will find out nonetheless - and they are better off learning from us. Painful Realities in

a Safe Context

When discussing death or sharing frightening information, the goal should be to convey accuracy with a realistic sense of safety and security. The news or notification should always be couched in the perspective that death is, in the vast majority of circumstances, natural, expected and the climax of years of aging. Building an awareness that even under ideal situations, individuals age and ultimately leave this world, is no more than familiarizing a child with the painful realities of normal life. One has to look no further than the chumash and its unequivocal description of the deaths of its protagonists to be aware of the universality and inevitability of death. In the event of more catastrophic or unnatural death involving a young person, the rarity of such events should be highlighted in

conjunction with the enormity of this misfortune. The excruciatingly painful nature of such tragedy should not be sugar coated, but the immediate threat to others can be ameliorated by emphasizing the unlikelihood of its recurrence. Keep in mind, however, that children under six do not necessarily have an awareness of the magnitude of time and world population. Since their world is confined to their immediate surroundings, the word “rare” has little meaning. For such young children, we often categorically assure that such events will not recur or have impact on them or in their proximity. Before imparting or discussing tragic news, adults must make sure that they have incorporated their own personal acceptance of this loss and calamity. Children who feel scared or threatened absorb not only adults’ words, but their facial expressions, voice tones and body language as well.

Managing the Responses

For both children and adults, the full magnitude of cataclysmic news rarely sinks in right away. The recipient of such notification may be in shock or, as is often the case with children, too stunned to respond. A child may momentarily look perplexed and then resume his or her play or prior activity. It may only be later – and sometimes weeks or months later – that the full impact of this information gets internalized and absorbed. The adult should take his cue from the child. The older or more pensive child may need more immediate attention and response. Others may need their space while they acclimate to this news. The child’s age has bearing as well. Preschool-age children who do not have a developed understanding of death may respond in a nonchalant or carefree manner. The only adverse response that may occur is a fear of one of their own parents experiencing this mysterious occurrence called death and then be apart from them. School-age children possess an understanding of death and often

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seem particularly interested or preoccupied with the details surrounding the loss of life. This is particularly true when the death or injury occurred in sudden and violent catastrophes. It would not at all be uncommon if such children, especially boys, inquire more about the details surrounding the mishap than experience the sadness and horror of the death. This is typical for the age, and questions should be accurately and succinctly answered. These children are most prone to rumors, and it is imperative that the information is conveyed in an accurate fashion and consistent with that conveyed to their peers. Adolescents have a developed capacity to intimately relate to the experiences of others. Upon learning of a catastrophic event, they may more easily place themselves in the position of the deceased or his or her loved ones. The profundity of their responses can be pronounced and may occasionally even need to be contained. Children of these ages may more readily question the divine purpose or justice of a catastrophe. The inexplicable nature of such tragedy or inability to understand the actions of Hashem is within the realm of what they can understand and can be imparted to them as well.

Conclusion

The eminent and famous psychologist, Dr. Erik H. Erikson, once stated that “healthy children will not fear life if their elders have integrity enough not to fear death.” Without diminishing the pain and heartfelt emotion that accompanies the death of a loved one, the more naturally and accurately we communicate to our children this unfortunate but realistic aspect of life, the better prepared and fortified they will be if confronted with such misfortune in the future. Norman N. Blumenthal, Ph.D is a li-

censed clinical psychologist practicing in Cedarhurst, New York. He is the Director of Bereavement and Crisis Intervention Services for Chai Lifeline and the Educational Director of the Harry and Bella Wexner Kollel Elyon and Semikha Honors Program at Yeshiva University.

February 2013


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Psychlogical Treatment and the Haredi Community By Seymour Hoffman

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he attitude of ultra-orthodox rabbis toward mental health practitioners varies from outright hostility and distrust to respect and cooperation. The former generally view psychotherapists as a threat to religion and religious values, while the latter generally relate to them as colleagues in ministering to the emotional and psychological needs of people in distress. The former group, generally, is highly vocal in its condemnation and criticism and vary from temperate, cautious criticism and advice, to ridicule and outright prohibitions against seeking psychotherapists’ counsel. Rabbi Shlomo Wolbe, z”l, a prominent Israeli haredi rabbi, author and educator wrote in an article (“Psychiatry and Religion” in “In the Pathways of Medicine,” 5 Sivan, 5749 (Hebrew)), “there is an urgent need to organize courses for practicing rabbis and educators, in order to disseminate basic knowledge of the symptoms of neurosis and psychosis and their treatment, in order that they will know to refer mentally ill people immediately to the psychiatrist. Basic knowledge will remove many prejudices.” Below is an excerpt of an interview with Harav Shmuel Auerbach, about his father Rabbi Shlomo Zalman, (“From the Mouth of our Rabbis” (Bnei Brak 5768, pp. 120-121): Interviewer’s question: In the past, a letter of yours has been published in the name of Rabbi Shlomo Zalman against the treatment of Bnei Torah by psychological professionals ... There is also the phenomenon of the amateurs/charlatans (‘’chappers’’) who treat people’s souls without any know how whatsoever. What was the exact opinion of Rabbi Shlomo Zalman, and what is your opinion? Rabbi Shmuel’s reply: [He criticizes the] American style atmosphere of weakness and frailty, which is desperately frightened of suffering ... [but on the other hand] I would like you to publicize at this opportunity ... my father’s and my own clear opinion, that in a situation of a real crisis, arising from the soul within: anxieties, depressions, or any form of severe suffering, we

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are obligated, simply and clearly, to turn to the right professionals, psychologists and psychiatrists who fear G-d, and the [subsequent] sal-

make more effective and appropriate diagnoses, referrals and interventions in their clinical work. In this spirit, “Nefesh Israel”, an

“There is an urgent need to organize courses for practicing rabbis and educators, in order to disseminate basic knowledge of the symptoms of neurosis and psychosis and their treatment…” vation is in the hands of Hashem. It is severely forbidden to neglect one’s physical and mental health ... My father, himself, sent many adviceseekers to psychological help ....” Clergymen and clinicians have something of value to offer to each other. Therefore it is extremely important that both professions recognize the limits of their own professional competence and consider the benefits of working and consulting with eachother. Interdisciplinary collaboration between clergymen and mental health practitioners — especially psychotherapists — in treating emotionally disturbed patients is a rare phenomenon. One explanation for this is the relative ignorance of and unfamiliarity with each other’s field and area of concern. This tends to produce anxiety, doubt, suspicion, and mutual distrust. Bi-directional programs of education and collaboration should be developed and offered to clergymen and clinicians. By providing clergy with some basic knowledge and exposure to psychopathology and psychiatric and psychological treatment, they will develop a greater appreciation for the complexity of the human mind and psychotherapy, and will be in a better position to make more appropriate referrals and provide supportive counseling to their emotionally disordered and distressed parishioners. Likewise, a basic knowledge of religious laws, customs, values and rituals will enable psychotherapists to better appreciate the benefits of religious belief and conduct to mental health and

organization comprising orthodox and ultra-orthodox mental health professionals in Israel, sponsored the publication of two books, one in English and one in Hebrew, entitled respectively, “Case Studies of Unorthodox Therapy of Orthodox patients and “Psychotherapy of Ultra-orthodox Patients: Case Studies” (Golden Sky Books, 2012). These books contains case studies of the psychological treatment of orthodox

and ultra-orthodox patients whose presenting problems included, social phobia, religiosity, depression and obsessive-compulsive, eating and conduct disorders, amongst others. Hopefully, members of the haredi community, especially rabbis, seminary heads, arbiters and community leaders will be sufficiently curious to read of psychological treatment for people suffering from emotional, disturbances. As Leah Abramowitz, M. S. W., co-chairperson of “Nefesh Israel” stated, “Nefesh Israel is all for a positive and practical approach to change misconceptions about psychotherapy among rabbinical leaders in the haredi community through education”. Seymour Hoffman, Ph. D ., is a super-

vising psychologist at the “Chiba” Community Mental Health Clinic in Bnei Brak, Israel. He co-edited the two books books mentioned above and also ”Psychotherapy and Judaism” (Hebrew) and authored “Mental Health, Psychotherapy and Judaism”, all sponsored by”Nefesh Israel” and published by Golden Sky Books.

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Self-Esteem and True Identity By Yehuda Lieberman, LCSW-R, QCSW, DCSW

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s social beings, we often base our selfesteem on external factors in our lives, like our jobs, achievements, physical capabilities, gender, religion, race, ethnicity, as well as many others. Though these factors do not speak to true self-esteem, it is more common than not to focus on them rather than on our intrinsic attributes. As long as we feel good about a number of external factors, we are usually able to be generally happy. When someone places his focus on one particular aspect as the dominant basis for how he feels about himself, however, it often leads to problems including anxiety and depression. Sometimes this aspect is reinforced in early childhood, by parents, peers, or others influential in the child’s life. Children who are constantly told that they are smart often have trouble differentiating between being smart (recognizing that this is based on their thought process) and doing smart things, like getting good grades. Children often learn to link their actions to who they are, feeling that they are smart only because they get good grades; that they are funny only because they gets laughs; or that they are caring only because they do nice things. Religion and community can also play a strong role in identity formation. People often form a strong sense of belonging to a particular culture or way of life. While this can be a healthy part of one’s social life, if it becomes the only foundation of one’s sense of self, it can be problematic. Many people view their religion as a part of who they are. This does not represent a problem if it is seen in a descriptive sense (similar to race or gender). For instance, if I recognize myself as Jewish in a descriptive context but also clearly recognize intrinsic aspects of myself, there need be no contradiction between the two. The former refers to an extrinsic description, while the latter refers to who I am intrinsically. If, however, my entire sense of self is based around this descriptive facet of my life, this factor becomes a need without which I cannot feel positive toward myself. Many people who have no internal self-esteem hide in a group identity. Those who develop this sense of group identity in place of an individual sense of self often get caught up in the need to

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be a part of the group. If their entire identity is defined by the group, they need to continually reinforce that sense of belonging. Peer pressure is often applied, forcing the person to adapt to the ideas and beliefs of the group for fear of losing his sense of identity. In some groups, the group mentality is so overbearing that the members of the group feel threatened by any deviation from the group’s rituals. If a member of the group acts in a way that is contrary to its rigid structure, the identity of the group— and therefore of the individuals in the group—is threatened. This often results in the shunning of the offending member. Once the person is evicted from the group, the group identity seems once again safe. Once evicted, the person needs to find a new group (or other sense of identity) or face feelings of inadequacy. People who are searching for their sense of self often gravitate to this type of group (like cults) in order to achieve a sense of group identity in the absence of an individual one. On the other hand, there are times when the sense of identity is not necessarily enforced by the group but rather by the individual. I have been told by many people that they disagree with many of the beliefs and practices of the group to which they belong and that acting differently from the other members of the group would have little or no impact on their status within the group. Nonetheless, they feel incapable of changing their group behavior. When they do, they feel high levels of anxiety that only abate when they once again conform to the group. Their anxiety is not due to any external threat (e.g., being ostracized). Rather, it is due to their unconscious scrutiny of their sense of self. Beginning to identify our intrinsic attributes, then reminding ourselves to focus on who we really are, can go a long way toward changing our feelings about ourselves and leading to true happiness. Yehuda Lieberman, LCSW-R, QCSW, DCSW is a NYS licensed clinical social worker. He maintains a private practice in Brooklyn, NY, where he counsels individuals and couples. He specializes in anxiety and depressive disorders. Yehuda’s book, “Self-Esteem: A Primer” is available at Amazon.com or on his website: www.ylcsw.com. He can be contacted through his website: www.ylcsw.com, or at 718.258.5317.

February 2013


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Breeding For Succeeding:

The Teacher/Parent Relationship By Ilana Orange, LMSW

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y student’s mother is impossible!” exclaimed Mrs. Melamed to the other teachers. “Her son’s pants are always falling down an inch. I’ve been making an extra check box in red next to his homework with the word ‘belt’ to remind Mom. She fills out the rest of the homework but ignores ‘belt;’ the next day, this kid’s pants are falling down.” Ever sympathetic, the other teachers commented that you can ‘bring a horse to water but not force it to drink’. “My son’s teacher is driving me crazy,” vented Mrs. Aimbiyisroel to her friend. “Every day, this teacher sends his homework with red check boxes for me, as if I am a child. Recently, she’s been making an extra checkbox, titled ‘belt’. True; he is thin; but never needed a belt before. I work during the day and spend several hours visiting my hospitalized mother out of town. Yesterday, I traveled in the rain to buy a belt which didn’t fit properly, necessitating a return trip to the store. You’d think that according to this teacher, parents should spend all day shopping for belts,” continued Mrs. Aimbiyisroel to her sympathetic friend. What is going on? It seems that parent and teacher have not communicated directly. They don’t appreciate or trust the other’s agenda. Each did not assume that there was more to the story than what met the eye and so the child went without a belt. Fortunately, a child without a belt is not a “challenged child.” We cannot blame Teacher or Mom for being overwhelmed. However, we can learn several lessons from the above true story. Lesson One: A child succeeds more when his parent and teacher communicate well, the earlier the better. Practically, if possible, a teacher can call each parent before the year begins, introduce herself, and ask the parent for any information which would affect the child’s academic or social emotional performance. Or, if a parent is comfortable, (s)he can call the teacher with this information. The advantage here is that because both parties care deeply, the student will receive more individualized instruction. Ross Greene, in his book titled “The Explosive Child”, tells about a child whose parents and teachers discussed his specific needs and how to best meet them- in advance. However, they forgot to inform the physical education teacher, who insisted on having the child wear a jacket in 55 degree weather. After several minutes of argument between teacher and student, the child punched a hole through a window (pp. 86-87). Lesson Two: Model problem solving and role playing. Daniel, age 6.5, suffered from anxiety and hair pulling, necessitating frequent short- haircuts to prevent his hair pulling. Daniel was embarrassed to go to school looking “bald.” His therapist

February 2013

guided his parents to slowly and gently imitate Daniel’s classmates, who would ask him about his appearance. Daniel would receive a small reward every time he submitted himself to this exercise. As Daniel got more comfortable with it, and with his permission, his siblings joined the game. They made fun of his appearance while he 1- ignored them, 2-answered in a non-commital manner, or 3-laughed it off (and was rewarded every time with a chocolate sprinkle). Next, Daniel consented to have some neighbors come over and comment on his appearance. (Mom purposely selected boys who would have otherwise made fun of Daniel the following day.) Ironically, when pressed to think of something to say, the neighbors could barely come up with anything other than “Daniel, did you get a haircut?” Mom rewarded Daniel and the neighbors with a chocolate sprinkle each. After Daniel was comfortable with his appearance and bored, Mom pulled out her digital voice recorder and indicated that she had recorded all the conversations. Daniel listened delightedly and laughed, while Mom saved the recordings for the future, to repeatedly show Daniel how capable and confident he was. Mom also asked Daniel to count every incident of others “poking fun” for the next few days. Two days and ninety sprinkles later, either Daniel was cured of his anxiety or else his friends discovered that it was no fun poking fun at him. Lesson Three: Both a parent and teacher should show each other respect and appreciation from the get go, earning trust and facilitating the child’s success. During his parent initiation meeting, Rabbi Cohen acknowledged parents for entrusting their ‘diamonds’ to his care. Throughout the year, he thanked them for helping their own children with their homework, even though “evenings are really busy for everyone.” When the year was over, he humbly asked that his students keep in touch with him, because he invested so much time into their progress and cares about how they are doing. Mrs. Siegel sells professional, hand crafted jewelry. Every year, she crafts one personalized item for each of her children’s many teachers, as a gesture off appreciation, and to show her children how much she values their teachers. Lesson Four: Take care of thyself. Most of us are maxed out due to our responsibilities. We may know how to teach our children or students, but lack the time, patience, or emotional strength to put that knowledge into practice. So if you can, indulge yourself in whatever it is that makes you better at what you are doing. Lesson Five: Most importantly, pray for success; davening always helps! Ilana Orange, LMSW, is a social worker who works with parents and children in NYC. All vignettes are true stories. Mrs. Orange can be reached at challengeilana@ gmail.com or on her business line at 917.587.7356.

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& MIND, BODY SOUL

Better Late than Never By Pamela Siller, M.D.

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he phone rang once, but was ignored. However, the caller was persistent, and the pattern was repeated. Mrs. Rosen sat at the kitchen table with her head in her hands. She did not need the caller ID to tell her that her daughter’s school was calling yet again. Leah’s problems started when she was a young child. Her early tantrums were passed off as the normal “terrible two’s,” but as her behaviors escalated to throwing objects and hitting people, more people were beginning to take notice. With this came the advice; “you need to give her more attention,” “you need to give her less attention,” “you need to punish her,” “a light spank never hurt anybody,” “never raise a hand to your child.” A person could get dizzy with all the contradictions. It was much easier to just ignore the problem. Unfortunately things just got worse. Leah began to strike out at her brothers and sisters. The neighbors nervously would hear her yell and scream for hours. When she started school she did not make friends. The aggressive behaviors began to get better at school, but she began to cry and refuse to leave her mother’s side while at home. She began to wake up in the middle of the night crying uncontrollably and remember nothing about it in the morning. She began to become afraid of the dark…and loud noises… and the elevator…and the rain. She did not concentrate in school, and brought home failing grades. Ms Rosen cannot understand what went wrong. Her three other children never acted like this. She feels so guilty, like a failure, because she feels like she cannot manage to raise her own child. She loves Leah, but can’t understand her, which leads to feelings of distance from her, although she tries to hide it. Her husband assures her that she is a good mother but she does not believe this. The school has recommended therapy and medications but Ms. Rosen is reluctant wondering what this move says about her ability to be a good mother. In addition, she fears this will harm her daughter’s future shidduchim. As a last straw, Mrs. Rosen got a letter from the school asking her daughter to transfer to another school as this school was not seen to be a productive environment for her, as her behaviors were “too intense”, and “unmanageable.” The school recommended she speak with Mrs. Levy who sent her child to a psychiatrist for an evaluation, and subsequent therapy with the possibility of medications if needed. This was seen to be very helpful and productive.

Unfortunately, children are often not brought into treatment until their behaviors escalate and schools take notice, or parents find the behaviors become unmanageable. There are several reasons this occurs. It can be very difficult for parents to accept that their child is having a problem that they cannot fix themselves. Many feel a great sense of guilt, and unease, exacerbated by worries of stigma. Some parents or family members may suffer from psychiatric difficulties as well, and do not want their children to follow the same trajectory. Often parents are not exposed to the symptoms of depression and anxiety, do not know what they mean, and do not know how they can manifest in children. Children are not miniature adults. They perceive life events on their own cognitive level, which often leads them to see the world as revolving around themselves, and so any coincidence or occurrence may be seen as resulting from their behaviors or thoughts. If a child has symptoms of anxiety or depression, it may manifest as acting out behaviors or irritability. Contrarily, the same feelings can cause tears and fears in a different child, or the same child, at different time. Symptoms and behaviors may differ significantly in different environments, such as school and home, or with different caregivers, such as a parent and a grandparent. In the above example, Leah may have had difficulties with attachment, which can occur at an early age, and subsequently progress into childhood or adulthood. She may have an undiagnosed learning disorder, ADHD, or anxiety and depression, leading to night terrors and enuresis. The example was left vague, as it is difficult to diagnose a child without a careful evaluation over a period of time. Family involvement is crucial. Therapy takes time, and starts with building trust which is the cornerstone of any relationship. Sometimes medications are needed to help the person start the process of healing. The most important lesson to be learned is that often if behavioral difficulties, fears, anxieties, and traumas are addressed early, skills can be learned by both the parents and children to rectify the situation in a non-traumatic, and noninvasive way. There is no shame in seeking help; rather it can be the best gift that you can ever give your child.

“She feels so guilty, like a failure, because she feels like she cannot manage to raise her own child.”

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Pamela P. Siller, MD is a Board Certified Child, Adolescent and Adult Psychiatrist who provides medication management as well as individual and family therapy to children and adults. She maintains a private practice is in Great Neck, New York. Dr. Siller is also an Assistant Professor of Psychiatry at Westchester Medical Center, where she works in the adolescent inpatient unit, and is a staff psychiatrist at Interborough’s mental health center in Brooklyn. She can be reached at 917.841.0663.

February 2013


& MIND, BODY SOUL

Holiday Blues By Dr. Michael J. Salamon

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very industry, has its own busy season, and for mental health professionals, the holiday seasons seem to be the busiest. What is interesting is that the stressors that cause these holiday blues are not linked to any particular religious or ethnic group. All people seem to suffer increasing seasonal stress even if they do not celebrate the actual holiday. Starting from a few days before Thanksgiving until a week or so after New Years, people are generally more susceptible to and report more cases of depression and anxiety. This appears to happen in some cases because a small number of individuals are prone to a form of depression known as Seasonal Affective Disorder, which is linked to the amount of exposed sunlight. As the days grow shorter, people who suffer from this disorder become increasingly depressed and anxious. As spring and summer return, they improve rapidly. Treatment often consists of traditional psychotherapy along with exposure to a light source that mimics sunlight. Passover and Easter holiday times also see a rise in anxiety and depression so we must explore other causes. Some individuals who suffer from a form of anxiety known as Social Anxiety Disorder (also known as a Social Phobia) suffer when exposed to social situations that they find fearful not unlike family gatherings and holiday parties. Most individuals with this disorder believe that they will publicly make mistakes and be humiliated by others. The more people they are exposed, the greater the fear of embarrassment. This form of distorted thinking causes those suffering from this phobia to be afraid to eat, speak or even interact with others. And the anxiety can build for weeks before any social event and linger for months after. Treatment for this disorder which may also be linked with Obsessive-Compulsive disorder and Panic disorders includes psychotherapy and in more severe cases, medication. Other causes for holiday stress include financial concerns which are almost always worse due to the increasing expenditures that occur and the fact that holiday time is busier than usual. Unresolved family conflicts contribute to the stress of the season as well. When families get together there are expectations based on historical events that may cause people to fear how their relatives will treat them. Old arguments arise anew and immature coping mechanisms often resurface. Controlling these issues requires some insight into what a more mature response would be and avoiding old conflicts. Perhaps the greatest contribution to stress comes from a disparity in what social psychologists and cultural anthropologists refer to as ‘balanced reciprocity’. In general, when individuals give something to someone they expect something in return. In economic situations this form

February 2013

of reciprocity is obvious. If I purchase an item the seller anticipates payment in return. There is also a form of balance referred to as moral reciprocity, which is defined as the assistance or destruction people give to one another based on the perception of what they received from the other. In essence, we develop a balance that has been called “one hand washes the other.” If you help me I will help you; if you hurt me I will hurt you. The theory of reciprocity is sometimes related to expectations and not a direct exchange. A very clear example of negative expectations and how damaging reciprocity can cause serious outcomes is exemplified by the famous Midrash of Kamsa and Bar-Kamsa cited in Talmud Gittin. A wealthy man sends his servant to invite a friend, Kamsa, to a party that he will be hosting. In error, the servant invites Bar Kamsa, an enemy. At the party the wealthy man throws Bar Kamsa out despite Bar Kamsa’s three attempts to make peace and develop a new balance in the relationship. Humiliated, Bar Kamsa seeks revenge by telling Caesar that Jews will not allow him to bring an offering at the Temple. Bar Kamsa sees to it that the animal Caesar sends is slightly disfigured by him. The Rabbis decide that they cannot allow the animal to be sacrificed which angers Caesar and ultimately leads to destruction. This seemingly minor mistake by a servant that ultimately leads to the destruction of a nation is replete with important lessons. The Maharal of Prague explains the story as one of social divisiveness, a situation where individuals are barred from events even when they wish to make amends. This interpretation, not unlike a situation of negative reciprocity, a case where the expectations for censure are the expectation, helps us to understand another cause for the holiday blues. Many people have fears of attending social events and go out of their way to avoid the anxiety that attending a party causes. Many have expectations of being invited to gatherings, and when they are not, they react in a negative fashion, not quite like Bar Kamsa but not that unlike him either. The most effective way to overcome this cause for depression and anxiety is through direct communication. The most effective way to help someone cope with feeling low is by enhancing relationships without negative expectations. Not everyone can be invited to every party and it is important to be accepting when you are not. People, even those with Social Anxiety, respond well to social support, but it is important to receive this support without negative reactions. Dr. Salamon, a Fellow of the American Psychological Association, is the founder and director of the ADC Psychological Services in Hewlett, NY. His recent books include, “The Shidduch Crisis: Causes and Cures,” published by Urim Publications and “Every Pot Has a Cover: A Proven Guide to Finding,” “Keeping and Enhancing the Ideal Relationship,” published by Rowman & Littlefield and “Abuse in the Jewish Community” published by Urim.

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Advances in Minimally Invasive Heart Procedures

H

GOLDEN YEARS MEDICINE TODAY HEALTHY LIVING H&L TECH COMMUNITY PROFILE

31

way to remove those wires without surgery was through gentle pulling techniques, which sometimes caused additional complications. Now, laser lead extraction allows us to use concentrated, ultraviolet beams of light to vaporize scar tissue that has formed around the leads over time,” said Gioia Turrito, M.D., director of electrophysiology services at NYM. “It’s truly a leap forward in our ability to safely maintain all aspects of implanted cardiac devices.” According to a statement issued by the Institute for Cardiology and Cardiac Surgery at NYM, patients with heart conditions who want more information about these new, non-invasive procedures which replace the surgical scalpel with a catheter or a beam of laser light, can ask their doctor for a referral to one of NYM’s cardiac specialists, or call 866.84.HEART (866.844.3278).

WOMEN’S HEALTH

February 2013

wires (also called leads) that are attached to the heart. Like all electronic devices, a pacemaker requires some maintenance over the years to keep it functioning well. Pacemaker wires rarely need replacing, but when they do – either because of infection or malfunction – it’s a very delicate process, since the wires run all the way through the blood vesTerrence Sacchi, M.D., chief of cardiology at New York sels from the pacemaker, Methodist Hospital, performing a coronary angioplasty which is usually implantsult in shortness of breath, fatigue, ed near the left shoulder, into the heart palpitations and swelling of heart. However, a team of cardiolothe legs and feet. gists at NYM are now using lasers According to Dr. Sorin J. Brener, to remove these wires without inthe director of NYM’s cardiac cath- vasive surgery. eterization lab, “ASD is the single “Generally, scar tissue forms most common type of congenital around pacemaker wires, ‘embedheart defect.” ASD accounts for ding’ them in the heart wall and nearly ten percent of genetic heart blood vessels. Previously, the only defect cases and, until recently, open surgery was the only option to repair it. Now, the minimally invasive ASD repair procedure may be an option.” The new procedure for ASD repair involves the insertion of a catheter into a vein in the leg. An umbrella-like device then travels up the vein into the heart, and opens once it reaches the defect in the septum, plugging the “hole.” Minimally invasive ASD repair takes just two hours and only requires one night in the hospital. The patient must take a blood thinner for three months following treatment but can otherwise resume a normal life. Another new, minimally invasive surgical method now being used at NYM is called laser lead extraction (LLE). It is used to safely replace failing electrical leads connecting pacemakers to the heart while leaving the device in place, without the need for open surgery. More than 500,000 Americans currently live with an implanted cardiac device, such as a pacemaker, which helps their hearts to keep beating in a normal rhythm. Pacemakers work by delivering properly timed pulses of electricity through thin

RAISING OUR CHILDREN

eart specialists at New York Methodist Hospital (NYM) report that they are now able to routinely substitute new, minimally invasive and non-surgical procedures to treat potentially lifethreatening conditions. In many cases, non-invasive procedures, such as angioplasty and stenting, have eliminated the need for more risky open surgery, which previously had been the only way to reopen a blood vessel that has been blocked over time by an accumulation of cholesterol or fat. Instead of requiring a large, open incision, angioplasty and stenting utilize very thin tubes called catheters, which physicians can guide up the arteries directly into the affected areas of the heart to widen the blocked passageways, and to keep those passageways open. Angioplasty and stenting are now in widespread use for treating heart disease without open heart surgery, but cardiologists are now improving and extending these non-invasive techniques using new technology to treat other common cardiac problems, such as the atrial septal defect (ASD), and for the need to replace malfunctioning or infected pacemaker wires. Atrial septal defect is a congenital heart condition that results when the heart has not been properly formed before birth. In the heart of a developing fetus, blood is allowed to flow between the left and right upper chambers of the heart called atria, because the baby’s lungs are not yet developed. But the hole connecting the two atria is supposed to be closed before birth by the growth of a barrier called the interatrial septum. That permits the heart to pump oxygen-poor blood arriving at the right atria from the rest of the body to the lungs to be oxygenated and then be returned to the left atria so that it can be pumped to the rest of the body. In a patient with ASD, the septum which is supposed to separate the two atria of the heart has never closed the hole, reduc-

ing the amount of oxygen in the blood which the heart pumps to the rest of the body. This can re-

ISSUES

By Health & Living Staff

INTRODUCTION

MEDICINE TODAY


INTRODUCTION ISSUES RAISING OUR CHILDREN WOMEN’S HEALTH GOLDEN YEARS MEDICINE TODAY HEALTHY LIVING H&L TECH COMMUNITY PROFILE

MEDICINE TODAY Positions in Health Care

Pros and Cons of Becoming a Nutritionist

By Barry Katz

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f one were to ask people to name their favorite things in life, most people would probably have food and money right at the top of their lists. This might be a reason some choose to become nutritionists. According to the Boston Medical Center, 45 million Americans diet each year. Those watching their caloric intake are likely familiar with which foods are healthful and which are not. Thus, one might conclude that becoming a nutritionist (or certified as a registered dietician) is a fun and easy way to make a living. One glance at the required coursework, however, is enough to make one realize that pursuing a career in nutrition can be challenging. To earn a Bachelor of Science degree at Brooklyn College in Health and Nutrition Sciences, one

must take courses such as Health and Human Ecology, Introduction to Biostatistics for the Health Sciences, and Organic Chemistry For Health-related Professions. Each state has different standards regarding who can call themselves a nutritionist, what a nutritionist is allowed to do, and how to become certified. In New York, for instance, once one has obtained his or her undergraduate degree, one must do fieldwork and pass an exam for licensure. And as is the case with many professions, to renew certification one needs to take continuing education courses throughout one’s career. The amount of work needed to obtain a license might discourage some from pursuing a career in nutrition. Yet those who are willing to go through the process will find that nutritionists have many job options. Some work at fitness

centers, helping clients choose more healthful foods. Others are employed at hospitals or nursing homes, where they are responsible for ensuring that the patients receive proper nourishment. Additionally, nutritionists can be found at day care centers, making sure the children are eat-

However, another former nutritionist, who asked to rename anonymous, left the field because she found the salary was too low. “When I was in college I was taking all these science courses alongside pre-med students, and when I graduated, I found that the starting salaries were the same as [what]

ing properly. Some work for food companies, determining how much sodium and how many calories their items contain. Others conduct research, at times guiding public officials in their decisions to ban certain foods. Then there are dietitians who choose to do private consultation. According to the US Bureau of Labor Statistics, the median pay for a nutritionist in 2010 was $53,000 per year. Expected job growth for the next ten years is 20 percent, which is faster than average. This is perhaps due to laws that dictate strict dietician to patient ratios at health care facilities. Chanie Vizel, a registered dietitian, has worked in nursing homes and found the job to be rewarding. “It felt good knowing that you were responsible for the patients eating properly,” she said. Likewise, she enjoyed working alongside the doctors who had to approve her plans. While a number of nutritionists say they often feel disrespected by some doctors who are quick to disregard nutritionists’ recommendations, Vizel said that was not her experience. “If you like this kind of work, and given that medicine is a hot field, it’s a good career,” she concluded.

secretaries [earned],” she said. As a Women, Infants, and Children (WIC) counselor, this woman was responsible for providing lowincome families with information about healthful foods and with coupons to buy items such as milk, eggs, and bread. Inasmuch as she enjoyed the social aspect of the position, she disliked that much of the work is now done on a computer, making the communication less personal. Despite the relatively low salary for a health care professional – physician assistants, for instance, earn about $86,000 a year – Vizel still thinks the field of nutrition is a worthwhile endeavor. But, she advises, do your homework beforehand. First, look into the various options within nutrition and decide which to pursue. Then, examine the salaries so that there are no surprises. This advice is especially apt for those who think they should become nutritionists because they once lost weight on some diet.

32

Barry Katz is a college administrator

and adjunct professor who lives in Brooklyn, NY with his wife and three children. He can be contacted at iambarrykatz@ gmail.com.

February 2013


Rare Genetic Cancer Risk Factors Raise Treatment Questions

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There are many aspects to consider before deciding whether to learn about one’s personal genetic risk profile. Some individuals may decide they do not wish to know if they carry a genetic risk factor

33

Claire Davis is a certified genetic coun-

selor with years of experience consulting with families affected by hereditary cancer syndromes. She is also the assistant director of the Masters in Genetic Counseling Program at the Icahn School of Medicine at Mount Sinai. Ms. Davis is particularly interested in supporting patients’ psychosocial adaptation to risk information and teaching students to do the same.

COMMUNITY PROFILE

February 2013

Additional Considerations

H&L TECH

Key Points

individuals is a carrier of a BRCA1 or BRCA2 mutation.  Women with a BRCA1/2 mutation have a 55-85% lifetime chance to develop breast cancer and a 15-60% chance to develop ovarian cancer.  Men who have a BRCA1/2 mutation have increased chances to develop prostate and male breast cancers, and possibly other cancers.  An inherited predisposition to cancer can be managed in two ways: enhanced surveillance and prevention through prophylactic surgeries or risk-reducing medications.

Inheritance

As you may know, each person has two copies of every gene – one inherited from the mother and one from the father. An individual with a BRCA1 or BRCA2 mutation has one working copy of the gene and one nonworking copy. Each child of an individual with a BRCA1 or BRCA2 mutation has a 50% chance of inheriting the mutation from a parent. This is known as a dominant inheritance pattern. Both men and women can pass a BRCA1 or BRCA2 mutation to offspring. There are several reproductive options for individuals who are concerned about passing a mutation to future children to help manage the inheritance of this genetic predisposition.

HEALTHY LIVING

Women with a BRCA1 or BRCA2 mutation have an increased chance to develop breast, ovarian, and possibly other cancers. For example, women with a BRCA1/2 mutation have a 55-85% lifetime chance to develop breast cancer and a 15-60% chance to develop ovarian cancer. Men with a BRCA1 or BRCA2 mutation have increased chances to develop cancer, primarily prostate and male breast cancer. There are two approaches to medical management of an inherited cancer predisposition: enhanced surveillance and prevention. We recommend that a woman or man with an increased chance to develop cancer pursue rigorous, frequent cancer screening to increase the likelihood that a cancer would be detected at an early stage. Diagnosis at an early stage often allows for a better out-

MEDICINE TODAY

or medications (such as tamoxifen to reduce breast cancer risk or oral contraceptives to reduce ovarian cancer risk), may be options for women who would like to decrease their chances of developing cancer.

GOLDEN YEARS

 One in 40 Ashkenazi Jewish

MEDICAL MANAGEMENT

for cancer because the information may cause emotional or mental distress. Alternatively, learning whether one carries a BRCA1 or BRCA2 mutation may provide relief from uncertainty – a person’s risks to develop cancer may be determined based on the presence or absence of a mutation and medical care can then be tailored based on these risks. Individuals at risk can pursue enhanced cancer surveillance and prevention options, while individuals who do not carry a mutation may be spared unnecessary screenings or surgeries. We suggest that everyone considering genetic testing reflect on how they might respond to risk information and how such information might influence their medical decision-making. Genetic testing results may have significant implications for relatives, as genetic risk factors are often shared by family members and learning one’s genetic status may have implications for the genetic status of others. Furthermore, we review logistical considerations, such as the cost of testing, the extent of insurance coverage, and the possible impact of genetic information on eligibility for life insurance, long-term care coverage, and disability insurance. There is much to consider when deciding whether to pursue genetic testing for hereditary breast and ovarian cancer. Genetic counseling supports the decision-making process by providing each individual with a forum for gathering information, asking questions and airing concerns. If you are concerned about your cancer risks, we encourage you to speak with your personal physician about whether genetic counseling and genetic testing are appropriate for you.

WOMEN’S HEALTH

THE GENES

Inherited changes (mutations) in two genes, BRCA1 and BRCA2, are thought to account for a majority of hereditary breast and ovarian cancers. BRCA1 and BRCA2 are tumor suppressor genes; they usually protect cells in the body from becoming cancerous. If an individual inherits a mutation in one of these genes that prevents the gene from functioning properly, the individual has an increased chance (a predisposition) to develop cancer. Mutations in BRCA1 and BRCA2 are uncommon in the general population (1 in 400 people). However, one in 40 Ashkenazi Jewish individuals has a mutation. This increased incidence of muta-

come. Enhanced surveillance does not decrease the chance of developing cancer, but prevention can. Prevention, including riskreducing surgeries like mastectomy (removal of the breasts) or salpingo-oophorectomy (removal of the fallopian tubes and ovaries,

RAISING OUR CHILDREN

ost individuals who are diagnosed with cancer develop the disease by chance, without any known risk factor or cause. However, approximately 5% of women with breast cancer and 10% of women with ovarian cancer develop these diseases because of an inherited cancer predisposition. Genetic counseling and testing may help identify those who have an increased chance to develop cancer due to a genetic risk factor. These services provide information about inherited cancer risk and can be used to tailor medical care to an individual’s estimated risks. Individuals who have a history of cancer diagnosed at a young age, a personal history of multiple cancer diagnoses, or a family history of relatives affected with similar or related cancers are most likely to benefit from genetic counseling and testing.

tions in the Ashkenazim is due to three specific mutations in BRCA1 and BRCA2 known as founder mutations; it is thought that they originated thousands of years ago in a small group of ancestors and subsequently were passed down through the generations.

THE GENETIC FRONTIER

ISSUES

By Claire Davis

INTRODUCTION

MEDICINE TODAY


INTRODUCTION ISSUES

MEDICINE TODAY

What do Teens, Adults and Seniors Have in Common? Excessive Daytime Sleepiness By Dr. Jacques Doueck & Dr. Hal Alpert

COMMUNITY PROFILE

H&L TECH

HEALTHY LIVING

MEDICINE TODAY

GOLDEN YEARS

WOMEN’S HEALTH

RAISING OUR CHILDREN

J

oe is 65. He came to see us because he found he was unable to drive after 4 PM without falling asleep. Barbara is 17 years old and falls asleep in class or every time she watches TV. We see these types of cases all the time - nearly every day, someone will come to us for help with excessive daytime sleepiness.

Causes of excessive daytime sleepiness:

 Among Americans, a common cause is self-imposed sleep deprivation. People sleep less in order to get more done. People now sleep about 20 percent less than they did a century ago.  Sleep breathing disorders such as snoring and obstructive sleep apnea (OSA) are often associated with excessive sleepiness. OSA is a condition in which a person’s breathing keeps stopping during sleep. The airflow is stopped or limited because of a blockage. These blockages usually end with a deep breath or a choking sound. OSA leads to abnormal sleepiness during waking hours no matter how many hours a person actually spent in bed.  Medications or alcohol are another cause of excessive daytime sleepiness.  Daytime sleepiness is becoming an epidemic nationwide that affects adults, teenagers and seniors and is more serious than in sounds. Sleep deprivation is biologically similar to having impaired mental health; not only will your body break down, it’s going to have serious mental issues as well. These risks are great, yet 85% of people with excessive daytime sleepiness never get tested. With the ease of home testing, there really is no excuse as a simple, easyto-do sleep test in the comfort of your home can help you solve your daytime sleepiness. Children with behavioral problems should have a sleep test even if they say they get enough sleep. Researchers have found that factors like depression or anxiety, inattention, obesity, asthma and

trouble falling asleep were linked with excessive daytime sleepiness in these kids. A study by the Louisiana State University has shown that a possible contributor to excessive daytime sleepiness is having low levels of Vitamin D.

Risks of excessive daytime sleepiness:

Risks for adults and seniors - According to a recent Harvard Mental Health Letter, daytime sleepiness often leads to:  Increased risk of falls  Affected memory leading to mood disorders  Fogginess or inability to think clearly  Existing medical conditions made worse  Anxiety, depression and bipolar disorder Risks for children and teens - A new study of published in SLEEP shows that those with the following problems often suffer from some form of sleep problem:  Trouble paying attention at school  Obesity  Asthma  Being hyperactive  Difficulty learning and conduct problems  Attention deficit hyperactivity disorder (ADHD) Excessive daytime sleepiness should be taken seriously in teens and children. A recent Pediatrics journal article shows that kids with sleep problems -- such as sleep apnea or snoring -- have a 40 to 100 percent increased risk of ADHDlike behavioral problems. According to Dr. Simcha Y. Cohen, Psy.D, “The statistic that really raised concern for me as a mental health professional was that 85% of the population is undiagnosed. How can that be? If we have a known condition that has such direct effect on a person’s life expectancy, why aren’t people lining up to be tested?”

Driving and Excessive Dayime Sleepiness:

Combine excessive sleepiness with an automobile and a long

drive, and your risk for falling asleep behind the wheel and crashing increases significantly. In fact, 28% of American drivers have admitted to falling asleep at the wheel, according to a recent National Sleep Foundation poll, and more than half (54%) said they have driven while drowsy. “People think they can judge the precise time they are too tired and don’t realize that ‘drowsy driving’ is a serious danger,” says David Cloud of the National Sleep Foundation. “They don’t know that it’s possible to fall into a 3-4 second microsleep without realizing it. Traveling at 65 MPH, that’s enough time to travel the length of a football field basically unconscious.” Even if you manage to stay awake, sleepiness causes slower reaction times, vision impairment, lapses in judgment and delays in processing information, which are all critical elements leading to auto accidents. “Getting enough sleep can literally save your life,” adds Cloud. A recent survey conducted by the AAA Foundation found that young people are more likely to drive drowsy. Specifically, one in seven licensed drivers ages 16-24 admitted to having nodded off at least once while driving in the past year, as compared to one in ten of all licensed drivers who confessed to falling asleep behind the wheel during the same period. Young Americans are sleepy, and this affects their health and safety. About one in six deadly crashes involves a drowsy driver. A recent poll found that among those who drove, about one-half (52%) indicated that they have driven drowsy, with more than one-third (37%) doing so in the past month.

Sleep testing could save your life:

People know that they shouldn’t text or drink when they drive, but many don’t realize that driving while drowsy is also very dangerous. In this economy, more people are working longer hours and multiple jobs and getting less sleep. If you are diagnosed with a sleep dis-

34

order like obstructive sleep apnea, treatment can be life saving. Your medical insurance will cover the sleep testing and the treatment. Obstructive sleep apnea is a disorder in which breathing is briefly and repeatedly interrupted during sleep. The “apnea” in sleep apnea refers to a breathing pause that lasts at least ten seconds. Early identification and treatment can help reverse or improve many chronic diseases that are associated with sleep disorders.

Tips to help reduce excessive daytime sleepiness and sleep apnea severity:

 Get tested. A home sleep test is easy and it’s covered by your medical insurance.  Don’t push yourself to the point of cutting out precious hours of sleep. At least seven hours of sleep are needed for your body and mind to repair and refresh.  Lose weight. If you are overweight, this is the most important action you can take to cure or improve your sleep apnea.  Avoid alcohol; it causes frequent nighttime awakenings and makes the upper airway breathing muscles relax.  Quit smoking. Cigarette smoking worsens swelling in the upper airway, making apnea and snoring worse.  Sleep on your side, not on your back! Some patients with mild sleep apnea or heavy snoring have fewer breathing problems when they are lying on their sides. Dr. Jacques Doueck, DDS is a mem-

ber of the American Academy of Sleep Medicine, Academy of Dental Sleep Medicine and Academy of Minimally Invasive Biomimetic Dentistry. He is a consultant for the Dental Advisor, writes monthly articles on dentistry for Image Magazine and Community Magazine, and hosts a weekly radio show discussing various health topics on 97.5 FM, Mondays at 8PM. Dr. Doueck practices dentistry in Brooklyn, NY and can be reached at 718.339.7982. Dr. Hal Alpert is a pulmonologist and sleep medicine specialist at the New York Sleep Institute. He is a member of the New York State Society of Sleep Medicine, and the American Academy of Sleep Medicine.

February 2013


Your Snoring may be a symptom of a Serious Medical condition Snoring is no joking matter. It can lead to many problems. Chronic fatigue. Depression. High Blood pressure. Even sleep apnea – a deadly medical condition that millions of Americans don’t even know they have.

Take the first step and call for a home sleep study.

Dr. Hal Alpert is Board Certified in Sleep Medicine and Fellow of the American College of Chest Physicians. Does your spouse say “You snore” or quit breathing during sleep? • Have you ever “snorted” yourself awake? • Do you find yourself getting sleepy during the course of the day? Dr. Alpert is specially trained to help you. – by appoint at DoueckDental 563 Kings Highway. Dr. Jacques Doueck is specially trained in Dental Sleep Medicine to provide a custom dental appliance that will stop your snoring and improve your health without the need for CPAP hose and mask in many cases. For ovEr 35 yEArS FrIEnDS AnD nEIgHBorS HAvE TruSTED Dr. DouECk. CAll HIM ToDAy AnD STop SuFFErIng!

Covered by Medicare. Many medical insurance plans cover part or all of the cost of this treatment. www.DoueckDental.com (718) 339-7982 TrusT ExpEriEncE since 1977 Doueck Dental 563 Kings Highway Dr. Jacques Doueck, Am Academy dental sleep Medicine Dr. Hal Alpert, pulmonologist, sleep physician 35


FDA Monitor

ISSUES

INTRODUCTION

MEDICINE TODAY

By Ita Yankovich

H&L TECH

HEALTHY LIVING

MEDICINE TODAY

GOLDEN YEARS

WOMEN’S HEALTH

RAISING OUR CHILDREN

Approvals

COMMUNITY PROFILE

Biotech Salmon for Dinner?

The FDA approved an anti-clotting drug called Eliquis, developed by BristolMyers Squibb Co. and Pfizer Inc. The pill treats the most common type of irregular heartbeat, atrial fibrillation, in patients at risk for strokes or dangerous clots. Atrial fibrillation patients typically have been treated with the blood thinner warfarin, (sold under brands that included Coumadin), but the issue with warfarin is that users must get frequent blood tests to ensure they’re getting enough to prevent strokes but not too high a dose, which can cause dangerous internal bleeding. The FDA has also recently approved a new drug to help treat high cholesterol known as Juxtapid. The drug injections will cost $200,000 to $300,000 annually. Varzig is now approved for reducing chicken pox symptoms. While most people are immune to the virus after getting infected, this new drug helps reduce symptoms in those who do get the lifethreatening virus. Gattex is another new drug approved by the FDA to help patients suffering from short bowel syndrome (SBS) to absorb nutrients and replace intravenous nutritional support. It is administered by a once-daily injection. SBS results from the partial surgical removal of the small or large intestine due to cancer, colitis, Crohn’s disease or other conditions.

hat’s for dinner tonight? It might just be genetically engineered salmon from your local supermarket. The FDA is in the process of approving the controversial food claiming that the fish does not pose any threat to the environment and is safe for human consumption. The AquAdvantage salmon eggs are developed by AquaBounty Technology to accelerate the production of salmon eggs to meet global demand. The fish have the potential to grow to market size in half the time of conventional salmon. If this product gets final approval, it would be the first food

from a transgenic animal - one whose genome has been altered - to be approved by the FDA. Critics have pressured the FDA to reject the genetically-altered fish, asserting that the FDA has relied on outdated science and substandard methods for assessing the new fish. There were also concerns the FDA would not require the genetically modified salmon to be labeled as such.

Mylan Inc. announced a voluntary nationwide recall to the retail level of three lots of Hydrocodone Bitartrate and Acetaminophen Tablets, USP 10 mg/500 mg (Lots 3037841, 3040859 and 3042573). The three lots were manufactured by Qualitest Pharmaceuticals, and Mylan Institutional repackaged and distributed the product in unit dose (CD100) under the UDL Laboratories, Inc. The recall was initiated in Dec. due to the possibility that a small number of tablets from the affected lots may exceed the weight requirement and could exceed the label claim

potency requirements for the ingredients hydrocodone bitartrate and acetaminophen. Unintentional administration of tablets with increased acetaminophen content could result in liver toxicity, especially in patients on other acetaminophen containing medications, patients with liver dysfunction, or people who consume more than three alcoholic beverages a day. P&J TRADING is conducting a voluntary nationwide recall of the company’s dietary supplements sold under the brand name SLIMDIA REVOLUTION (there

W

The FDA has made no final decision on labeling or on the application for approval.

Recalls

is no identifying lot number). The recall was issued after testing found the SLIMDIA REVOLUTION products contain Sibutramine, an appetite suppressant that because of the risks associated with its use, should only be taken only under the direct supervision of a qualified health care professional. Sibutramine is known to substantially increase blood pressure and/or pulse rate in some patients and may present a significant risk to patients with a history of coronary artery disease, congestive heart failure, arrhythmias or stroke.

Generic Meds Cymbalta (generic name- Duloxetine), which is manufactured by Eli Lilly and Company, currently has no generic form in the U.S. Consumers can find a generic version from other countries, but there is really no way of knowing if you are getting genuine Cymbalta. Their patent expires in June 2013 so it can then become generic. Cymbalta treats various conditions such as-depression, anxiety disorder, fibromyalgia, nerve pain due to

36

diabetes, arthritis and back pain. Aciphex-(generic name Rabeprazole) can become generic in May 2013. It treats conditions such as-GERD, erosive esophagus, Duodenal ulcers, and Pathological hypersecretory conditions (such as Zollinger-Ellison syndrome). The May 2013 patent for Aciphex has already been legally challenged, and the court’s decision upheld the patent. It is possible (but unlikely) that the patent could be challenged again.

Xeloda (generic name Capecitabine) is a prescription medication used to treat breast and colorectal cancer. It is manufactured by Hoffmann-La Roche, Inc. The first patent for Xeloda expired in January 2011, but a generic version of the drug is not yet available. The next patent expires in December 2013. That is the earliest predictable date that a generic version of Xeloda could become available.

February 2013


Signs of Progress Towards an Alzheimer’s Cure

A

H&L TECH COMMUNITY PROFILE

beth, NJ and is a frequent contributor to the Jewish Press.

HEALTHY LIVING

37

Leah Rothstein is originally from Eliza-

MEDICINE TODAY

cases of Alzheimer’s, according to Dr. Paul Aisen, an Alzheimer’s researcher at the University of California, San Diego,. Dr. Sperling hopes to catch patients before they decline and use solanezumab to slow the rate of cognitive degeneration. Patients from 50 different sites will be treated with the new drug. Two other drugs are being tested in similar studies, and the results will be compared to see if any of them has a significantly stronger effect than the others. A key point of attack for researchers is the possible link be-

GOLDEN YEARS

and researcher at the CHU de Québec research center, said, “When our team started working on Alzheimer’s disease a decade ago, our goal was to develop better treatment for Alzheimer’s patients. With the discovery announced today, I think we’re close to our objective.” Dr. Rivest’s team is not the only source of hopeful news on the Alzheimer’s front. Dr. Reisa Sperling, director of the Alzheimer’s center at Brigham and Women’s Hospital in Boston, is helping to lead a federally funded study to test whether a drug called solanezumab can prevent Alzheimer’s.

tween Alzheimer’s and diabetes, as indicated by some studies. Reports coming in from long-term study in Hisayama, Japan, showed that diabetes patients had a 74% increased risk of dementia. Patients with high glucose levels similar to a pre-diabetes state had a 35% higher risk. It’s one thing to discover a statistical link between the two diseases,, but another thing altogether to work out the biological mechanisms responsible for the connection. A Salk Institute study of protein accumulations in the brains of diabetic mice has helped to clarify the mechanisms that link the two diseases and to provide a closer look at their causes. Pamela Maher, a senior staff scientist in Salk’s Laboratory of Cellular Neurobiology, reported that the study showed that type 1 diabetes “increases vascular-associated amyloid beta buildup in the brain and causes accelerated brain aging.” We know that Alzheimer’s brain plaques inhibit the transfer of nutrients from the blood to the brain, affecting brain function. Low insulin levels in the brain can weaken brain activity, and lead to impaired cognition and other symptoms. Insulin resistance has been implicated in the formation of plaques. Other studies have looked at specific, individualized characteristics of Alzheimer’s. Some research groups have made progress looking at gender differences in the effects of the disease, offering the hope that more customized treatments can target patient’s problems more effectively. Another approach is to look at environmental factors for the patients, and helping caregivers take positive steps in improving the patient’s ability to cope. The cure may not be around the corner, but each small step is gradually bringing improvements, and the research is starting to look more hopeful for both treatments and prevention.

WOMEN’S HEALTH

February 2013

There have been major improvements in recent years in our ability to scan brains to detect plaque formation, even before any symptoms appear. This enables studies to be done on brains that are not yet damaged, where the drugs have the best chance of stopping the plaques before they get a chance to grow larger. Initial trials of solanezumab showed that it had its best effects on people with mild to moderate

RAISING OUR CHILDREN

lzheimer’s disease, a degenerative dementia, is sixth among the leading causes of deaths in America. It affects 5.4 million Americans, with estimated annual health care costs of $200 billion, according to the Alzheimer’s Association. The toll the disease takes on caregivers and family members multiplies the impact of the disease exponentially- an estimated 15 million Americans are caring for someone with Alzheimer’s or related forms of dementia. There are drugs available that help treat some of the cognitive symptoms of Alzheimer’s, but a cure has yet to be discovered. Researchers are working hard to attack the problem, and have recently reported a number of important developments that hold signs of promise. A team of Canadian researchers worked with pharmaceutical company GlaxoSmithKline to attack Alzheimer’s by using the brain’s own immune system. In January, the scientists reported that they’d found a way to stimulate natural defense mechanisms in the brains of people with Alzheimer’s. This breakthrough may lead to new treatments, and possibly even a vaccine that can prevent the illness. Alzheimer’s disease is characterized by amyloid beta proteins building up in the brain and forming plaques. The microglial cells that defend the nervous system are unable to destroy the plaques. The Canadian team located a molecule that stimulates the brain’s immune cells, called MPL (monophosphoryl lipid A). MPL has been used in the past as a vaccine adjuvant, aiding vaccines in activating immune responses, and has been proven to be safe for use. The researchers hope that their discovery will be put to use in slowing and preventing the disease. Giving MPL as an intramuscular injection could slow the progression of Alzheimer’s in those who already have it, by increasing their immune system’s ability to

resist. It could also be developed into a vaccine to be given to people with risk factors of Alzheimer’s, as a preventative measure. The study examined mice treated with MPL injections over 12 weeks. They lost up to 80% of the plaques. The mice showed improvement in cognitive function and were able to learn new tasks more quickly. Dr. Serge Rivest, professor at Université Laval’s Faculty of Medicine

ISSUES

By Leah Rothstein

INTRODUCTION

MEDICINE TODAY


INTRODUCTION ISSUES RAISING OUR CHILDREN WOMEN’S HEALTH GOLDEN YEARS MEDICINE TODAY HEALTHY LIVING H&L TECH COMMUNITY PROFILE

HEALTHY LIVING

Israeli Doctors Discover Life-Saving Properties in the Pomegranate By Anna Harwood

S

itting at his desk with a panoramic view across the Haifa bay, Professor Michael Aviram greets me with a warm smile. Professor Aviram is a distinguished scientist who has been revolutionizing cardiovascular medicine in his 32 years at Rambam hospital and on the Technion Faculty. He is both senior vice dean of the Technion-Rappaport Faculty of Medicine (which includes the prestigious Technion American Medical School,TeAMS) and also the Director of the Clinical Research Institute at Rambam. Professor Aviram has written and published over 450 original scientific papers and is widely cited in international journals. Each year, Rambam hospital launches around 500 new research

projects and has achieved medical breakthroughs directly benefitting many of the tens of thousands of patients that they treat each year. Close to 300 of the clinicians at Rambam are also on the teaching faculty at the Technion-Rappaport Faculty of Medicine. These two heavyweights in medical research frequently combine forces to develop groundbreaking medical advances and to train the budding doctors who will implement this medicine of the future both in Israel and the USA.

Aviram’s first research finding was that the type of cholesterol was very significant. No longer was the level of blood cholesterol the only factor in determining the risk of atherosclerosis. What was more important was determining whether it was good blood cho-

Preventing Heart Attack and Stroke

Professor Aviram’s chief area of research is the investigation of LDL (“bad cholesterol”) and its formation to cause atherosclerosis (thickening and hardening of the arteries), which leads to heart attacks and strokes.

lesterol (HDL) or bad blood cholesterol (LDL) and also, whether it was oxidized or not. “Blood cholesterol, either in HDL or in LDL, can be in its native form or it can also be oxidized cholesterol,” explained Professor Aviram. “Oxidation occurs through everyday exposure to chemicals such as smoke and pollution, radiation, viruses and bacteria. These oxidized cholesterol molecules are extremely harmful to the arteries.”

cal molecules. “Most of the antioxidants that I found were present in the skin of the fruit” said Professor Aviram, “with the most cardio-protective foods being pomegranate, red wine and olive oil”. Finding the health benefits of red wine has been a satisfying discovery for wine drinkers worldwide. The deep red coloring of the wine results from the grape skin which also contains powerful antioxidant qualities. A glass of red wine at meal times has been demonstrated to reduce the levels of oxidized bad cholesterol in the bloodstream and thus the potential for developing atherosclerosis. Next on the research agenda was pomegranate juice. When Professor Aviram’s team gave patients with atherosclerosis a glass of pomegranate juice to drink each day, the dangerous buildup in the artery walls was decreased by a massive 30% after just one year. In patients who didn’t drink the pomegranate juice, average buildup increased by 10%.

Natural Protection

“Once we had discovered the major effect of cholesterol oxidation, it was clear that there must

Lifesaving fruits

Discovering cholesterol oxidization led Professor Aviram to look for antioxidants, molecules that block the oxidation of cholesterol and other fats. He studied over 100 different fruits, vegetables, beverages and wines to find the health benefits of these magi-

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February 2013


Anna Harwood made aliya to Israel

GOLDEN YEARS

two years ago from London, England. She writes for the Jewish and international press about issues pertaining to Israel, ranging from scientific breakthroughs to award-winning wines.

WOMEN’S HEALTH

with Professor Aviram has been American medical student John Ward from Michigan. John is part of the Technion American Medical School which matches their students with top scientists to collaborate on their MD research projects. “I’ve worked in many labs prior to commencing my medical studies but none have even come close to working with Professor Aviram,” enthused Ward. “Simply amazing! During my research I studied the cells which ‘eat’ cholesterol and eventually was able to publish my research in a leading medical journal.” Performing research at such a high level enables the doctors of

RAISING OUR CHILDREN

be an additional mechanism in the body which naturally protects against this oxidative stress, as not everyone goes on to develop dangerous levels of oxidized bad cholesterol and not everyone drinks pomegranate juice each day,” explained Professor Aviram. His third area of research looks

at how oxidized cholesterol can be broken down and atherosclerosis development can be reversed, and the results so far have been very promising. He and his team discovered a protective enzyme, paraoxonase (PON) which is attached to blood HDL and is responsible for breaking down oxidized bad cholesterol. Furthermore, they also discovered that pomegranate juice activates PON production. Thus, pomegranate juice not only blocks cholesterol oxidation, but at the same time also stimulates PON activity, reversing the atherosclerosis-causing effects of oxidized bad cholesterol. Working on the PON research

the future to fully understand the anatomy of the diseases they are learning to treat. Professor Aviram embraces this task, supporting his students and tailoring projects for them to maximize the benefit for their medical studies. Professor Aviram and his team in Haifa are rapidly progressing with their research and believe that the future of cardiovascular medicine looks promising. Hopefully, within the next few years, they will have developed a simpler method for detecting “bad cholesterol” and discover new ways to exploit the beneficial natural properties of the pomegranate, red wine and olive oil.

ISSUES

“Most of the antioxidants that I found were present in the skin of the fruit, with the most cardio-protective foods being pomegranate, red wine and olive oil.”

INTRODUCTION

HEALTHY LIVING

MEDICINE TODAY HEALTHY LIVING H&L TECH

39

COMMUNITY PROFILE

February 2013


INTRODUCTION ISSUES RAISING OUR CHILDREN WOMEN’S HEALTH GOLDEN YEARS MEDICINE TODAY HEALTHY LIVING H&L TECH COMMUNITY PROFILE

HEALTHY LIVING

Unraveling the Mystery of the French Paradox By Sheryl Mayer, MS, RD, CDN

C

roissants, butter, and cheese, oh my! Most dietitians would agree that consuming high percentages of dairy fat is the enemy of a healthy heart. However, in France, it is common for bread, cheese and butter to be meal staples. The term “French Paradox” was coined by French scientist, Serge Renaud, to describe this ironic observation of low incidences of coronary heart disease in French people despite diets of high saturated fat and cholesterol. How is it possible for French people to eat full-fat cheese, croissants with butter, breads and wine without suffering from obesity or high incidences of cardiovascular disease (CVD) induced mortality? Following are two theories to explain this paradox: The first answer may lie in the attitude that the French people have towards eating behaviors. While American culture has glorified the “supersize it” mentality, French culture serves small portions that are presented beautifully. French meals are lingered over and have time set aside for, encouraging eating for pleasure which ultimately leads to higher satisfaction from food. In contrast, American meals are typically casual, mindless and “on the go,” never really leading to satiety. While snacking is a multi-million dollar industry in the United States, French culture keeps snacking to a minimum and there are far fewer packaged and processed snacks in French supermarkets. Fat-free and low fat snacks (i.e. fat-free ice cream and cakes) are very popular in the US for weight control, where additional sugar is added to foods to compensate for the lower fat content. In France, full-fat foods without added sugar are consumed in moderate amounts. Besides being more conscious of portion sizes, the French also are aware that if a large meal is consumed, the other meals are kept lighter. So if a typical French meal of soup, bread and cheese is had for lunch,

breakfast and dinner plans are kept light for balance. Red wine is another staple in French culture. Wine drinking was never promoted for good health before a documentary in 1991 on “60 Minutes” popularized the hypothesis that the longevity patterns in France may actually be attrib-

life spans in mice in several studies, a study in 2003 concluded that the amount of resveratrol absorbed from drinking wine is minimal and not enough to be solely responsible for lower CVD incidence. Research also isolated antioxidants, such as polyphenols, which are also found in French red wines,

However, it is an error to conclude that saturated fat intake is the primary predictor of CVD risk. It is just one of many nutritional factors. It is also erroneous to propose that drinking a few glasses of red wine is all you need to make a bad diet right. Looking at the whole picture shows that the bal-

uted to the regular consumption of red wine by the French. The popularization of this theory led to a large increase in the sale of imported and domestic red wine. Public interest in the French Paradox after this show was broadcast inspired many scientific studies hoping to link compounds in red wine to a lower risk of CVD. Resveratrol is one component that was believed to explain the health benefits of drinking red wine. Studies have found that it protects the arterial vessels from oxidative damage, reduces LDL (“bad” cholesterol) and plays a role in preventing blood clots. While high doses of resveratrol (in capsule form) have been linked to longer

that may be protective of the heart by increasing HDL (“good” cholesterol) and protecting against the buildup of athersclerotic plaque. These polyphenols are absorbed adequately in the body and can help in protecting the heart when combined with a healthy diet. Remember that research is only suggestive and not conclusive of the cardioprotective effects of wine. That being known, wine should always be consumed with food, red wine is preferred over white, and wine drinking (only in moderate amounts) should only be done by otherwise healthy individuals without any pre-existing medical conditions. The theories trying to explain the paradox may be confusing.

ance is more significant than any one component in ensuring good health and preventing disease. You can have your cheese and eat it too, but just compensate with some extra fruit and vegetables. So let’s make a L’chaim with a glass of good red wine and remember the adage that our grandmothers have taught us: “Everything in moderation.” Eat a little, drink a little and be b’simcha. Wishing all my readers and clients a very Freilichin Purim.

40

Sheryl Mayer, MS, RD, CDN is a registered dietitian with an M.S. in Health and Nutrition. To make an appointment or to suggest ideas for future articles, please call 347.850.3438 or email her at SherylMayer.RD@gmail.com.

February 2013


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February 2013


INTRODUCTION ISSUES RAISING OUR CHILDREN WOMEN’S HEALTH

The Alternative Way By Esther Hornstein, L.Ac., Dipl.

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ears ago when I was an acupuncture student, I was chatting about the fascinating treatments that I was learning about at the Shabbas table. I described a technique of putting an alcoholdrenched, lit cotton ball quickly into a glass cup, pulling out the cotton ball (which was still on fire) and putting the cup quickly on the skin, making a suction-cup action. My grandmother, A’H, piped up and said, “Oh, that’s bankes!” Bankes? We called it cupping, but apparently in Eastern Europe it was referred to as bankes. My grandmother went on to tell me that her mother and grandmother would do bankes to treat pneumonia. Plus, she still had her mother’s cups. (Yes, she gave them to me and I use them all the time!)

Cupping Therapy: An International Treatment Cupping is also known as bentusa, vendouse, gac hoi, bahnkes, kyukaku, kupa cekme and bankovani. The exact geographic origin of cupping is unclear. Records and traditions indicate that cupping is a healing method that is and was used in numerous countries from Japan to Greece to Venezuela. In earlier centuries, cups were fashioned out of bamboo, nut shells, hollowed-out animal horns, earthenware and so on. This suction technique was used to purge poison from snake and insect bites, clear out infectious flesh and even to balance emotions. Today, glass cups are widely used. The industry is introducing silicon cups and plastic cups that use suction valves instead of fire. Licensed acupuncturists and other practitioners use cupping for a whole host of issues:  Deep tissue massage and

After you’ve saved lives under rocket fire, treating patients in a storm goes without saying.

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This month, Israel suffered almost unprecedented rain, flooding, and snow. And while many of our 180 rapid-response motorbikes were sidelined by weather, our 900 ambulances were out in force, treating people for weather-related injuries, saving heart attack victims, and delivering babies in transit. Because after risking personal safety to treat the injured amid rocket attacks just a few months ago, what’s a little inclement weather? Support the heroic men and women of Magen David Adom. 352 Seventh Avenue, Suite 400 New York, NY 10001 866.632.2763 • northeast@afmda.org www.afmda.org

myofascial release to relieve muscle tightness  Lymphatic drainage to increase immunity and eliminate edema  Sprains and inuries  Fibromyalgia  Cough and lung congestion, especially for children  Detoxifcation after medication, anesthesia and harmful substances  Chronic conditions and pain  Rejuvenate skin and clear wrinkles, cellulite, scars, stretch marks and varicose veins  Temporalmandibular Joint disorder Cupping is administered most commonly on the back and neck for detox. It can be used on any part of the body, depending on the complaint or area of injury. Special narrow, low-pressure cups are used on the face for scar reduction and facial rejuvenation.

The healing mechanism of cupping is the circulation that is jumpstarted by sucking up the skin. The compressed skin forces the blood to move in the muscles beneath the skin and results in a filtering of toxins from the tissues, as well as softening tight muscles. Once removed, the cups usually leave round marks that vary in color

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from pink to dark purple/red. The shade of darkness left by the cup shows how much stagnation or “sha” was released from the tissues. Darker marks indicate that those areas had a lot of blockage freed from the skin or muscle. Lighter marks show that there was not too much loosened, or perhaps, that there is not much stagnation to move. A red/purple bruise is the most common side effect from cupping. These bruises look painful, but actually the patient does not feel pain during the treatment or after. Sight pressure or tightness is felt wherever the cups are placed. The level of suction can be altered, so if the patient is uncomfortable, the level of suction can be reduced. Practitioners should instruct patients to keep the cupped area covered as much as possible after cupping. By releasing toxicity from the skin and opening the pores, the area is vulnerable to “wind invasion,” which is the traditional Chinese medical term for a cold or windy draft entering the body. “Wind invasion” can cause a person to catch a cold or be susceptible to flu. Making sure that the cupped (or bruised) area is covered will ensure the patient stays healthy. For this reason, one should avoid bathing or swimming immediately after cupping. For 2-3 days after cupping, be sure to get dry, warm, and covered as soon as possible after bathing. Cupping is a safe alternative treatment for wellbeing and health. Esther Hornstein is a New York State

licensed acupuncturist. Her Brooklynbased private practice emphasizes personal attention and effective and gentle methods for wellness. Questions and comments can be sent to Acupuncturesther@gmail. com or visit www.2ndNatureAcu.com.

February 2013


Top 8 Facts About... An Egg-Citing Journey from the Hen to Your Frying Pan

ISSUES

By Leah Lebel, MS, CNC

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The Scoop on Egg Labels

Did You Know?

An average hen typically lays about an egg a day, but some hens can lay up to four eggs a day--that’s over 1000 eggs a year! Factories work to try and maximize the number of eggs the chickens lay, which can vary because chickens tend to lay very few eggs at some points during the year, especially in the winter. In order to keep the number of eggs produced the same, the hen house is temperature controlled and uses florescent lights which usually shine for about 15 hours a day. In addition, chickens are fed a calcium-rich diet because this makes for stronger eggshells (eggshells are made out of calcium).

 Did You Ever Wonder How Eggs Don’t

Hens are kept in factory cages that are slanted, so the eggs roll automatically onto a slow-moving conveyer belt and then are gently slid to the packaging plant. There they are cleaned, disinfected, graded, sized, and stamped. While the eggs move along a conveyer belt, workers remove any eggs that are cracked, and lights are used to check inside each egg for any visible spots of blood.

 Have You Heard of Peewee-Size Eggs? You may have seen small, medium, extra-large or even jumbo eggs in supermarkets, but there’s also an egg size known as peewee size - smaller than an ounce and a half each. The older a hen gets, the bigger the egg she lays. Eggs are also graded on a quality scale of AA (highest) to restricted (lowest). Only Grade AA and Grade A eggs are sold in supermarkets, while Grade B and below are generally used by factories that process them for things like egg powder and in products like cake and mayonnaise.

A Goldmine of Nutrients

The USDA recommends: Only buy eggs that have intact shells, and never buy eggs that are beyond the sell-by date that’s stamped on the carton. Use pasteurized eggs in recipes that call for raw eggs, and otherwise only eat eggs that are thoroughly cooked, poached, boiled, or otherwise prepared.

Sources:

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www.uspoultry.org www.aeb.org

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www.fsis.usda.gov/FACTSheets/ Egg_Products_Preparation_Fact_ Sheets/index.asp

Leah Lebel holds a master’s degree in nutrition from Brooklyn College. She can be contacted at leah_lebel@yahoo.com.

February 2013

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At only 80 calories in a large egg (65 calories in the yolk and 15 in the white), eggs are a nutritional goldmine. Eggs are a rich source of protein, and contain vitamins A, B6, B12, D, E, riboflavin and folic acid as well as choline, iron, calcium, phosphorus and potassium and even coenzyme Q10. The lutein in eggs also makes them excellent for eye-health. Most of the vitamins, protein, fat and all the cholesterol in eggs are found in the yolk, even though the yolk only makes up about a third of the weight of the egg. Interestingly, the diets of chickens can greatly impact the nutritional quality of the egg. Thus, eggs that are high in omega-3 fatty acids are usually produced by feeding the chickens large quantities of flax seeds and other foods rich in omega-3.

USDA Egg Safety Tips

HEALTHY LIVING

A brown egg is functionally and nutritionally identical to a white egg and even looks the same when cracked open. The difference in color is determined by the color of the actual hen. Brown hens lay brown eggs, while white hens lay white eggs. This might come as a surprise, considering that brown eggs usually cost more than white eggs.

MEDICINE TODAY

Brown or White – What’s the Difference?

GOLDEN YEARS

According to the USDA, raw eggs that are refrigerated at 40 degrees or below will last 3-5 weeks. Once the eggs are cooked, however, refrigeration shelf life decreases to a one-week maximum. Cooked eggs should not be left outside the refrigerator for more than two hours. The easiest way to tell if an egg is fresh is to look at the shell. Fresh eggs have a rough surface, while spoiled eggs are smooth. Another way is to immerse the egg in a pan of cold, salted water. If an egg sinks, it’s fresh, but if it floats, it’s spoiled. Old eggs develop bacteria which produces gas, causing an old egg to float.

Break During the Packaging Process?

Safe Storage

WOMEN’S HEALTH

Typical eggs are produced from chickens that are kept in battery cages. Cage-free eggs, as their name implies, are produced from chickens that are not kept in cages. Notice they may still be kept indoors all day; they just aren’t caged up. Free-range eggs are produced from chickens that are given the opportunity to go outside for some unspecified amount of time. Organic eggs may or may not be kept in cages, but are given organic food and don’t receive any vaccinations, hormones or antibiotics that other chickens may get to maximize the number of eggs they produce.

RAISING OUR CHILDREN

eyond the factory, the grocery, and the fridge, eggs can wind up in, well, egg-citing places. They can be hidden anywhere from fried chicken dishes to ice cream to even shampoo, and can be consumed for breakfast, lunch or supper in a variety of ways. Eggs are the eighth most common food eaten worldwide and the US alone produces roughly 75 billion eggs every year. With so many versatile, delicious, and healthful ways to prepare them, they provide just another reason to get cracking and chow down on the incredible, edible egg.

INTRODUCTION

HEALTHY LIVING


INTRODUCTION ISSUES

HEALTHY LIVING Trim & & &Fit

By Tanya Rosen

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RAISING OUR CHILDREN

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t’s the husband who is so happy his wife is on a diet but brings her cake, the friend who tells you your face is getting too skinny, the woman next to you at the wedding who keeps staring at your uneaten plate… Sound familiar? These people all fit into the category of what I call “diet sabotagers.” They are (well-meaning?) strangers, or non-strangers, who sabotage your efforts and progress. Working with women, I hear about this on a daily basis. One client told me how she was sitting on the couch on Thursday night feeling so accomplished over how good she had been on her diet plan all week, when her husband walked in with her favorite danish. She started to tell her husband that she is on a diet and he is making it difficult for her, but was interrupted by the look of hurt and disappointment in his eyes. He felt personally insulted that she was trying the “kind gesture” he had made. Not wanting to disappoint, she had the danish (not a taste, the entire thing), which led her to continue to cheat more throughout the weekend. Now you may be thinking that this man is such a nice spouse and should be only praised, but I disagree. This husband actually encouraged his wife to start a diet plan and had made several remarks in the past about her weight. If he wanted to show that he cares, flowers or giving her time to herself would have done the job. Often these counterproductive comments come from other women. One comment I have heard came from a Mikvah lady who told my client that she is losing too much weight for her own good. Other examples are people at a wedding or public function asking you why you are not eating, or why all you are eating is salad. What amazes me is that these same people would not say a word if you were piling your plate with too much food, or only eating breads and cakes. These same people do not say a word when

Diet Sabotagers … The “Non-Food” Kind they notice you are gaining weight or that your clothing is getting tight. Yet when it’s the other way around, everyone has assumed permission to speak their minds, unfiltered and unasked for! One interesting comment came from my client’s sister, who told her that she better stop losing so much

jealous of what they do not have and will make negative comments to make themselves feel better. Going back to the gender difference, women also care more than men about what people think of them. That is another quality we women are blessed with, the eagerto-please part of us. My client told

weight because her face is going to get saggy and she will need Botox. Mind you, this woman is only 28 - her main concern should be continuing to lose weight, not worrying about Botox! It is interesting to note that men do not get the same comments as women. When a man is on a diet, he is respected and catered to, and is seen as someone with self-control. His wife will cook healthier for him, he will get special dishes made for him at events or family gatherings, and overall he is admired for it. I think a lot of this has to do with jealousy amongst women. Although we hate to admit it, women are and always will be a jealous species. Yes, we may be happy for our friend/sister etc. but we are also jealous. The first question I ask my clients when I hear these stories is whether the person making the comment was heavy. The answer is almost always a “yes.” What if the comment comes from someone who is thin? Many thin people do not feel as in-control as a heavier person that is dieting and IS in-control. People get

me that she was at work counting out the 20 almonds that I allow her for a snack, when she noticed a coworker looking at her. She automatically stopped and put away the bag, not touching it all day because she was afraid her coworker would ask about it. Another reason why people make diet sabotaging comments is their inner fear that you will now judge their food behavior and habits. It’s like two friends who always gossip together. One friend decides to change his ways and stop gossipping. Although his friend is internally happy for him and wishes the same willpower on himself, he feels judged now, and is afraid of how the relationship will change. I personally live and breathe nutrition and fitness, but guess what? I do not judge the people I am eating with. I actually do not even notice half the time what is on the other person’s plate! Most dieters are so self-absorbed and focused on their own food that they are probably not judging others around them. A third reason why people make comments is because they are

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afraid. They are afraid that if you finally lose the weight and become a thin person, you will also be a different person. This is a partially plausible fear. Some people really do change when they lose a lot of weight. Some become more confident. Some become more “obsessed” with their gym routine and meal plans. Some decide that they like to do other things besides ice cream store trips or going out to eat. These changes can be threatening to the people they are close to. I have a client whose husband begged her to lose the 70 pounds she had gained since they got married. At the end of her journey, she was down those 70 pounds plus another 15. She looked better than she had at her wedding. All of a sudden, her husband began saying she is too thin, looks “too young,” and that she was more fun when she was heavy,. He was also unhappy with her running out every night to an exercise class -- nights were when they used to sit and munch on junk. How to handle these comments and sabotages depends on who it is coming from. If it’s a stranger, you can politely smile and change the topic or your seat. However, if it is a close friend or family member, I suggest having an open discussion. Do not accuse him/her of being jealous, just make it about YOU. Tell her that YOU need to do this for yourself, and that YOU need as much support and as few comments and observations as possible during this process. If the person does not stop, try not to let it get to you. Realize that you are doing what’s best for you and stick to it. You will hopefully find support elsewhere, such as your gym, your trainer, your nutritionist, or a fellow dieter. Tanya Rosen is the co-owner of Shape

Fitness in Flatbush. Tanya is a certified nutritionist, personal trainer, and aerobics instructor, and is the creator of the SHAPE FITNESS KOSHER WORKOUTS DVD, available in Judaica stores or online at www.shapefitnessgym.com. She can be reached at tanyashape@gmail.com.

February 2013


Fit and Fab for 2013: All About Quinoa

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Chickpea Cauliflower Stew

ho says eating vegan has to be boring? This creamy dish is full of flavor and will please even a meat lover’s belly. Serve it over quinoa with a crisp garden salad and some crusty garlic bread.

Warm Mushroom Quinoa Salad

Directions: Place the quinoa and broth in a pot. Bring to a boil then simmer until liquid is absorbed. Mean-

February 2013

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Ingredients: 1 cup of uncooked quinoa 2 cups of vegetable broth or water 1 package of mushrooms, wiped clean and sliced 1 tablespoon margarine

while, sauté the sliced mushrooms in the margarine until tender. Add the soy sauce to the mushrooms and continue to cook until soft. Place the lettuce in a large serving bowl. Add the tomatoes and diced avocado, cooked mushrooms and prepared quinoa. Combine the balsamic vinegar and brown sugar in a small container with a lid and shake well. Dress the salad before serving.

Directions:  Place quinoa and broth in a pot, bring to a boil, then lower flame and simmer until liquid is absorbed. Fluff with fork, then set aside.  Heat up 1 tablespoon of olive oil in a large frying pan. Sauté onions until golden. Add tomatoes and cook until tender. Add chickpeas and black olives and cook for several minutes. Remove from heat.  Place cooked quinoa in a large bowl or serving platter.  Add tomato mixture on top.  Top with crumbled feta  Drizzle olive oil on top of salad.  Squeeze lemon and season with salt and pepper on salad.

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1 teaspoon soy sauce 1 box of cherry tomatoes, cut in half 1 head of lettuce cut up (or pre-cut bag; i used a blend of radicchio lettuce) 2 avocados, diced 2 tablespoons balsamic vinegar  1 tablespoon brown sugar

Ingredients: 1 cup of quinoa, uncooked 2 cups of vegetable broth or water 1 onion, diced 3 tomatoes, diced 1/4 cup of chickpeas 1/4 cup of black olives 1/2 cup of crumbled feta olive oil 1 lemon salt and pepper to taste

HEALTHY LIVING

y friend Chaya Mink is a wonderful cook. She enjoys a good meal as much as I do, which means when we get together it’s all about eating good grub. She recently had me over for a dinner party and served this salad. It’s a great winter salad featuring some of my favorite ingredients: avocado, mushrooms and quinoa!  

Greek Quinoa Salad

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Directions: Combine quinoa and broth in pot. Bring to a boil then cover and simmer on a low flame until water is absorbed. Remove from heat and

fluff with a fork. While the quinoa is cooking, heat up olive oil in a large pan. Add onions and sauté until tender. Add cauliflower to the pan and cook several minutes until slightly toasty. Add the chickpeas and season with spices. Add the crushed tomatoes and mix well. Add the coconut milk and combine well. Simmer on a low flame for 10 minutes. Serve over quinoa and add cashews before serving.

ing recipes for www.kosherinthekitch.com. Everything is fresh, fast and TASTY! Sign up for weekly pre-planned dinner menus with shopping lists by going to www.kosherinthekitch.com.

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Ingredients: 2 cups of quinoa, uncooked 4 cups of vegetable broth or water 1 tablespoon of olive oil 1 onion, diced 2 cloves of garlic, diced 1 head of cauliflower, washed, rinsed and broken into pieces 1 can of chickpeas 1 tsp. black pepper

1 tsp. salt 1 1/2 tsp. ginger powder 1 tsp. turmeric 1 can of crushed tomatoes (i use 6 oz) 1 can of coconut milk 1 cup of cashews

Nina Safar likes to whip up great tast-

WOMEN’S HEALTH

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for texture, or make a hearty salad with it. Try out these tasty quinoa recipes for a  fit  and fabulous new you! Be sure to check out kosherinthekitch.com for more great tasting recipes and easy menu ideas!

RAISING OUR CHILDREN

t’s 2013 and if you want to stick to your New Year’s resolution to get  fit  and fab, quinoa is going to be your new best friend! It’s just as satisfying as carbs, but it’s packed

with protein and nine essential amino acids. It’s gluten free and easy to digest, making it great for a healthy diet. You can do just about everything with quinoa. Stuff mushrooms and chicken with it, add it to your favorite soup or stew

ISSUES

By Nina Safar

INTRODUCTION

HEALTHY LIVING


INTRODUCTION ISSUES RAISING OUR CHILDREN WOMEN’S HEALTH GOLDEN YEARS MEDICINE TODAY HEALTHY LIVING H&L TECH COMMUNITY PROFILE

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Ipad Apps for Healthier Living By Aaron Friedman

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hatever you think of Apple and its constellation of devices - the iPhone, iPod Touch, iPad, iPod Nano, and its traditional desktop and laptop offerings, it can’t be denied that they are all hugely popular and well-made. There is truly an incredible number of applications available in the iTunes Store (close to a million apps, as of this writing), and they are varied enough to cater to most tastes and needs. This article will focus on a small subset of apps: those that can help you live a more healthy life. The iPad is well-suited to helping you live a healthy life. The apps discussed below can help you keep track of your daily calorie intake and exercise, track symptoms if you’re sick, inform you about drug side effects and interactions, and more. The iPad’s utility will increase as more apps are developed. Eventually, one of its successors may become the equivalent of Star Trek’s tricorder - wave it over a patient and get a full medical workup. In the meantime, the following 10 apps can help you (or your doctor) keep you fit and healthy. Remember that an app is never a substitute for a real doctor. If you have any concerns about your health, speak to your doctor as always.  MyFitnessPal (free) is your go-to app for all things food and exercise related. Using an online account, the app lets you track the nutritional value of your daily food, plan and calculate calorie burn for various exercises, and keep you honest to your long-term fitness goals. MyFitnessPal’s major attraction is its gigantic crowdsourced nutrition database, which helps you figure out the approximate caloric value of home-cooked and restaurant foods. You can also add your own meals to the database for future use. There’s an optional social networking component, so you can share your goals and achievements with friends.

Best of all, everything is synced to the MyFitnessPal website and your other devices.  WebMD (free) is like an always-available doctor in your pocket. The app is an offline version of the WebMD site, and offers an incredible number of features like the Symptom Checker, which lets you input your symptoms and will give you its best guess as to what (if any) illness it thinks you have. You can also find in-depth information on diseases and conditions, treatments, drugs, and more. Have a random pill? The Pill Identification Tool will figure out what it is based on shape, color, and other criteria. WebMD also includes a handy first aid guide, map views of local pharmacies, doctors, and hospitals, and sharing functionality for all of the above.  Medscape (free) is a tool for medical professionals. It offers upto-the-minute medical news in a wide range of specialties and access to the MEDLINE database. It has an extensive offline drug database with dosing calculators, 4000 enhanced-content articles, and step-by-step procedure videos. Medscape also reduces errors by analyzing drug interactions for up to 30 drugs at a time, providing comprehensive pill images and prescription information for over 8000 drugs. It also includes a large number of CME videos and activities.  Glucose Buddy Pro ($5.99) is an app to help diabetics control their blood sugar. You can enter glucose numbers, carbohydrate consumption, insulin dosages, and activities, all of which sync with the Glucose Buddy website. In addition, it keeps track of your height, weight, age, gender, type of diabetes, type of blood pressure, pump, and insulin device. In other words, it tracks everything you need to manage diabetes. There’s a user forum where you can find support and information, and you can use it to set reminders for meals and

dosing. All the information is presented as easy-to-read graphs that you can print or email to your doctor. A free version with reduced features is available.  DrawMD (free $1.99) is a set of applications for use by medical professionals. There are 11 specialties, including pediatrics, vascular, OB/GYN, and general surgery. Each specialty app allows a doctor to illustrate parts of the body, the details of procedures, and more. The apps come with high-resolution images of the area of anatomy under the specialty and include large stamp libraries. Doctors can freely add to or annotate the images with the details of procedures, and patients can see what procedures entail. You can also add your own images.  Vitogo Fitness: Personal Trainer ($2.99) is a personal trainer for your iPad. Vitogo helps you create a workout plan tailored to your individual schedule and needs. It includes descriptions and videos of every exercise in your workout, keeps track of reps and sets, and has a bevy of features for use during workouts, like a rest timer, Runkeeper and Loseit integration, and calorie tracking. In addition, it syncs with the Vitogo website, where you can join communities, share your stats, and get support.  Fitocracy (free) turns fitness into a game. The app uses gamification techniques to keep you motivated to work out. Each successfully completed workout earns you experience points, which let you level up. Significant achievements earn badges, and friends can give you props for sticking to your goals. Of course these things have no real value, but studies have shown that this sort of system has incredible motivational effects. The app is easy to use, well designed and hugely fun.  Cook IT Allergy (Free - $6.99) is a musthave if you’re cooking for people with aller-

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gies. The app provides substitutions for recipes that call for common allergens like eggs, gluten, dairy, nuts, soy, and more. There are recipes with tried-and-tested substitutions available directly in the app, and you can look up substitutions for recipes of your own. You can share your recipes and results from within the app, and it includes tips for making sure that your substitutions come out right. The app also doubles as a shopping list organizer: tell it what foods you’re making and it will create a checkable shopping list with allergy notifications.  HealthTap (free) is your connection to doctors everywhere. The app lets you send information and questions to member doctors, who then provide you with answers. All member doctors are licensed to practice in the U.S., but they won’t provide diagnoses or prescriptions over the application. For general questions, like how to prevent asthma after exercise, the app is quick and useful. You can pay an additional fee for a more comprehensive communication with a particular doctor, and you can see a doctor’s reputation and information in the app.  Caffeine Zone 2 ($0.99) is great for those of us who worry about whether we should have that next cup of coffee. This app tracks your coffee intake and predicts the effect that caffeine has on you based on a pharmacokinetic model of caffeine. You can see the effect of the dosage of the caffeine you’ve consumed and calculate when you can have another one for maximum effectiveness. A really nifty feature is the sleep calculator, which helps you figure out when to stop drinking in order to have a good night’s sleep. Aaron Friedman is a graduate of the Benjamin N. Cardozo School of Law. He was a member of Cardozo’s Intellectual Property and Information Law Colloquium and served as a staffer on the Cardozo Arts & Entertainment Law Journal.

February 2013


Choosing the Right Treadmill for You

Tech Support

ISSUES

By Shimon Lewin

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WOMEN’S HEALTH

eventually break, so you will want to make sure that you are covered because replacing those items can get expensive, counting both labor and parts. Also note that treadmills are very heavy, so if you are buying it from a store you might want to opt for home delivery, even though it costs more. You will also generally need at least two people to lift it or to move it. Once you finally have your

treadmill set up, please exercise responsibly and carefully. If you are out of shape, please make sure to start working out slowly and gradually increase speeds. Jumping into exercising when out of shape can be painful and downright dangerous. Shimon Lewin is the IT director at the Jewish Press and the author of numerous articles on technology and software. He can be reached at: electoday@jewishpress.com.

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disease activity, quality of life and their work productivity. Patients’ answers are instantly transmitted wirelessly to doctors and nurses for review. The iPad also provides traffic reports that patients can monitor when they head to their clinic appointments. Depending on patient responses, doctors and nurses can intervene in a number of ways, from offering prescriptions for new medication, making an appointment for an office visit, to helping the patient psychologically cope with the anxiety and isolation that can occur when dealing with a chronic disease.

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Patients, doctors and specialized nurses at the University of California, Los Angeles, are using iPads to help care, track symptoms and communicate with each other in real-time about disease management. Studies show that close monitoring, early intervention and educational programs aimed at better managing these diseases have a profound effect on patients’ quality of life, work and relationships. This approach also significantly lowers health costs. The device is interactive, and asks patients questions to gauge how they’re doing in areas of

HEALTHY LIVING

iPad: Having a Doctor on Call 24/7 in Your Back Pocket

MEDICINE TODAY

tory and how many calories you burn. They even have preconfigured workout sessions with different speeds and inclines to help keep things interesting. Extra features that you may want to consider are built-in speakers for music to help keep you going. Studies show that music helps the overall exercise experience and will make your workout more fun. Some treadmill models have better sounding speaker systems than others. If you are comfortable wearing headphones while exercising, skipping the speakers will help reduce the cost of your treadmill and make your choice easier. But many people do not like to work out while wearing earphones because they either fall off, become uncomfortably sweaty, or even break while working out. Some high-end treadmill models come with built-in video screens to enable you to watch your favorite entertainment. Another important thing that people overlook is getting an extended warranty. Most of the time warranties are worth the investment, especially if you plan on exercising heavily and keeping your treadmill for a couple of years. After using your treadmill for a few years, the belt or motor will

GOLDEN YEARS

February 2013

RAISING OUR CHILDREN

hoosing a treadmill can be an adventure. Treadmills are used for exercising, and they are one of the top used devices for doctor-recommended cardiovascular exercise. The advantages of owning a treadmill are great, but you really need to do your homework before buying one. The first thing you need to do is to figure out your budget. Treadmills can run from a couple of hundred dollars to several thousand. There are too many different brands and models with various optional features to fully explore here. One of the things to take into consideration is your height. If you are very tall and take longer steps, then you will need a larger treadmill to run comfortably. While some people can learn to adjust, some do not. That is why it is important to try out the models you are interested in so that you do not purchase a treadmill where the runway is too short or narrow. One important thing that many people do not realize when purchasing a treadmill is that if you live in an apartment building or a house with people living under you, the treadmill will bother them with the thumping and noise that it creates. If you live in a coop, you might even be forced to give it up. Placing a carpet underneath the treadmill will help reduce the noise to some degree, but probably not enough to keep your downstairs neighbors happy. You also have to be careful with carpet because it could ruin some treadmills. Another consideration is space. Some treadmills can fold up while others cannot. If you are tight on space, a treadmill that folds is definitely a plus. Most treadmills come with sensors to monitor your pulse; this is a good way to keep track of your health if ordered by your doctor. It is also a good way to keep your workout at a safe level. The better treadmills come with features that keep track of your workout his-

INTRODUCTION

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Showcase Compiled By Aliza Levinger

Therapro.com: Tools and Resources for Therapists, Parents and Educators

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t’s often difficult and time consuming to track down the unique tools and toys that are beneficial for children with special needs, sensory processing issues, motor or speech delays and more. Aiming to resolve these difficulties, Therapro.com offers a onestop shop for those seeking a range of supplies for preventative, developmental and rehabilitative care. Some sample products include balls and mats for strengthening gross motor skills; crafts, lacing, and peg boards which encourage fine motor skills and planning; chewable toys, whistles, and interactive books to aid in developing speech and com-

munication skills, and much more. The variety of assessments, games, activities, and toys means that there are options for those merely looking for a few support tools as well as those looking for full programs of development covering every stage, like their complete handwriting systems and books, Therapro also offers a range of workshops and seminars for therapists and teachers. Karen Conrad Weihrauch, PhD, OTR/L, the founder and president of Therapro, is a clinician with several decades of experience under her belt, meaning all the products sold are tested and therapist-approved.

One Egg is a Fortune

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Award-Winning Kosher Cookbook Emerges from Australia

leven years in the making, One Egg Is A Fortune by Pnina Jacobson and Judy Kempler is a cookbook with global appeal featuring recipes, stories and biographies from 50 prominent Jewish people from around the world, including Alan Dershowitz, Marlee Matlin, and Dennis Ross. Each contributor tells a personal anecdote highlighting the diversity of Jewish life and illustrating how the enjoyment of food is a common thread

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that binds us together. One Egg Is A Fortune includes over 100 delicious recipes with easy-to-follow instructions and stunning food photography, and best of all, proceeds go for a great cause – helping support Jewish elder care in the U.S., U.K. and Australia. Showcased at Kosherfest 2012, One Egg Is A Fortune has taken out six international awards. The book can be purchased at www.oneeggisafortune.com and selected outlets.

No More Lost Keys with New Ingenious Device

ow many times has this happened to you? You are about to leave your home and you reach for your keys – but they aren’t there! Panic quickly sets in. “Where could they be? Did I leave them on my night table? Did they fall out of my pocket? Are they in my other coat? I know they have to be here, but I don’t have time for a full scale search.” Few things in daily life are as frustrating. But now that can be easily solved by using the “Mini Key Finder” sold by retailer Brookstone.com. It consists of two small, battery-powered devices: one is a wireless transmit-

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ter with a range of up to 60 feet, and the other is a receiver, small and light enough to conveniently keep attached to your key ring. If you misplace your keys, simply go to the transmitter and press the center button. If your key ring is within range, the receiver will emit a sound loud enough to be heard and located. Just like that, your keys are found, the crisis is ended, and life can go on. The Mini Key Finder costs $19.99 plus shipping and tax and is available from Brookstone. com.

February 2013


Showcase

mango and cranberry-raspberry. Manufacturing began in Israel but has since spread worldwide to accommodate demand. Currently, the company offers several different machine models which are sold in major stores in 43 countries, including Bed, Bath & Beyond, Wal-mart, Target, and Costco. Annually, SodaStream enables 600 million liters of carbonated drinks to households worldwide. In the company’s own words: “We seek to revolutionize the beverage industry by reducing plastic bottle waste and being an environmentally friendly product. Learn more at www.sodastream.com.

RAISING OUR CHILDREN WOMEN’S HEALTH GOLDEN YEARS

odaStream, an Israel-based company made famous by its recent Superbowl ad, gives consumers the opportunity to create their own soda minus the preservatives, high fructose corn syrup, plastic waste, and expense of buying regular soda. Their standard soda maker involves a carbonator, a one-liter bottle, and flavoring. The bottle gets filled with regular tap water to which carbon dioxide is added, accounting for the fizz. Then your flavor of choice is added. To date, the company offers 150 flavor options ranging from familiar ones such as cola, orange, and ginger ale to more unique soda flavors like orange-

Unique Art Classes and Studio in Brooklyn

E-mail us at: sales@jewishpress.com

February 2013

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If You Can Dream It, We Can Get You There we

get you there

(877) 346-7987 • bussanimobility.com

Extensive product lines • Custom mobility van conversions New and Pre-owned Wheelchair accessible vehicles

COMMUNITY PROFILE

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H&L TECH

is actually an excellent method of strengthening the study and performance skills required in academic classes. As schools cut art funding, private programs are often the answer. Zelda’s Art World offers classes in acrylic painting, oil painting, portraiture, drawing, cartooning and more for children, teens and adults. Painting is taught using a unique “logic based layers” system developed by Zelda, who believes that understanding the natural patterns of the world is essential to painting it, while drawing classes use the most up to date “right brain” observational methods. In addition, Zelda’s has recently added a pottery curriculum with clay and pottery wheel instruction, as well as a drop-in ceramic painting studio. Zelda’s Art World is located at 2291 Nostrand Ave., Brooklyn, NY 11210. You can also visit www.ZeldasArtWorld.com.

HEALTHY LIVING

elda’s Art World has been promoting excellence in art education for many years with the longest running and most innovative program of its kind in the area. As an art educator for over 30 years, Zelda has found that each child has their own path to self-esteem and their own light to shine, and for every individual that light is different and its application unique. For many, that light lies in art production. But too often in our quest to give students the educational tools they need (math, reading, etc.), we overlook the vehicle through which students can achieve the self-confidence needed to master these skills. Generally, people need to experience successes in order to be successful. Achievement in one area develops a confidence-level necessary for success in others. Patience, discipline and focus training are all required to produce a credible work of art. Therefore, training in arts

MEDICINE TODAY

Z

ISSUES

Fizz Up Your Own Drinks with SodaStream

S

INTRODUCTION

H&L TECH


Community Profile Fighting Illness with Love

ISSUES

INTRODUCTION

COMMUNITY PROFILE

COMMUNITY PROFILE

H&L TECH

HEALTHY LIVING

MEDICINE TODAY

GOLDEN YEARS

WOMEN’S HEALTH

RAISING OUR CHILDREN

By Sandy Eller

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hen pediatric oncologist Peter Steinherz decided to create a medically-supervised kosher camping experience for children who were afflicted with cancer in the summer of 1987, it is doubtful that he had any clue that he was planting the seeds for an organization that twenty-five years later would offer over three dozen services to seriously-ill children and their families in five different countries. But, like so many other renowned organizations, Chai Lifeline was born from a single idea brought to life by one dedicated individual. Currently the director of Leukemia and Lymphoma Studies at Memorial Sloan Kettering Cancer Center on Manhattan’s Upper East Side, Dr. Steinherz was hoping to create a free summer camp experience for Jewish children with cancer, modeled after a similar program that had been created by the hospital. The result was the very first season of Camp Simcha. Dr. Steinherz and his wife Laurel, currently director of Pediatric Cardiology at Sloan Kettering, served as medical staff for the eight children who signed up for that inaugural summer, providing them not only with fun recreational activities, but also a group of peers who could relate to the medical and emotional challenges they were facing. “These children were different than their peers,” explained Melanie Kwestel, director of communications at Chai Lifeline. “They had missed months of school, were completely isolated and had pretty much lost all their friends. Coming to camp was an incredible experience. They had a phenomenal time, made real friends and got a much-needed emotional boost.” Camp Simcha was the very first program of Chai Lifeline which, under the guidance of Rabbi Simcha Scholar, executive vice president of the organization from its

earliest days, quickly mushroomed from summer camps and visiting patients in homes and hospitals into something exponentially larger. “People wanted to be a part of Chai Lifeline,” reported Mrs. Kwestel. “There was so much interest in what we were doing and in no time at all, Chai Lifeline had grown like crazy and was spreading all over the country.” While both Chai Lifeline and Camp Simcha continued to flourish, there was a clear need for another summer camp, this one for children with serious chronic illnesses other than cancer, and in 2001, Camp Simcha Special was born. “Ninety percent of the time, cancer has a resolution and these children will move on with their lives,” said Mrs. Kwestel. “But kids with chronic illnesses are going to be sick for their whole lives. This never ends.” Within one year, Chai Lifeline’s client load doubled, and Mrs. Kwestel estimates that half of Chai Lifeline’s clientele consists of children with chronic illnesses. Today, Camps Simcha and Simcha Special each consist of separate two week sessions for boys and girls with an estimated total of 450 campers. Located in the Catskills in Glen Spey, New York, the facility boasts a kid-friendly 11,744 square foot medical center with an emergency room, that, according to Mrs. Kwestel, rivals that of any hospital, as well as handicapped accessible bathing facilities that allow campers to bathe with dignity. “The kids call it ‘The Spa’,” quipped Mrs. Kwestel. Bunks at the camp site are currently being renovated and future goals for the camps include expanding with an eye towards accommodating another three to four hundred children every summer. Aside from the two camp programs, Chai Lifeline also offers hospital services, counseling, educational assistance, telephone support groups, big brother and big

sister programs, toy drives, insurance support services, crisis intervention, fantasy trips, vacations, community services and many other activities and events. “Anything we can anticipate, from providing kosher food in the hospital, transportation, insurance advocacy, to emotional and social support for both the patient and their entire family and so much more - our goal is to offer this panoply of services that provides one-stop shopping, for anything that might be needed,” said Mrs. Kwestel. Many of the services provided by Chai Lifeline were actually created by the volunteers themselves. Team Lifeline, a group of marathon races which has raised over $1 million for Chai Lifeline, was created by one volunteer who had never run a race, but decided that it was a challenge he wanted to conquer. “He ran the Disney Marathon for research, and while he was running, he thought to himself, ‘wouldn’t it be great to run for Chai Lifeline instead?’” recalled Mrs. Kwestel. “The first year he leaned on his friends and got thirty runners to race in Miami. The next year it doubled to sixty, and the following year we had one hundred, and it just keeps on growing. It is an incredible weekend for the runners, and it connects them with our kids. For our children, it is an empowering experience realizing that there are total strangers out there hoping that they get better. It is like sending flowers to a sick patient, except this is like an entire hospital room filled with flowers.” According to Mrs. Kwestel, Chai Chai Lifeline

Lifeline pioneered the concept of competitive racing to benefit a tzedaka. The organization has several other races including Bike 4 Chai, a 175 mile cycling event; Le Tour De Simcha, a sixty mile women’s biking race; Team Lifeline Israel, a race of varying lengths held in Jerusalem; and several Chai-A-Thon projects enabling children to raise money for the organization by recruiting sponsors for Swim-AThons, Bowl-A-Thons, Jump-AThons and more. Chai Lifeline has regional offices serving all fifty states, as well as Canada, England, Israel and France. Over 4,000 patients and their families each year turn to the organization and its 130 employees, who do their best to help Chai Lifeline to carry out its mission of fighting illness with love. “There is a whole psychology of happiness and there is probably all kinds of research saying that if you feel better you will have a better outcome,” explained Mrs. Kwestel. “I am not sure what science has proven, but I can tell you what our kids say. They go home and they start counting down the days until the camp starts the next summer, until our next trip or activity. We give kids an opportunity to live their lives a little. I can’t tell you if our services prolong life, but it makes our patients want to live.” Sandy Eller is a freelance writer who has written for various websites, newspapers, magazines and private clients in addition to having written song lyrics and scripts for several full-scale productions. She can be contacted at sandyeller1@gmail.com.

 Touched the lives of 4,300 children and

At a Glance

their families worldwide this year.  Gave 460 kids and teens with cancer, other life-threatening illnesses, chronic diseases and disabilities an incredible summer at Camp Simcha/Simcha Special.  Ran 263 family recreational events for thousands of sick children and their parents.  Counseled over 8,700 children and families affected by trauma, tragedy or death.  Spent thousands of hours in hospitals assisting sick children and their parents.

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February 2013


MARTIN ZONENSHAYN, M.D., F.A.C.S.

Medical Profile SHIRA BURNSTEIN, MD

HENRY HASSON, MD

DR. JOSHUA U. KLEIN

BILAL CHUGHTAI, MD

DR. JACQUES DOUECK

Dr. Bilal Chughtai is an Assistant Professor of Urology at Weill Cornell Medical Center, specializing in voiding dysfunction. His surgical expertise includes minimally invasive surgical techniques for incontinence, benign prostatic diseases, and vaginal reconstruction. His specialized training has allowed him to pursue cutting edge surgeries and treatments. He completed his BA at New York University, his MD at the State University of New York at Stony Brook, and his residency at Albany Medical Center. He completed his fellowship at Weill Cornell Medical Center and Memorial Sloan Kettering Cancer Center. He has over 50 peer reviewed publications and 15 book chapters on voiding dysfunction. He sees patients at the Iris Cantor Men’s Health Center.

February 2013

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COMMUNITY PROFILE

563 Kings Highway • Brooklyn, NY 11223 718.339.7982 www.DoueckDental.com www.AvoidRootCanal.org www.HealthWatchRadio.com Dr. Doueck is a member of the American Academy of Sleep Medicine, Academy of Dental Sleep Medicine, and Academy of Minimally Invasive Biomimetic Dentistry. He is certified by the Academy of laser Dentistry and has Ozone certification from the American College of Integrative Medicine and Dentistry Clinical consultant for the Dental Advisor, Dr. Doueck writes monthly articles for Image and Community Magazines. He hosts a 45 minute weekly radio show Mondays 8PM on 97.5FM on various health topics.

H&L TECH

Urology 425 East 61st Street, 12th Floor New York, New York 10065 646.962.4811

HEALTHY LIVING

Dr. Joshua U. Klein is the Medical Director of RMA of New York – Brooklyn and specializes in treating infertile couples using both basic and advanced technologies, such as IUI, IVF, and Egg Freezing. Dr. Klein received his medical degree from Harvard Medical School and completed residency at Massachusetts General Hospital and Brigham and Women’s Hospital in Boston, and fellowship at Columbia University. He has been recognized as a “Top Doc” by Health Magazine and has been featured in publications including CNN.com, US News and World Report, the Boston Globe, the Huffington Post, and Livestrong.com.

MEDICINE TODAY

Pediatric Neurology and Epilepsy Assistant Professor of Neurology and Pediatrics Albert Einstein College of Medicine www.hassonmd.com 2769 Coney Island Ave. Brooklyn, NY 11235 718.785.9828 Dr. Hasson is board certified in Child Neurology and Clinical Neurophysiology (EEG) by the American Board of Psychiatry and Neurology (ABPN). After studying at NYU, he continued to medical school at the Albert Einstein College of Medicine of Yeshiva University. He evaluates and treats children with general neurological concerns specializing in Epilepsy/seizures, ADHD, headaches, concussion, autism, and other neurodevelopmental disorders. His office offers the convenience of EEG, ADHD, and concussion testing. By offering the latest technology in home EEG monitoring, patients avoid a hospital stay lasting several days. His office provides pharmacologic and non-pharmacologic treatment for ADHD including behavior therapy, counseling and bio-neuro-feedback.

Reproductive Endocrinology and Infertility specialist. Manhattan-212.756.5777 Brooklyn-718.532.8700 L.I.-516.746.3633, White Plains-914.997.6200 wwwrmany.com 

GOLDEN YEARS

Dr. Shira Burnstein graduated from Barnard College, received a Masters in Anatomy from Columbia University graduate school and a medical degree from New York Medical College. She completed her Internal Medicine residency at Maimonides Medical Center. She is board certified in Internal Medicine with over 25 years of experience and currently has a private practice in Brooklyn, New York. Annual physical exams, blood drawing, throat cultures, and EKGs are done on premises. Convenient evening hours are available.

WOMEN’S HEALTH

Internal Medicine 2044 Ocean Avenue, Suite B2, Brooklyn, NY 718.998.1700

RAISING OUR CHILDREN

TUVIA MARCIANO, DO

Chief, Pediatric Endoscopy Division of Pediatric Gastroenterology, Hepatology & Nutrition • Winthrop Pediatric Associates 120 Mineola Boulevard • Suite 210 Mineola, New York 11501 516.663.4600  Dr. Tuvia Marciano graduated from Johns Hopkins University and New York College of Osteopathic Medicine. He completed his pediatric residency and chief residency at SUNY Downstate Medical Center. He did his pediatric gastroenterology fellowship at Montefiore Medical Center – Albert Einstein College of Medicine. He is board certified in Pediatrics and Pediatric Gastroenterology, Hepatology and Nutrition. He is an Assistant Professor of Pediatrics at the SUNY Stony Brook School of Medicine. He has been recognized as Top Doctor for the past 5 years. Dr. Marciano has expertise in all aspects of Pediatric Gastroenterology including milk protein allergy, GERD, constipation, functional abdominal pain and Crohn’s disease. His office is designed to meet the needs of children with special needs.

ISSUES

Chief of Neurosurgery New York Methodist Hospital 263 Seventh Avenue, Suite 4-D Brooklyn, NY 11215 718.246.8660 Martin Zonenshayn, M.D., is a board certified neurosurgeon and member of the Congress of Neurological Surgeons and American Association of Neurological Surgeons. After earning his medical degree from the New York University School of Medicine, Dr. Zonenshayn completed his residency in neurosurgery at Weill Cornell Medical College, as well as a fellowship in stereotactic and functional neurosurgery at the New York University Medical Center. Currently recognized as a “Top Doctor” by both New York Magazine and U.S. News and World Report, Dr. Zonenshayn specializes in minimally-invasive spinal surgery and brain tumor surgery, as well as stereotactic and functional neurosurgery for pain management and movement disorders.

INTRODUCTION

COMMUNITY PROFILE


Community Provider Bulletin Boro President Stringer Visits the Boro Park Jewish Community Council

COMMUNITY PROFILE

H&L TECH

HEALTHY LIVING

MEDICINE TODAY

GOLDEN YEARS

WOMEN’S HEALTH

RAISING OUR CHILDREN

ISSUES

INTRODUCTION

COMMUNITY PROFILE

M

anhattan Boro President Scott Stringer recently visited the offices of the Boro Park Jewish Community Council. In a wide ranging discussion with Rabbi Yeruchim Silber, BPJCC Executive Director they talked about the various services offered by the Council and toured the Boro Park YM-YWHA, in whose building the JCC is located. BPJCC, an affiliate of Met Council, was founded to serve Boro Park and surrounding areas with all their social service needs, including Medicaid and Child Health

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L-R: Ezra Friedlander, CEO The Friedlander Group, Roni Shoyfer, Branch Manager Investors Bank 13th Avenue, Yidel Perlstein, Chair Community Board 12 and Board Member, Boro Park Jewish Community Council, Shlomo Winard, Career Counselor, Met Council Connect To Care, Manhattan Boro President Scott Stringer, Rabbi Yeruchim Silber Executive Director, Boro Park Jewish Community Council,Joel Eisdorfer, Community Activist, Naftali Reiner, Board Member Boro Park Jewish Community Council

MDA on Call as Woman Prematurely Births Twins at Home

our weeks ago, a pregnant Shiri, home alone except for her young son in an adjacent room, went into labor and unexpectedly began giving birth to twins on her living room couch. Within minutes, the first baby was out. Frantic, and with her husband rushing home from work, Shiri called MDA, Israel’s national emergency response and ambulance service. On the other line was MDA paramedic Maya Aloni. “I just gave birth in my living room! I don’t know what to do! I’m having twins,” shouted Shiri,

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Plus, food stamp enrollment, employment services, crisis assistance and services to seniors and holocaust survivors.

her words captured in a recording of the emergency call. “The [first] baby’s on the couch and I can’t hold him. I can’t move! I’m scared! The baby’s crying!” As Shiri’s voice spiraled into panic and confusion, Aloni settled the situation and brought a soothing, almost zen-like serenity to the emergency. “I’m here, I’m with you,” the 25-year-old Aloni said in a calming tone. “The fact that the baby is crying is a good thing.” As Aloni guided Shiri over the phone through caring for her min-

utes-old child and keeping him sufficiently warm, she dispatched

an MDA ambulance to the scene. Minutes later it arrived and the second baby was born en route to the hospital. Today, mother and children are in perfect health. Drawing on her training as an MDA first-responder, Aloni was able to combine steely nerves with a medical background to lead and comfort Shiri until the MDA am-

bulance arrived on the scene. Unlike many other Western countries, including the U.S., Israel’s MDA staffs its emergency call centers with trained paramedics. Israelis know that whomever picks up the phone at MDA has extensive lifesaving training. And that simple, yet critical, point may have made the difference in the lives of Israel’s newest twins. “I didn’t expect to give birth at home, but it was beyond my control,” Shiri said later. “And I couldn’t do anything about it. It happened so fast.”

Breaking News about MedRite Urgent Care Expansion

n April 15th, MedRite will be expanding its horizons with the opening of a new location on the West Side. Members of the community are elated with the news, as they will finally be able to benefit from an urgent care facility in their immediate neighborhood. The community will certainly enjoy the advantages of MedRite, where patients can be

in and out in no time without disrupting their schedule. It also goes without saying that urgent care is more affordable than a visit to the emergency room. Patients will also appreciate MedRite’s onsite lab and x-ray under one roof. The MedRite team is looking forward with breathless excitement to its new location, where we will be able provide for

the community’s urgent medical care. With its close proximity, MedRite will be making people’s lives easier in more ways than they can imagine. Furthermore, patients can look forward to MedRite’s renowned professional and friendly service along with the special personal care that our doctors and staff provide. Stay tuned for more updates on the new location.

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February 2013


COMMUNITY? CALENDAR Where: Rockefeller Center Fifth Avenue and West 49th Street • New York, NY 10020 When: 5-11 A.M. Contact: 212.453.3258 Help the more than 10,000 New York City, Westchester, Putnam, Rockland, Orange and Sullivan county residents affected by multiple sclerosis. Over 200 volunteers are needed to ensure a safe and fun event. Join our dedicated volunteers and contribute your energy and passion to help the National MS Society move toward a world free of multiple sclerosis.

March

15

Climb to the Top Volunteer

March

Sleep/Sleeplessness: The Effects on Your Body

3

March

APRIL 2013

Meet Me at Moma Dementia Program

March

8

Inflammasomes in Health and Disease

Where: Rockeller University Zuckerman Auditorium, MSKCC, 417 E. 68th St. Where: 4:30-5:30 P.M Contact: Kirsten Hively at hivelyk@mskcc.org

April

11

Personal Health: Healthy Eating/Making Changes

April

For Women with Developmental Disabilities Where: 11 Broadway, New York, NY 10004 14th Floor Conference Room When: 7 P.M. Contact: Batya Jacob at batyaj@ou.org to register visit: www.njcd.org/womenshealth Defining Healthy Relationships. Presented by Henna White - Community Liaison from the Brooklyn District Attorney’s office, Batya Jacob - Director of the International Jewish Resource Center for Inclusion and Special Education.

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Sign Language Tours at the Jewish Museum Where: 1109 Fifth Avenue • New York, New York Contact: 212.423.3225 • 212.660.1515 (TTY)

Yachad Presents: Women’s Health and Wellness Series

For Women with Developmental Disabilities Where: 11 Broadway, New York, NY 10004 14th Floor Conference Room When: 7 P.M. Contact: Batya Jacob at batyaj@ou.org to register visit: www.njcd.org/womenshealth Women’s Cancers: Risk, Prevention, and Treatment presented by Dr. Erica Friedman a Soft Tissue Fellow at New York University School of Medicine will discuss how women can prevent and treat cancer.

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April

30

J-BABE MeetUp Group

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February 2013

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Where: OHEL • 4510 16th Avenue • Brooklyn, New York When: 7:00-9:00 P. M. Contact: 718.972.9338 • Askohel@ohelfamily.org • www.Ohelfamily.org Have you adopted or are planning to adopt a child? Are you a foster parent or looking to become one? Is someone else’s child living with you? This 8 part parenting seminar is for you. Free admission. Registration required.

MAY 2013

May

35

YACHAD Family Shabbaton

Where: Hudson Valley Resort, NY Contact: 212.613.8285 • haglere@ou.org An uplifting Shabbaton for individuals with disabilities and their families. Families come together for a weekend of support while learning from one another and noted speakers. It is the highlight of the year for the 600+ individuals who attend.

COMMUNITY PROFILE

Where: Kings Bay Y at Windsor Terrace 1224 Prospect Avenue • Brooklyn, NY 11218 When: 10-12 A.M. Contact: 718.407.6377 or E-mail: info@ywindsorterrace.org. The J-BABE Meet-Up Group is designed for moms and dads of newborns ages 0-3 months. Topics include conversation on common newborn issues, feeding concerns, sleep for baby and parents, childcare, health, nutrition, Jewish parenting on your own terms, and more.

Loving & Raising a Child that is Not Your Own “Is a Child’s Play Necessary or Frivolous?”

H&L TECH

March

Yachad Presents: Women’s Health and Wellness Series

HEALTHY LIVING

March

Young Child Expo & Conference

MEDICINE TODAY

March

For Women with Developmental Disabilities Where: 11 Broadway, New York, NY 10004 14th Floor Conference Room When: 7 P.M. Contact: Batya Jacob at batyaj@ou.org to register visit: www.njcd.org/womenshealth Your Child’s Changing Body. Presented by Dr. Norman Ravski – Obstetrics and Gynecology, Dr. Anna Tirado - Head of Gynecology, Gaylord Hospital, Jori Belkin – Professional Doula

Where: New York’s Hotel Pennsylvania 401 7th Avenue 33 Street • New York, NY 10001 (Across from Madison Square Garden) Contact: 212.787.9700 ext 333 www.youngchildexpo.com Providing early childhood professionals and parents the latest information about early childhood development, services, resources, and products to help all children reach their full potential.

1719

Where: Hoboken Public Library 500 Park Avenue • Hoboken, New Jersey 07030 When: 6-7:30 P.M. The library will be hosting a series of health and fitness seminars taught by a certified Nutritionist for Optimal Health, Wellness, and Sports thru TESC of NJ and Group Exercise thru AAAI. These are all FREE seminars!

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Yachad Presents: Women’s Health and Wellness Series

GOLDEN YEARS

6

April

WOMEN’S HEALTH

March

Creating a Health Care Notebook

Where: Grand Army Plaza Flatbush Ave. at Eastern Pkwy • Brooklyn, NY 11238 When: 10-1 P.M. Teaching parents how to keep records for children with disabilities.

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Where: Museum of Modern Art 11 West 53rd Street • New York, New York When: 2:30-4:00 P.M. Contact: 212.408.6619 • 212.247.1230 (TTY) accessprograms@moma.org Free interactive programs for individuals with dementia and their family members or care partners provide a forum for dialogue through looking at art. Registration required.

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Where: NY Presbyterian/Weill Cornell Medical Center 525 East 68th Street (between York Avenue and FDR) New York, NY 10065 When: 5:30-7 P.M. Contact: 1.877.697.9355 call to register

RAISING OUR CHILDREN

March

ISSUES

MARCH 2013

INTRODUCTION

COMMUNITY PROFILE


Health AND Living Service Marketplace

ISSUES

INTRODUCTION

COMMUNITY PROFILE

ADDICTION RECOVERY

COMMUNITY SUPPORT

4382 Northlake Boulevard, Suite 109 Palm Beach Gardens, FL 33410 888.899.8301 • RecoveryRoad.com Clinical excellence paired with an unmatched approach to treating Jewish men suffering from addiction.

Recovery through Torah

151 W. 30th Street, New York, NY, 10001 212.465.1300 • www.chailifeline.org Through programs that address the emotional, social, and financial needs of seriously ill children, their families, and communities, they restore normalcy to family life, and better enables families to withstand the crises and challenges of serious pediatric illness.

ASSISTED LIVING

718.535.9061 • www.chayimaruchim.com/network Get updated with the latest information about the world of medical care from a patient sensitive and halachic perspective.

RAISING OUR CHILDREN

Recovery Road

1720 Pacific Avenue, Suite 235, Venice, CA 90291 310.505.0439 • RecoveryThroughTorah.com A Torah path to 12-step recovery from addiction. Confidential/anonymous phone appointments.

WOMEN’S HEALTH

718-258-3991

Ateret Avot

GOLDEN YEARS

1410 East 10th Street, Brooklyn, NY 718.998.5400 Luxury senior retirement facility. Exciting & stimulating activities for Jewish seniors, morning and afternoon programs available.

Lakewood Courtyard

52 Madison Avenue, Lakewood, NJ 08701 732.905.2055 • lakewoodcourtyard.com A glatt kosher assisted and independent living community, located in the heart of the Lakewood community.

MEDICINE TODAY

The New Nautilus

2001 Ocean Boulevard, Atlantic Beach, NY 11509 516.239.1400 • www.newnautilushotel.com An upscale oceanfront Senior Residential Hotel that provides a socially active retirement lifestyle in a secure and friendly environment.

Regency Home Health Care

HEALTHY LIVING

5110 19th Avenue, Brooklyn, NY 11204 718.223.1520 Your family members will enjoy a community setting and quality of service that is second-to-none at our modern facility in the heart of Boro Park.

CHIROPRACTIC CARE

H&L TECH

Dr. Melinda Keller

Placenta Encapsulation

Facial Rejuvenation Pain Relief

Healing

“I’m expecting B’H! How can I prevent Post Partum Depression?”

5911 16th Ave. Brooklyn, NY 11204 718.234.6206 • www.brooklynspinecenter.com Brooklyn Spine Center helps treat neck and back pain, pediatric care, posture correction, pregnancy care, stress relief etc.. Modern treatment done with old fashioned care.

COMMUNITY PROFILE

Chayim Aruchim

Kids of Courage

445 Central Ave, Suite 216, Cedarhurst, NY, 11516 516.612.8844 • www.kidsoc.org An innovative, all volunteer organization dedicated to improving the lives of sick children and their families. We offer year round programming as well as an annual ski weekend and a medically supervised Dream Trip to the West Coast, all at no cost to the parents.

Magenu

2294 Nostrand Ave. Suite 1017, Bklyn, NY 11210 718.408.SAFE (7233) Magenu works to protect our children by promoting education in personal safety. Magenu believes in a coordinated effort between schools, parents, and children to achieve our children’s safety. The safety of our children is our first responsibility.

Our Place

1815 Avenue M, Brooklyn, NY 11230 718.692.4058 Our Place employs a multi-faceted approach to counseling, rehabilitating and guiding troubled Jewish youth in their return to mainstream society. Over the past 15 years OurPlace has saved over 8,000 teens in our local communities and nationwide. OurPlace is a haven for 800-1,000 teens annually.

Rofeh Cholim Cancer Society

762 Bedford Ave. Brooklyn, NY 11205 718.722.2002 • www.rccscancer.org An array of services for cancer-stricken patients in need, including the subsidizing of health insurance premiums, enabling them to obtain the best medical care.

Yad v’Ezer

Call 2nd Nature Acupunture, we can help...

718.613.1818 Under the guidance of Rabbi Yosef Y. Holtzman, chief Rabbi at SUNY Downstate Medical Center, Yad v’Ezer provides freshly cooked meals to families in temporary need.

917-414-3831

For a full list of treatments,visit www.2ndNatureAcu.com

Email: AcupuncturEsther@gmail.com

Esther Hornstein L.Ac., Dipl.

Chai Lifeline

Brooklyn, NY

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February 2013


Health AND Living? Service Marketplace

Puah Institute

RAISING OUR CHILDREN

Doueck Dental

563 Kings Highway Brooklyn, NY 1.800.SNORING • www.DoueckDental.com Sleep apnea is a serious disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea put themselves at risk for high blood pressure, stroke, heart failure, diabetes, depression, GERD. Dr. Doueck uses the latest in technology to diagnose and treat this disorder.

Dor Yeshorim

5205 New Utrecht Ave, Brooklyn, NY, 11219 718.384.6060 • www.modernlab.org/doryeshirum An international, confidential genetic screening system which attempts to prevent the transmission of genetic disorders among members of the Ashkenazi Jewish community.

ISSUES

DENTISTRY

Dr. Zev Maybruch

5904 13th Ave, Brooklyn, NY, 11219 718.437.7474 • www.refuahresources.org Refuah Resources is a non-profit organization dedicated to providing medical referrals, research, advocacy and support to individuals and families facing medical challenges.

ELDER LAW

Korsinsky & Klein LLP

EMERGENCY MEDICAL CARE MedRite

family health A Time

Bonei Olam

February 2013

Alternate Staffing

4918 Ft. Hamilton Parkway, Brooklyn, NY 11219 718.972.2500 Specializing in Alzheimer/Dementia Care. Registered Nurses, Certified Home Health Aides.

Americare CSS

171 Kings Highwway, Brooklyn, NY 11223 Insurance-covered home care: 718.872.2630 Private Pay Services: 866.331.6873 Nurses / Therapists / Social Workers / Home Health Aides

Attending Home Care

1125 Fulton Street, Brooklyn, NY 11238 718.508.4400 • attendingllc.com Home health aides, 24 hour live-in care, personal care aides.

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COMMUNITY PROFILE

1755 46th Street, Brooklyn, NY, 11204 718.252.1212 - www.boneiolam.org Helping couples that are experiencing infertility to realize their dreams of having a child of their own. Its mission is to provide funding for all aspects of fertility treatments, thus relieving couples of the financial, emotional, and physical stress resulting from infertility.

HOME HEALTHCARE

H&L TECH

1310 48th Street, Suite 406, Brooklyn, NY, 11219 718.686.8912 • www.atime.org The premier, internationally acclaimed organization that offers advocacy, education, guidance, research and support to Jewish men, women, and couples struggling with reproductive health & infertility.

If you take many medications, there is hope! Senior care pharmacist will review your medications and make recommendations to improve your well being in the comfort of your home. www.goldenreview.org • 917.719.6337 Dr. Chana Hershkop, PharmD

HEALTHY LIVING

919 2nd Ave (Bet. 48 & 49) NYC 212.935.3333 • www.medriteurgentcare.com Emergency care and general health care. X-ray and lab onsite - Open early till late.

Geriatric Pharmacist Services

MEDICINE TODAY

2926 Avenue L, Brooklyn, NY 11210 718.312.3222 Specializing in Elder Law, Estate Planning, Medicaid Law, Probate, Wills & Trusts, & Guardianships

Relief Resources

5904 13th Ave. Brooklyn, NY 11219 718.431.9501 • www.reliefhelp.org A non-profit organization dedicated to providing medical referrals, research, advocacy and support to individuals and families facing medical challenges.

GOLDEN YEARS

144-32 68 Road, Kew Gardens Hills, NY 11367 718.263.8300 Comprehensive dental care with emphasis on snoring and sleep apnea treatments.

Refuah Resources

WOMEN’S HEALTH

Joseph Lichter D.D.S

1709 Kingshighway, Brooklyn, NY 11229 718.336.0603 • www.puahonline.org Experts in the World of Jewish Fertility: devoted to providing counseling, advocacy, halachic and medical diognostics and expertise, supervision, research and education worldwide.

1420 Ave. P Brooklyn, NY 718.339.7878 • www.josephlichter.com Now in a new and expanded facility, laser, cosmetic and comprehensive dental work offered to all phases in family dentistry. Convenient appointments as well as emergency service and treatment available.

INTRODUCTION

COMMUNITY PROFILE


INTRODUCTION

COMMUNITY PROFILE

Health AND Living Service Marketplace

ISSUES

HamaspikCare

855.HAMASPIK Home health aide, personal care aide, nursing, PT/OT, speech therapy, social work, nutrition.

COMMUNITY PROFILE

H&L TECH

HEALTHY LIVING

MEDICINE TODAY

GOLDEN YEARS

WOMEN’S HEALTH

RAISING OUR CHILDREN

Homecare Planning Solutions

A division of Edison Home Health Care 946 McDonald Avenue, Brooklyn, NY 11218 718.838.3838 • www.hpsny.com HPS will assist you in qualifying and applying for Medicaid to receive home health care, establishing pooled-income trusts, private pay arrangements, assistance with long-term care insurance claims.

Preferred Home Care of New York

Corporate Headquarters: 1267 57th Street, Brooklyn, NY 11219 Manhattan Office: 1370 Broadway, NY, NY 10018 718.841.8000 • 212.444.9009 www.preferredhcny.com

Nannys for Grannys

718.997.1800 • 212.288.1200 • 516.481.4182 www.NannysforGrannys.com Companion care to keep your loved ones safe at home. Live-ins, hourly, overnight available.

Reliable Community Care, Inc.

160 Broadway, 16th fl. NYC, NY 10038 212.587.1400 • reliablecommunitycare.net When you entrust your loved one to Reliable Community Care, you become a member of our family. Call today for help with home care or private nursing services.

Revival Home Health Care

5350 Kings Highway, Brooklyn, NY 718.629.1000 • revivalhhc.org Skilled RN’s, home health aides, PT/OT, speech/ lanuguage pathology, nutrition, infusion therapy, medical supplies, equipment, and social service.

INFORMATIONAL WEBSITES

MetroStar Home Health Products

5359 Kings Highway, Brooklyn NY 718.838.3333 ext. 300 Medical equipment rental program. Call today to guarantee delivery in time for Yom Tov.

Shabbos Stairlift

646.543.8811 Your home becomes accessible again. Everyday. Shabbos and Yomim Tovim included.

MEDICAL PRACTICE Joshua U. Klein, MD

www.rmany.com Reproductive Medicine Associates of NY offers patients high success in helping with IVF procedure under rabbinical supervision, egg freezing, embryo analysis and genetic testing by a world class NY laboratory. See website for different locations.

Dr. Lawrence Levitan

212.679.2223 • PREMIERNYOBGYN.COM Dr. Levitan, who is affiliated with Lenox Hospital, is temporarily located at 18 E 41 St. 1st FL. New York, NY 10017. Watch for the grand opening of their new NY location at 137 E36 NYC 10016

Women’s Contemporary Care Associates Joan Altman-Nueman, MD 1175 West Broadway, Suite 33 Hewlett, NY 11557 516.616.4522 Board certified obstetrician and gynecologist offer routine OBGYN care in addition to treatment of irregular bleeding, menopause, sonograms, family planning and Kallah needs with full knowledge of Tahart Hamishpacha laws. Sunday and evening hours available.

NUTRITION/WEIGHT LOSS Inch Knocker Fitness Center

4918 Ft. Hamilton Parkway, Brooklyn, NY 11219 718.972.1500 • www.inchknocker.com Lose 3-7 inches in only two weeks!

Shape Fitness

Maxi Health

1.800.544.MAXI • www.maxihealth.com Get your children to take their vitamins with Maxi Health’s tasty and fun tablets. Offered in strawberry, fruit punch and assorted flavors, the new Multi Yums allows your children to get their daily intake of nutrients with no artificial coloring or flavoring.

Pharmacies J Drugs

1205 Avenue J, Brooklyn, NY 718.258.6686 • www.myGNP.com Try the excellent service and professional care available at your local Good Neighbor Pharmacy. Free delivery. Curbside service.

Kings Bay Chemists

3610 Nostrand Avenue, Brooklyn, NY 718.891.3447 • www.myGNP.com Try the excellent service and professional care available at your local Good Neighbor Pharmacy. Free delivery. Curbside service.

J Drugs II

3402 Avenue N, Brooklyn, NY 718.258.5858 • www.myGNP.com Try the excellent service and professional care available at your local Good Neighbor Pharmacy. Free delivery. Curbside service.

REFERRAL SERVICES Medstar

718.787.1800 • www.medstarmedical.org Providing medical referral and guidance to the Jewish community for 20 years. Comprehensive health care information for the Jewish patient and traveler in NY, New Jersey, Florida and cities all over the world.

REHABILITATION CENTERS Meadow Park

718.338.8700 • www.shapefitnessgym.com The fitness DVD you’ve been waiting for. Order now!

718.591.8300 Ext. 248 - mprcare.com Queen’s only glatt kosher rehabilitation and health care facility. Professional chef on staff for an exquisite dining experience.

MEDICAL SUPPLIES

NUTRITIONAL SUPPLEMENTS

Sephardic Nursing & Rehabilitation

800.877.9100 www.AmericanDiscountMed.com Never pay retail for medical equipment. We specialize in pediatric and adult home care equipment.

bluebonnetnutrition.com Kosher certified Targeted Multiples® that are scientifically formulated to meet women’s and men’s specific and changing nutritional needs as they age.

Kosher in the Kitch

www.kosherinthekitch.com Fresh and fast recipes. Sign up for free weekly dinner menus.

American Discount Medical

CPAP

800.356.5221 • cpap.com Great prices on the Sleep Apnea products you know. Text your e-mail address to 516.240.9162.

Bluebonnet Nutrition

Kosher Vitamins

2266 Cropsey Ave., Brooklyn, NY 11214 718.266.6100 - sephardichome.org Our mission is to provide the elderly with the best quality of life in a respectful, dignified, safe and compassionate environment, in accordance with Jewish tradition.

800.645.1899 - koshervitamins.com Better health is only a click away. Largest selection brand name kosher vitamins at discounted prices.

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February 2013


Health AND Living? Service Marketplace Nachas Health

1310 48th Street, Suite 402, Brooklyn, NY, 11219 718.436.7373 • www.nachashealth.org

Ohel Bais Ezra

Pesach Tikvah

718.851.6300 • www.ohelfamily.org Addressing the needs of OMRDD (Office of Mental Retardation and Developmental Disabilities) and OMH (Office of Mental Health) populations, they have proven invaluable in tackling a wide range of social issues.

Assistant to the HR Director

Medicaid Service Coordinator

Harmony Services is looking for a Medicaid Service Coordinator (MSC). Must have a BA & a min of 1 year exper working with indiv with developmental disabilities. Fax resume to 718.435.9080 Att: Ronit

Medical Biller

Wanted F/T for Multi-Specialty Medical Center. Candidate must be detail oriented & able to communicate effectively w/insurance companies. Some exper in medical billing reqd. F/T position w/benefits. Please send resume to fax no. 718.686.2098 or hr@ezramedical.org

Psych/SW

Attendant/Companion

F/T for varied Senior activities. Sundays a must. Computer skills necessary. E-mail resume to: amagill@ateretavot.com

Day Hab Counselors

F/T Male Counselors to work in an Adult Day Hab. Experience pref ’d. E-mail resume shanie@otsar.org

Res Hab

Caring individual needed to work with a young girl w/Down Syndrome. 5-7 Mon & Wed. Ave P & E.22nd St. Special Care 718.252.3365 x102

Service Coordinator

Challenge Ei Center Service Coordinator, F/T Staten Island location. Experience preferred. BA in Human Services or related field. Computer literate, detail oriented, excellent communication skills. Competitive compensation pkg. Fax resume to: 718.370.1597

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To Advertise in the Marketplace Contact Shaindy: 718.330.1100 x 373 or sales@jewishpress.com

COMMUNITY PROFILE

February 2013

Recreation Personnel

H&L TECH

Dentist

Mobile Dentistry co. expanding & looking for P/T dentists to join our team. Car reqd to travel to each location. Compensation based on production. E-mail CV/resume: jobs@thebedsidedentist.com

HEALTHY LIVING

For a Community Healthcare organization in Bklyn. Assist w/hiring, personnel files, maintain benefit program. Organizational skills a must, prior experience preferred. E-mail resume to: hrhealth1@gmail.com

Mishkon has exciting opportunities for Psych/SW to work with individuals with intellectual disabilities. Must have experience and passion. E-mail resume to: msoto@jbfcs.org

Male, for Jewish man. Must speak English. Health bnfts. SS# nec. 718.336.9525

MEDICINE TODAY

HELP WANTED

Lose Weight Now

While gaining energy & improving your health!!! No Hunger!!! Call 347.989.4671 for free consultation today.

GOLDEN YEARS

Yeled V’Yalda

1312 38th Street, Brooklyn, NY, 11218 718.686.3700 • www.yeled.org The agency provides the New York City area with a variety of educational programs and social services, offering a seamless blend of child care and developmental services, as well as health and nutritional guidance.

Family Practice Internist

Ahava Medical, an article 28 facility, is hiring family practice Internist, PT, OT, SPT & all specialties. P/T, F/T. 718.951.8800x2165 lebovitsg@gmail.com

WOMEN’S HEALTH

community through programs of excellence. It seeks to identify community social challenges by pioneering new programs that elevate the lives of individuals and families.

HASC Center seeks Direct Support Counselors. 3-11pm shift. Rewarding position for an innovative, creative, and caring individual to work with adults with developmentaldisabilities & medical issues. Clean drivers license required. Attractive salary + benefits. Call 718.535.1937 or E-mail: hr@hasccenter.org

RAISING OUR CHILDREN

4510 16th Ave, Brooklyn, NY, 11204 718.851.6300 • www.ohelfamily.org Protects and strengthens individuals and families by meeting the diverse social service needs of the

Direct Support Counselors

ISSUES

SOCIAL SERVICES

INTRODUCTION

COMMUNITY PROFILE


INTRODUCTION ISSUES

COMMUNITY PROFILE From the Doctors Desk

By Dr. Ronald Kaleya

COMMUNITY PROFILE

H&L TECH

HEALTHY LIVING

MEDICINE TODAY

GOLDEN YEARS

WOMEN’S HEALTH

RAISING OUR CHILDREN

N

ot that long ago, a diagnosis of cancer was widely regarded as a death sentence. Today, more than 12 million Americans are living with cancer, and most of them can look forward to leading a satisfying and useful life for years to come. This is particularly important for the more than one and a half million Americans who will be diagnosed with some form of cancer this year. But the ongoing fight against cancer is a mixed picture. The mortality rate for some forms of the disease, which once claimed many lives, is down sharply today because of screening procedures such as PAP smears for cervical cancer and colonoscopy for colorectal cancer. They enable us to detect these cancers at an early stage when they can usually be successfully treated. We have also learned that some of the techniques which had been widely used, such as radical mastectomies to treat breast cancer, and PSA blood tests to detect prostate cancer, were not effective in lowering the mortality rates for these diseases. While the widespread use of mammography did improve the rate for detecting breast cancer, it resulted in only a modest increase in the survival rate, and that improvement came at a significant cost. Mammograms and the PSA tests often yield false positives, which require more intrusive procedures to confirm their findings. They create a tremendous amount of anxiety and fear in the lives of patients. Even when these tests accurately detect the presence of cancer, we now know that many of these patients would have survived just as long, and with a much better quality of life, even if their cancers had never been detected or treated. Some people die with cancer rather than of cancer. An article of faith in the early years of the war against cancer was that early detection and extensive surgical removal were the keys to successful treatment. The emphasis on early detection distorted the public’s understanding of the true nature of the cancer threat. For example, public service ads still tell women that they have a 1 in 9 lifetime probability of being diagnosed with breast cancer. But it does not tell them that they might

A New Outlook on Cancer Treatment live their whole lives with breast cancer and never know it. In 1987, Danish researchers conducted breast cancer examinations as part of the autopsies of 110 women, ages 20-54, who had died of other causes. They found that 20% of these women had various forms of cancer in their breasts, even though almost all of them had not been diagnosed with the disease while they were still alive. This suggests that many women are living normal lives with breast cancer, and that many would never become aware of their cancers unless they were convinced to undergo breast cancer screening regimen. This explains why there has been so much confusion and controversy over the recent changes in the guidelines for cancer screening, especially the use of PSA for prostate cancer and the use of mammography to screen younger women for breast cancer. Many women have become passionate advocates for mammography in the belief that every positive result means another life saved, when, in fact, there is a high percentage of false positives, especially in younger women. Undoubtedly, breast cancer screening has saved the lives of many women, but we also must recognize that others have suffered needless anxiety due to the limitations of the screening techniques. Medical research has also clinically proven that more elderly men die with prostate cancer than of prostate cancer. That is why we no longer automatically advocate active treatment for older men who are diagnosed with slower-growing forms of prostate cancer. But as long as reimbursement for medical care is procedure-based, there will continue to be a strong financial incentive to continue promoting the use of accepted screening, diagnosis and therapy procedures, regardless of their accuracy or usefulness. The heightened public awareness of cancer has also been very beneficial for fundraising by those high profile organizations and health care institutions which have associated themselves in the public’s mind with cancer research and treatment. This has given them, too, a strong vested interest in the aggressive promotion of cancer awareness and cancers screening programs, as a “public service.” (1) As a result, the public has tended to assume that the popular accep-

tance of cancer screening programs using flawed techniques has yielded substantial progress in saving lives, when this has not necessarily been the case. (2) On the other hand, government health programs and agencies which must pay for cancer screening procedures have a vested interest in limiting their use to cases where they are most likely to save both money and lives, by reliably spotting dangerous but treatable cancers at an earlier stage. These conflicting priorities make it much more difficult, even for medical professionals like me, to find reliable and unbiased cancer screening and treatment guidelines. The good news is that there has been significant progress in recent years in the way that we treat cancer and cancer patients. We have gained a much more sophisticated understanding of the disease, on a molecular biological level. This enables us to do a better job of predicting the course of the disease. As doctors, we are doing away with a “one size fits all” approach to treating various forms of cancer. We are learning how to fine tune treatment to better fit the unique needs of the individual patient and the specific genetic nature of their particular cancer cells. This may sound strange coming from a specialist in surgical oncology, but the fact that our new knowledge has reduced the use of surgery as the default treatment for all kinds of cancer is a good thing. Based upon careful analysis of clinical results, we now treat various forms of cancer differently than we did just a few years ago. Also, thanks to the revolution in information technology, no single health care institution holds a monopoly any longer on the most effective cancer treatment techniques. Gone are the days when one had to go to one of a handful of research institutions in order to get the best available treatment for cancer. In fact, based upon my experience and observations, I consider the quality of cancer care at institutions such as Maimonides Medical Center, and Montefiore Medical Center to be equivalent to that of the “name brand” institutions, with the added benefit of a more personal touch. Ask your doctor before choosing a hospital, and don’t make the com-

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mon mistake of automatically eliminating one in your own community in favor of those with the more prestigious names. A word about commercial ads touting a particular cancer treatment or health care institution as superior to all others. These ads exploit the fear and desperation of cancer patients and their loved ones. Buyer beware! Over the past 40 years, we have learned that the various forms of cancer are so different from each other that it is unlikely that we will ever find a single magic bullet that will “cure” them all. Instead, our goal today is to find more ways to turn cancer into a chronic condition, like diabetes, which can be managed effectively over the long term, extending the patient’s life while maintaining their quality of life as much as possible. Medicine today is willing to study and recommend all forms of treatment, including modifications in lifestyle, such as losing weight and becoming more fit and active. These result in physiological and psychological changes which, studies have shown, improved outcomes, sometimes in ways which we can explain, and sometimes in ways which we do not yet understand. Finally, there is the question of end-of-life care. As an oncological surgeon, this is an issue which, sadly, I must confront on a regular basis. The treatment for patients in the end-stages of cancer should have a different set of priorities and procedures than for patients whom we expect to recover. Terminal patients need an extra measure of compassion and sensitivity, and to be spared as much pain as possible but not at the sacrifice of the ability to share their final moments with family and friends. The transition from life to death is too important a process to allow the patient’s mental capacity to be obscured by narcotics. Their final wishes and beliefs deserve to be heard and respected, as do those of their family members.

Dr. Ronald Kaleya is the Chief of Surgical Oncology at the Maimonides Medical Center in Boro Park, Brooklyn, NY. He is board certified in General Surgery, and previously served as Professor of Clinical Surgery and vice chairman at the Montefiore Medical Center – Albert Einstein College of Medicine. He completed a fellowship in Surgical Oncology at Memorial Sloan-Kettering Cancer Center, and has lectured and published extensively in this field. Dr. Kaleya’s office is at 948 48th Street, 3rd floor, and he can be contacted at (718) 283-7952. (1) http://www.vnews.com/home/313692295/cancer-welch-screening-women (2) http://www.nejm.org/doi/full/10.1056/ NEJMp1209407

February 2013


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H&l mbs feb 2013 full