A Publication of
Being Prepared for the New School Year Page 14
Making the Multi-Generational Household Work Page 20
Recipes for Yom Tov Page 45
See Page 36
Mind, Body & Soul Inside
a hospital that’s sensitive to your needs When choosing a hospital, you want not only the best medical care you can ﬁnd — but also sensitivity to your cultural and religious needs.
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That’s why Mercy Medical Center, with support from Chabad of the Five Towns, provides special services and amenities for our observant Jewish patients, their families and other visitors. • Jewish Chapel with Mincha services Monday – Thursday • Glatt Kosher and Cholav Yisrael meals available to patients, and for purchase by visitors in our Dining Room and Patio Grill • Rabbinical services, prayer books and electric Sabbath candles on request
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■ Contents ■
* Indicates new feature
Circumcision Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Conversations in Health Care
Healthcare Conversations . . . . . . . . . . . . . . . . . . . . . . . .9
Over and over again, they were offered the choice of discontinuing her “aggressive” medical care, but the family held out. They continued her medical treatment.
Backpacking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Kids and Caffeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Pink Eye. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Sugary Cereals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Backpacking to School Statistics show that thousands of children are treated in emergency rooms each year for backpack related injuries. The most common complaints are sprains and strains.
Features Editor Karen Greenberg
Children Editor Dana Ledereich
Cover Story Editor Rachel Wizenfeld
Editorial Staff Aliza Levinger Leah Rothstein Raquel Wildes
Advertising Director Heshy Korenblit Back to School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Advertising Sales Women’s Health
Arthur Klass David Hoppenwasser
Delayed Cord Clamping . . . . . . . . . . . . . . . . . . . . . . . 16
Home Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Morning Sickness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Osteoporosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Golden Years Cover Design Alana White
Multigenerational House. . . . . . . . . . . . . . . . . . . . . . . 20
10 New York Hospitals Making Religious Accommodations Many New York area hospitals have added liaisons to the Jewish community to their staffs to serve as patient guides and advocates.
Logos and Sidebars Design Rivka Feder
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* Profile of a Caregiver. . . . . . . . . . . . . . . . . . . . . . . . . . 22 The Medicare Political Issue . . . . . . . . . . . . . . . . . . . . 23 NY Area Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Parenting Parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Prostate Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
■ Contents ■ Medicine Today
The Changing Face of Medical Care
Sleep Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 * Positions in Healthcare – Doulas . . . . . . . . . . . . . . 30
Dramatic and fundamental changes have been taking place transforming the way that individuals receive their medical care, and in the ways that health care professionals provide it, and are paid for it.
* FDA Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Changing Face of Medicare . . . . . . . . . . . . . . . . . . . . 32 * Genetics Frontier – Focus on Krohn’s . . . . . . . . . 35
Healthy Living Special Section – Weight Loss . . . . . . . . . . . 36-41
Gaming for Seniors It is no surprise that many retirement homes are now advertising Wii gaming in their brochures.
* The Alternative Way – Focus on Acupuncture . 42 About Cholesterol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 * Trim & Fit - Dieting Tips . . . . . . . . . . . . . . . . . . . . . . . 44 * Holiday Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
H & L Tech * Gaming Consoles for Seniors . . . . . . . . . . . . . . . . . 46 Shabbos Stairway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
From the Editors Health & Living is broadening the range of its recurring columns. In each issue, they will provide usable, reliable information, updates and insights designed to help our readers maintain their health, improve their quality of life and expand their horizons. The Doctor’s Desk is a unique forum in which a leading community physician shares their unique medical expertise with our readers, and gets a chance to sound off. Trim and Fit gives us tips to staying active and maintaining a healthier lifestyle. Kosher in the Kitchen adds variety, originality and flavor to our food choices. Tech Support shows us how to use the latest technological advances to enhance Jewish living. The Alternative Way expands our health horizons beyond the limits of conventional Western medicine. The Genetic Frontier explores the latest breakthroughs on the most exciting frontier of medical research. Positions in Healthcare illuminates the new job and career opportunities opening up in one of the fastest growing segments of the US economy. The FDA Monitor keeps you up-to-date on the new safe and effective medications and treatments now coming onto the market. In addition, each issue offers in-depth coverage on a variety of compelling topics. Our cover story is designed to help our readers fight their personal “Battle of the Bulge” with a survey of today’s most popular weight loss approaches and techniques, to help find the right one for you. We deal with cutting edge issues in the headlines today, such as the political debate over the future of Medicare and an explanation of the scientific and halachic controversy over the use of Metziza b’Peh in circumcision. We explain the new forces and concepts that are reshaping the American health care system. We also provide practical advice and insights for members of the “sandwich generation,” on how to effectively parent their parents and make the multigenerational household work.
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H & L Showcase. . . . . . . . . . . . . . . . . . . . . . . . . 48-49 The Gluten Free Lifestyle
Community Profile *Gift of Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Gift of Life
Medical Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
It was Feinberg’s four year odyssey to find a suitable donor that brought about the now massive Gift of Life registry, which, as of 2010, was the eleventh largest in the world. Diagnosed with chronic myelogenous leukemia.
Community Provider Bulletin. . . . . . . . . . . . . . . . . . . 52
Seniors Guide to Medicare Choices
Politics of Circumcision
Mind, Body & Soul Inside
Community Calendar . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Classified Listings . . . . . . . . . . . . . . . . . . . . . . . . . . . 54-57 *From the Doctor’s Desk . . . . . . . . . . . . . . . . . . . . . . . 58
Join Us for our November 2012 Issue
August 2012 ISSUES
Metzitzah BePeh: An Overview and Opinion By Gary A. Gelbfish, MD, FACS
etzitzah be- Peh is not a new concept. Metzitzah, the suction of blood from the circumcision wound, is codified in the Mishnah in Masechet Shabbos (133a), and is considered vital enough to warrant its practice even on Shabbos, despite its inherent chillul Shabbos. The Gemara (133b) dictates, that a mohel who does not perform Metzitzah places a child in danger and should be removed from his post. The Rambam, a renowned physician, formally codified the practice of Metzitzah (Hilchos Milah 2:2) as did the Shulchan Aruch (Yoreh De’ah 264:3). No specific method of suction or drawing away of blood is mentioned in the Talmud. The suction was historically done by the oral method because the mohel’s mouth was a convenient source of suction, and because the medical theory of the time considered the placing of one’s mouth on another person’s wound to be totally safe. Additionally, some kabbalistic sources advocate oral suction based on mystical reasoning. Thus, metzitzah was classically equated with metzitzah bepeh (MBP). That began to change in the first half of the nineteenth century with the gradual acceptance of the germ theory of disease. In 1837, a doctor in Vienna, suspected that children were being infected through oral contact during circumcision. He brought his concerns to the Chief Rabbi of Vienna, who asked the Chasam Sofer, considered the reigning posek of the day, for a ruling on this matter. The Chasam Sofer issued a short response stating that substitute methods may be used to replace MBP based upon the following arguments: A) Oral contact is not specifically mentioned in the Talmud when metzitzah is described, so any device that has a similar effect may be used. B) Metzitzah is not part of the essence of the mitzvah of circumcision. Its only purpose is for medical purposes for which other equally effective means may be used as a substitute. C) We are not bound today to use the specific medical interventions described in the Talmud. However, the Chasam Sofer’s ruling on the subject was soon challenged by other poskim of the late
19th century period. Even his disciple, the Maharam Shick, was urging communities to continue the use of oral suction, arguing that the practice may be a Sinaitic ruling, a Halacha L’Moshe M’Sinai. Nevertheless, many poskim in major Jewish population centers, including London, New York, Vilna, Frankfort and Berlin, issued responsa supporting the ruling of the Chasam Sofer and permitted the use of alternative methods of suction as a substitute for traditional MBP. The medical imperative to avoid oral contact was based on many case reports of infants who appeared to have contracted genital infections and died as a result of the traditional MBP process. However, over the past 65 years, such infections have been more effectively controlled, due to better understandings of epidemiology, personal hygiene and the use of antibiotics. This has led to the widespread belief that the traditional MBP method is now safe to use, and led to its renewed popularity. In the 1980’s, with the advent of the AIDS epidemic, MBP came under scrutiny again, this time out of concern for the mohel’s safety. The fear was that a mohel who performed oral suction could acquire the HIV virus from a baby who was born already infected with HIV from its mother. As a result, mohalim do not do MBP on babies whose family history gives rise to AIDS concerns. However, in most instances, this fear does not apply, and it has done little to reduce the frequency of the use of MBP. It was only in the 1990’s that a serious fear arose that the baby could contract an infection from the herpes simplex virus, type-1 (or HSV-1) from the mohel due to MBP. HSV-1 is different from the bacteria-based infections which had caused concern about the use of MBP before World War II. The HSV-1virus mostly resides in the mouth. It is a life-long infection once contracted, and does not respond to antibiotics. Even recent antiviral medications, which can suppress the infection and decrease its symptoms, are not a long-term cure. Most people who have the HSV-1 virus do not know they are infected. The virus can be contagious to others without open sores and can stay dormant for long periods of time. Most HSV-1 is not sexually transmitted, and it is so widespread that
even the most pious and careful mohel may still be an unwitting carrier. Studies have shown that rate of infection increase with age, and that more than 70% of adults are infected with HSV-1, giving real substance to the fear that the practice of MBP can lead to the further spread of the herpes virus. This is further supported by medical reports of roughly 20 infants contracting a herpes infection on their genitalia after circumcision. Of these, two children died, at least one has significant neurological impairment, and the others have contracted a lifelong infection. It must be noted that the number of cases are almost certainly greater since not all such cases are noted or have been linked to MBP by pediatricians, and they have not been reported in the medical literature or tracked in an organized way. Mandatory neonatal herpes reporting was only instituted in New York State in 2006, and herpes infections in babies are systematically tracked in only a handful of states. The reported cases of HSV-1 infection following MBP represent only a minute fraction of all circumcised children with MBP, but they came to the attention of the New York City Department of Health because more than one case was linked to a single mohel, and ‘clusters’ of HSV-1 cases on the genitals of infants are seen only in Charedi neighborhoods. A recent review by the US Centers for Disease Control (CDC) based on New York City data found that the risk for newborn male babies to contract a herpes infection tripled when MBP is performed. MBP violates a stringently practiced safety rule in modern medical practice which demands that bodily fluids like saliva (or blood) must not be exchanged with any patient, certainly with infants who have an immature immune system. There are some who do not accept the conclusion that the medical data proves a risk of Herpes infection to the child from MBP, and cite the lack of definitive DNA evidence to support it. They also critique the methodology used to analyze the available public health data and postulate that other infant caregivers or siblings may be to blame for all the reported cases. They also impugn the motives and methods of public health officials who oppose the practice of MBP. They assert that MBP is absolutely safe and
requires no modification. As a physician, I believe that the medical arguments of those who defend the safety of MBP are specious. It has been amply established that adults intermittently shed the herpes virus even without open oral sores. If so the mohel MAY be a source of infection just as any other person can. It is therefore unnecessary to demand the presentation of absolute proof via DNA analysis of Mohel-to-infant transmission in a given case, before accepting the sensible recommendation that we play it safe by modifying the practice of MBP in order to eliminate the risk that the Mohel might contaminate the open circumcision wound with his saliva. The Talmud and poskim have never demanded absolute proof when it comes to issues of pikuach nefesh. The evidence presented by modern medicine that MBP presents a credible risk of Herpes transmission may not yet be definitive, but it is at least sufficient to establish a serious safek at this point. Certainly, the available epidemiological data of babies with genital herpes infection shows a strong correlation with MBP. Unfortunately, some parents and mohalim who demand further evidence are making the process of collecting it more difficult by refusing to cooperate with the collection of saliva samples for DNA analysis and, at times, even the identification of the mohel involved. This raises the question of whether they are actually seeking the truth or, through their refusal to cooperate, looking for a way to avoid facing it. While more medical research to assess the risk from MBP is still needed, that is only half the story. Parents also need halachic guidance to answer a separate set of questions before deciding whether to allow the use of MBP in the circumcision of their child. For example, which physician(s) will you recruit to interpret the medical data for you? What level of risk is reasonable in the performance of a mitzvah? Most importantly, is MBP an integral part of the bris, or may it be modified if there is even a smallest suspicion that it may cause harm to the baby? To many, the halachic logic would seem to be simple. Given the great importance that halacha places on all issues of pikuach nefesh, we should rely on the halachic responsa starting
Important Conversations About Health Care By Barbara Olevitch
rticles in the media are recommending a certain kind of “conversation.” In an article in the Philadelphia Inquirer in 2010, Michael Vitez describes in detail how a palliative care team brought a family into a comfortable living room for repeated discussions about their mother who had been hospitalized for confusion and falling. Over and over again, they were offered the choice of discontinuing
her “aggressive” medical care, but the family held out. They continued her medical treatment. But in spite of the fact that their mother eventually woke up and went home, the family is not being held up as a good example. Rather, their decisions are being questioned. The article implies, look what they put her through, look how much it cost. A palliative nurse is quoted as having raised a “hard question,” whether her treatment was worthwhile, because maybe she’d end up in a nursing home. The contrast with our Jewish beliefs could not be greater. We believe that life is precious in or out of a nursing home. In fact, we believe that the treatment would be worthwhile even if it just extended her life for a few minutes. Moreover we believe that omitting this woman’s treatment would have been
from the Chasam Sofer and others, including Rav Moshe (Igros Moshe, Y.D. 1:223) who were of the opinion that metzitzah was intended only as a medically related procedure and is not part of the essence of the mitzvah of circumcision. To others, however, MBP is halachically an integral and essential part of the circumcision process which cannot be modified without the pre-
tantamount to murder. Make no mistake. This is a war of ideas. The reasoning of the palliative nurse and the innuendos in the newspaper article about the woman’s suffering and the expenses are, to us as Jews, completely unacceptable. Since, to us, letting her die would have been equivalent to murder, it is truly preposterous to assert that sending anyone to a nursing home is so terrible that a family should consider letting a patient die for that reason.
Even the palliative care nurse doesn’t really believe that. Would they agree to put to death everybody who needs a nursing home? Of course not. But, having long, seemingly intimate discussions with medical professionals on various questions like this confuses a family, and is intended to create a feeling that it would be rude to refuse to compromise. So what if the expenses were so high? That happens sometimes in a difficult case. They paid their premiums. They’re entitled to treatment. That’s what medical insurance is supposed to do - pay for expensive treatment. Why does our society take the amount of the bill so seriously? No one would claim that we don’t need all this expensive testing equipment in the
sentation of indisputable medical evidence that it presents a serious risk to the health of the child. I believe “To each their own,” as long as people are able to decide based on undistorted halachic and medical information. Ultimately the parents of a newborn must choose a mohel and make a decision based on their hashkafa and the advice of whomever they consult for such ques-
hospital. It doesn’t really cost the hospital a large amount every time they use the equipment. Her test didn’t wear the machine out. It will still be there for others. The amount paid for her treatment didn’t really go just for her treatment - it funds the hospital which is doing all sorts of good things for other patients as well. Families facing this sort of pressure shouldn’t think, “We are being selfish. We’re making our loved one suffer and costing society a bundle to satisfy our own beliefs.” That is the secular view. Instead, they could be inspired to think, “G-d loves the Jewish people. He gave us the rules that are the best not just for us but also for the entire world. It is not for the doctor or any human to determine when someone will die. We are not allowed to acquiesce in the taking of a human life or to sign a document to deprive a human being of what he needs to survive. Maybe my loved one will die or maybe he will live, but that is not my choice. All I can do is follow the Torah.” The important questions for the family to consider should be: “Which Rabbi should I tell about my loved one’s medical problem so that he can help us if we have a medical decision to make?”“Has my loved one signed a halachic health care directive indicating that he wants to be treated according to Jewish law as interpreted by our Rabbi?” “If my loved one ends up in a nursing home, how can I make his life as happy as possible?” Our job is to help our loved ones get medical care, visit them, take care of them, encourage them, and pray for them. Our Rabbis will know what questions to ask. The modern “ethicists” think they are qualified to make definitive decisions on these high-level questions of life or death, but without the Torah, they are unable to do so. By claiming otherwise, they are actually spreading dangerous confusion. Jewish families should be aware that they can get these halachic medical directives from Agudas Israel of America. May our actions in taking care of our loved ones give us the merit to have our prayers answered for a cure for them, and may the time be soon when illness will disappear. Barbara 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
tions. If you are not sure where you personally stand, I would recommend that you ask yourself the following question to help your thought process: If your baby unfortunately contracts herpes following a bris with MBP, will you accept it as part of the necessary dictates of Judaism and/or deny any connection to MBP? Or instead, will you feel that herpes could
have been avoided and a tube should have been used? Whatever your answer would be, let me say that I hope and pray that you will never actually have to face this question in real life. Dr. Gary Gelbfish is a vascular surgeon. He was certified as a mohel in 1982 by the Chief Rabbinate of Israel. He can be reached at firstname.lastname@example.org
RAISING OUR CHILDREN
Backpacking to School By Dana Ledereich
t’s that time of year again! Back to school sale signs are plastered all over the neighborhood. Items for purchase range from school uniforms to shoes to school supplies. But to your child, the most (important) significant purchase will be the choice of backpack. Backpacks range in size, style and price and may be her most important accessory choice this year. While your child may be mostly concerned with the image she projects with her backpack, your biggest consideration should be her health and safety. Statistics show that thousands of children are treated in emergency rooms each year for backpack related injuries. The most common complaints are sprains and strains. The most common mistake children make with their backpack is overloading it. They keep more books inside than are necessary for that night’s homework. Similarly, they neglect to go through their backpacks periodically to clear out all of the accumulated loose papers – a hodgepodge of old tests and previous homework
assignments. To ensure back health, a child’s backpack should not weigh more than 15% of her weight. If the average weight of a first grade girl is
those things necessary for that night’s homework. Some parents find it helpful to maintain an extra set of school books at home so that their child does
45 pounds (50th percentile) then her full backpack should not exceed 6.5 pounds Parents should check their children’s backpacks regularly to make sure that (it is) they are carrying only
not have to take them back and forth between school and home. Parents should take to the time to teach their children how to sort through the papers in their backpacks to determine what’s important to keep and what can be discarded. It’s often helpful to keep a special folder at home in which each child can keep the papers that she wants to preserve in order to prevent a buildup in her backpack. When loading books into a backpack, the largest and heaviest books should be placed first in the rear of the backpack. These organizational tips will serve the child well throughout her school career and beyond. When buying a backpack, it’s important to consider its construction. The lighter the material, the lighter the bag. Traditional canvas backpacks are therefore recommended over leather ones. The size of the backpack is important as well. When worn, the bottom of the backpack should not be lower than four inches below the child’s waist. A smaller child requires
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a smaller bag. Consider the straps of the backpack. Wide, padded straps will better distribute the weight and cushion the shoulder. Similarly, backpacks with a padded back provide extra cushioning (as well as) and protect(ing) the child from objects sticking out of the bag, such as pencils and protractors. Waist belts also help to distribute the weight better and are particularly helpful on a larger, heavier bag. Rolling backpacks are recommended because they provide the child with a convenient and safe way to avoid any strain on their back. (Make sure that your child is wearing her backpack properly, and using both straps to distribute its weight properly. Using only one strap on their backpack places too much strain on one side of their body, and can lead to overuse injuries.) Common symptoms exhibited by children suffering from an inappropriate choice or use of a backpack include back pain, shoulder pain, numbness and tingling and red marks on the skin. If your child suffers from these symptoms, check their backpack and how your child uses it. Make sure that it is not being overloaded due to books and items that your child does not need to carry. Some children sling their backpacks over only one shoulder but this places too much strain on that side of the body. Encourage them to use both shoulder straps to distribute the load and lessen the strain. When choosing the right backpack for your child, consider its size, material and cushioning in order to facilitate back safety. Be sure to also consider style; after all, it IS her most important accessory! Dana Ledereich, MA, OT/L is a pediatric occupational therapist who works in Yeshiva of Flatbush and also maintains a private practice. She evaluates and treats children age birth-13 years with sensory processing issues, poor handwriting, developmental concerns and neurological issues. She can be reached at 718-252-2939.
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BACK TO SCHOOL • A child’s backpack should not weigh more than 15% of her or her weight • Parent’s should check their children’s backpacks regularly to make sure they are carrying only those things necessary for that night’s homework • When worn, the bottom of the backpack should not be lower than 4 inches below a child’s waist • Rolling backpacks are recommended as a way to avoid any strain on the child’s back
RAISING OUR CHILDREN
Kids and Caffeine By Aliza Levinger
affeine consumption is an old debate, one that we read about as we casually flip through a magazine over morning coffee. Having come to the realization that there is no way to get through the day sans coffee, we just turn the page. What about kids, though? Caffeine is increasingly accessible and appealing to kids as sodas and caffeine-laced energy drinks have become more popular and accepted. A sip of dad’s bitter black coffee is no longer the extent of their potential caffeine intake. 75% of children surveyed reported a daily intake of caffeine, a 2010 study in the Journal of Pediatrics showed, and the more they drank, the less they slept. The American Association of Poison Control Centers reported 1200 cases per year of caffeine toxicity, or unhealthy levels of caffeine, in kids under age six. Dr. Todd Bania, Director or Emergency Toxicology in St. Luke’s Hospital said studies show twice the amount of caffeine toxicity in kids over adults. “Sometimes I can even see their hearts beating through their clothes,” he said. While studies of the effects of caffeine on kids are surprisingly sparse, the issue is now attracting more attention. Most researchers agree that caffeine’s effects on children are much the same as on adults. This means that caffeine can increase alertness and improve performance to an extent. However, at the same time, caffeine blocks serotonin, the chemical responsible for calming the brain, thus causing an increase in stress hormones. High stress responses can cause increased insulin resistance and fat storage, potentially leading to diabetes and obesity. Decreased serotonin levels also inhibit impulse control. There is a range of caffeine sensitivity, so not everyone will feel the effects of caffeine the same way, but some scientists believe that because kids are smaller than adults, they get a bigger jolt from the same amount of caffeine. Continuous use leads to withdrawal symptoms when the pattern of consumption is interrupted, which in adults can be produced by as little
as repeated consumption of a six ounce cup of coffee, according to Roland Griffiths, professor in the departments of psychiatry and neuroscience at John Hopkins University. This is an important concern for Gail Bernstein who is the director of the division of child and adolescent psychiatry at the University of Minnesota. In a study, for thirteen days she gave the equivalent of the amount of caffeine in about three soft drinks to 30 children between the ages of eight and thirteen. 24 hours after discontinuation of the caffeine, she found that the children’s performance on a computerized test had deteriorated. According to the Washington Post, “Bernstein said her findings suggest that kids who drink large quantities of caffeine-containing beverages, or who have erratic spells of heavy soda guzzling--while they’re on vacation, for example--may experience a dip in performance when they abruptly stop.” Another study, this one by the University of Buffalo, showed that boys were more stimulated by caffeine than girls, although after being primed with caffeine, both showed a preference for junk food. Current research suggests that too much ingestion of caffeine is problematic, but scientists say that small to moderate consumption of caffeine is okay, and that there is no need to close down Starbucks or empty the supermarkets’ coffee aisles. So how much is too much? For children, the American Dietetic Association put the cap at 100 milligrams daily, which is about the contents of a standard cup of coffee, or about two or three 12 oz cans of Coke or Pepsi. The effects of too much caffeine – insomnia, anxiety and poor impulse control – can be pretty easy to spot in your child, so it should be pretty clear when they’ve had too much. Although the golden mean of caffeine intake is still murky, as in all things, moderation seems to be the key. So if your child asks for a sip of your morning coffee you don’t need to scare him off with dire threats of stunting his growth. But you do need to monitor their caffeine consumption from all sources, and perhaps think about your own level of caffeine consumption as well.
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RAISING OUR CHILDREN
Pink Eye Essentials By Sandy Eller pproximately fifteen to twenty million Americans are afflicted annually with the epidemic keratoconjunctivitis, an infection or irritation of the thin, clear membrane, known as the conjunctiva, that lies over the white part of the eye and lines the inside of the eyelid. More commonly known as conjunctivitis or pink eye, because of the uncharacteristic red and possibly swollen appearance the eye takes on during this condition, it is most commonly
According to the National Institutes for Health, most cases of conjunctivitis are viral in origin and are generally accompanied by other bodily infections including measles, the flu or the common cold. Viral conjunctivitis, which often begins in one eye and can spread to the other eye in just a few days, is generally accompanied by a watery discharge and can spread to others through the air by coughing or sneezing. In most cases, there is no treatment for viral conjunctivitis. The condition will resolve itself after the virus has run its course, which can take as long as fourteen to twenty one days.
caused by either or a viral or bacterial infection. It can also be the result of an allergic reaction or other irritants. In newborns it may be due to a blocked tear duct. Both bacterial and viral pink eye can be highly contagious and can easily be spread for as long as two weeks after signs or symptoms first appear. The most common symptoms of pink eye include redness, itchiness, tearing, discharge that forms a crust at night and a gritty feeling in the eye. Symptoms can appear in one or both eyes. It is important to see a doctor in order to get a proper diagnosis as well as determining a proper course of treatment, if applicable. Doctors recommend that those with contagious conjunctivitis remain at home from work or school until they are no longer contagious. While conjunctivitis can occur in both children and adults, it is found more frequently in children, as it can spread rapidly in communal settings such as classrooms, day care centers and summer camps. The American Academy of Ophthamology estimates that more than three million school days are missed annually because of pink eye. Outbreaks of conjunctivitis are more prevalent in densely populated countries such as Japan, which has over a million cases annually. Approximately two percent of all primary care visits and one percent of emergency room visits are related to conjunctivitis.
Bacterial conjunctivitis is often accompanied by a slightly thicker yellow or green discharge that can form a crust on the eye when sleeping. It is generally treated with antibiotic ointments or eye drops which kill the bacteria responsible for pink eye. Patients with the bacterial form can generally return to school or work after twenty four hours, when they are no longer contagious, and symptoms should subside within a few days. Conjunctivitis caused by either allergies or an irritant can be improved by eliminating exposure to the allergen or any potential triggers. In the case of allergic conjunctivitis, which is characterized by itchiness, tearing and puffy eyelids, both antihistamines and avoidance of the allergen should provide relief. Wearing eye protection when working in the wind, heat, cold or with chemicals, as well as avoiding excessive smoke and perfume, should prevent instances of pink eye caused by irritants. Good hygiene is the key to limiting the spread of contagious forms of pink eye. The bacteria or virus can survive on items or hard surfaces touched by an infected person and spread it to others for as long as seven weeks. For those with infectious conjunctivitis, the Mayo Clinic recommends frequent hand washing, changing towels, washcloths and pillow cases daily, discarding all eye makeup as well as not
sharing towels, linens, eye makeup or any personal eye care items. Avoid touching your eyes and if you do, wash your hands immediately. Contact lens wearers should not wear their lenses until the infection has cleared. While regular contact lenses can be disinfected before wearing, disposable lenses should be thrown out, as should all accessories that could carry the infection, including contact lens solution and cases. Home treatment for conjunctivitis includes frequent hand washing and using compresses (cool for allergies, warm in all other occurrences) to provide relief. Wipe eyes from the inside corner outward, using a different compress for each eye in order to avoid spreading the infection. Non-prescription artificial tears may also relieve itching and burning, although the same bottle of drops should never be used for both an infected eye and an uninfected eye. Folk remedies to alleviate pink eye symptoms include placing cooled chamomile tea bags on the eyes or using an eye wash made of either eyebright, an anti-inflammatory wild herb found in Europe, or boric acid. According to reports on WebMD.com, Swedish pharmaceuticals company Adenovir Pharma is conducting trials on an eye drop called ADP-209 that may finally provide treatment for those suffering from viral conjunctivitis. The treatment targets several adenoviruses which are responsible for most cases of pink eye and creates an artificial surface on the conjunctiva, preventing the virus from binding to the eye and allowing it to be washed away by tears. While the treatment has so far only been tested on animals, results have been promising and Adenovir Pharma is currently working on the next stage of clinical trials. Conjunctivitis is rarely serious, but complications of pink eye can include corneal inflammation which may affect vision. Symptoms that should be brought to a doctor’s immediate attention include: decreased or blurred vision that does not clear with blinking, continuous or increasing eye pain, a developing sensitivity to light and persistent symptoms that become increasingly more severe or frequent over time. 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.
PINK EYE ESSENTIALS • 15-20 million Americans are afflicted annually • Doctors recommend that those with contagious conjunctivitis remain at home until they are no longer contagious • Good hygiene is the key to limiting its spread • Treatments depend on the type of infection, and range from antibiotics to home and folk remedies
Sugary Cereals and Your Kids By Raquel Wildes
ould you serve your child opiates for breakfast? We didn’t think so. Then why feed them sugar-laden cereals? Laboratory research suggests that sugar, which is habit-forming, stimulates the same brain responses as certain drugs. In the classic TV ad, Tony the Tiger was right when he said that Frosted Flakes are “more than good,” but he was wrong when he called them “great.” Advertisers have been quite literally sugarcoating these cereals with catchy cartoons and slogans, but in doing so, they are perpetuating childhood obesity. In fact, the amount of sugar in cereals like Frosted Flakes can be detrimental to a child’s overall wellbeing. On-going research suggests that childhood obesity effects not only a child’s health and self-esteem, but also their intelligence quotient (IQ). When a child eats a sugary cereal for breakfast, it’s almost no different than eating a dessert. Just one cup of Honey Nut Cheerios, Apple Jacks, or Cap’n Crunch, (among others), contains more sugar than three Chips Ahoy! Cookies. Furthermore, in a 2011 Environmental Working Group study on sugar-laden children’s cereal, findings show that children who eat high sugar breakfasts have more behavioral issues at school, become frustrated more quickly and struggle more with independent work than other children. By lunchtime, these students make more mistakes on their school-
work, have less energy and pay less attention to the teacher. Childhood obesity, an epidemic in its own right, is a paramount issue in today’s health culture. Over-
weight children tend to become overweight adults, and can develop an array of medical issues at a young age. In fact, according to a 2006 study, children who are overweight in their preschool years are five times more likely than other children to be overweight at age 12. As such, researchers are being proactive in
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turning their attention to childhood obesity as a way to curb adult obesity. In an effort to fight the childhood obesity epidemic, a panel of scientists and experts rallied Congress and created nutritional guidelines for foods marketed to children. These guidelines, to take effect in 2016, establish a 13-gram limit for sugar content per serving, which equates to 24-26 percent of the product by weight. Currently, only one in four varieties of cereals on the market meets these proposed standards. It is important to check the sugar content recorded on nutrition labels. Cereal, food and beverage companies have been lobbying against these regulations. The cereal industry’s own standard suggests that any cereal marketed for children should be 38 percent sugar or less. Regardless, Toucan Sam and many of his advertising compatriots market cereals that are more than 40 percent by weight. In general, children’s cereals have 56 percent more sugar, half as much fiber and 50 percent more sodium than “adult” cereals. Furthermore, approximately 90 percent of cereal ads targeting children are for products with sugar content higher than 26 percent. Researchers from the Yale Rudd Center examined the nutritional quality and advertising of more than 100 brands and nearly 300 varieties of cereal for Food Policy and Obesity. They found an overall imContinued on page 15
RAISING OUR CHILDREN
RAISING OUR CHILDREN
Back to School By Ita Yankovich
cannot think of any other time when one segment of society is so thrilled (parents) while the other is so miserable (kids) than the end of summer and the return of school. Summer is a time to relax but when school is out and camp is over and everybody is home and bored, it makes for a stressful time where most parents count down the hours till school resumes.
Things you can do to prepare for school
Make sure you’ve completed and submitted all back-to-school forms such as medical records, medication administration forms or vaccination records. You don’t want your child to be sent home on the first day of school because their required paperwork is not up-to-date. If you plan to participate in carpools, start organizing them now. Don’t wait too long, or you may be left with no one to transport your child to school. Being that the Yomim Tovim and the beginning of the school are close together this year, plan ahead to make more efficient use of the limited amount of preparation time available. For example, schedule a time to take the kids for a haircut so that you are not forced to wait with your child for hours at the barber shop the day before Yom Tov.
Nursery/Kindergarten If your child has been home with you up until now or with a babysitter, transitioning to a kindergarten or nursery environment for the first time will be a major milestone that needs to dealt with sensitively. Especially if your child has never been without you for an extended period of time before, you may want to schedule an extended time when your child is under the care of a familiar relative, neighbor or friend to get him/her accustomed to not having you always around. Parents need to explain to their child about what ‘school’ is in terms that they understand before their first day of class. Explain that there will be a 'Morah' and other kids present, and that the daily schedule will include circle time, lunch time, nap time and other activities. It is also a good idea to drive or walk by the school many times before the first day of school to help your child become familiar with
the neighborhood and landmarks along the way. If the school is open during the summer, try to stop by with your child to enable them to see the premises and become comfortable with the surroundings. You can also inquire about the other children who will be in your child’s class during the new school year, enabling you to contact other parents and arrange a small playdate with them so that your child will have one or more new friends right from the first day of classes.
Pre-School If your child is beginning preschool, at least two weeks before classes start, talk to your child about what it means to be in school. Pick out their knapsack with them and fill it with the school supplies they will need together so they feel like a ‘big kid.’ Discuss the concept of homework, and give them a taste of what it will be like. When buying crayons or paint for school, purchase a smaller box of crayons at home, so that your child can practice coloring and drawing. There are plenty of children’s books and videos about the first day of school which you can buy or borrow from your local public library that will help your child to get used to the idea that “big boys and girls” look forward to going to school On the first day of preschool, make sure that you can take your child to school yourself, and let him or her get used to the environment before you leave. Repeat this process for the next few mornings, if you can, until your child gets used to this major change in their day. It is also important to take your child to the school’s bathroom and let them become comfortable with the sink and toilet. This will reduce the possibility that a child who is already potty trained would regress and have accidents at school because they feel insecure using the unfamiliar bathroom facilities.
Elementary School Make sure your child has had a hearing and visual test prior to school starting. In many cases, if a young child shows some symptoms of learning disabilities, the problem turns out to be much easier to correct by fitting the child with the appropriate eyeglasses or hearing aides Elementary education is the foundation for the rest of your child’s formal education, so it is important to
use the free time in the summer to prepare a quiet, homework and study area for your child to use during the school year. If your child’s school requires them to wear a uniform, purchase it far enough in advance to make sure fits properly and allow them to get used to wearing it. Practice handwriting skills with your child, which is a precious gift which they will be using for the rest of their lives. Take out some appropriate children’s books from the library to help the child to develop their reading and writing skills. Your child will move from pre-reading skills to building crucial language skills in reading, spelling and writing. At home, when you read stories aloud to your child, ask them follow up questions such as: “Who are the characters in the story?” “Where does the story take place?” “What happens in the beginning, middle and end of the story?” Even if you plan to enforce a no Internet policy, you still need to make sure that your child has the basic computer skills they will need, such as the ability to type, save, retrieve and print documents on a PC, and also knows how to use calculators, tablets etc..
High-school The transition between elementary and high school can be challenging even when your child will be staying with attending a familiar group of friends in their new school. In high school, they will be expected to exhibit a greater degree of maturity and independence than ever before, at a time when they are already being challenged by the physical and emotional changes that come with adolescence. Because many teenagers are emotionally insecure, it is often advisable to broach the subject of their new responsibilities in high school while engaged in other, non-stressful activities such as shopping for new clothes or while dining out. Your teenager may be worried about fitting in and making new friends (especially if their current friends are going to different schools). Even if they are already popular, they may feel pressure to maintain that status. The same holds true for academics; whether your child was on the honor roll or an average student, high school brings new pressures and challenges, and many teenagers are worried about their ability to handle the added stress.
College College years confront parents with a whole new set of issues and potential dangers for which their children must be prepared. Be honest with them. Up until now your child has been sheltered from many of the threats of outside life. If they will be attending a public or non-Jewish college, they will now be exposed to people of the opposite sex, of different religions and nationalities and with different moral standards much more than ever before. They will also be exposed to the temptations of drugs and alcohol. Don’t let them confront those challenges in college life unprepared. Explain to them the dangers that lurk and what kind of behavior you expect from them. In college. no one forces you to attend class, do the required reading and submit homework. There are also many distractions in college life which can entrap freshmen and cause them to fail. That is why it is important for parents whose child is entering college already has good study habits in place.
A Parent’s Job Is Never Done On one level, does not matter whether your child will be entering preschool or Harvard this fall. As a parent, your job is to give them the preparation and support they will need to overcome the new challenges they will be facing, and to succeed. Ita Yankovich is a freelance writer. She also teaches English and Literature at Kingsbrough and Touro College.
THE EXODUS OF SUM MER AND THE RETURN TO SCHOOL • Be prepared for each of your child’s levels of schooling • Emotionally prepare younger children for new environments • Complete all technical forms and issues in advance • Reinforce what they are learning at home • Discuss new obstacles for older children honestly and openly
SO, WHAT’S A PARENT TO DO?
Sugar Cereal Continued from page 13
provement in the nutrition of cereals in recent years, but products geared for children are still much more harmful to a one’s health than those sold to adults. There are many culprits to blame for this vicious cycle, with the advertising agencies working for sugar-laden brands at the top of the list. From the time children enter kindergarten, their diet is heavily influenced by what they see on television. A 2011 study found that youngsters with relatively high exposure to food ads on television consume more soft drinks and fast foods than other kids do. Moreover, cereal companies continue to pour money into marketing the most sugar-laden products, despite a 2006 pledge by the Food and Beverage Industry to renovate its advertising approach to children’s cereal. Advertisers should be encouraged to use their resources and creativity to convince children they want products with lower-sugar content. It has been done in the past and surely can be done again for a 21st century, media-influenced clientele. In 1978, Kix introduced the slogan, “Kid Tested, Mother Approved,” and in the 1980s used a similarly themed television commercial jingle, “Kids love Kix for what Kix has got. Moms love Kix for what Kix has not.” In its current version, Kix will meet the federal guidelines that are set to go into effect in 2016. This paradox can be boiled down to the classic philosophical conundrum: what came first, the chicken or the egg? Are parents buying sugary cereals for their children because the advertisers made them do it? Or are advertisers taking advantage of child cereal preferences and parental nutritional ignorance?
Marion Nestle, a Professor of Nutrition, Food Studies, and Public Health at New York University, recommends that when selecting cereal, parents look for a short ingredient list, high fiber concentrations, and few or no added sugars. These cereals are usually located on the top shelves, out of reach and beyond eyesight. It is also important to remember that cereal is
already likes, and then add less and less of the more sugary cereal. Once the box of sugary cereal is empty, Fink advises not buying any more of it. Fink also suggests topping off low fat plain Greek yogurt with just a few tablespoons of their favorite sugary cereal and some fresh fruit for a healthier alternative. After all, anything is okay in moderation.
List of Kosher cereals that make the cut: • • • • • • • • • • •
REHABILITATION & HEALTH CARE CENTER
Raquel Wildes is a sophomore at Columbia University. She is a former editorial intern and contributing writer for SavvyAuntie.com, and writes for Columbia's daily newspaper.
not a child’s only option for breakfast. Some types of oatmeal, smoothies, and eggs can make great alternatives. Leslie Fink MS, RD from New York City, suggests to begin weaning your child off sugar cereals by mixing a low-sugar cereal with one your child
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Delayed Cord Clamping By Esther Hornstein, L.Ac., Dipl.
hroughout almost all of human history, in all parts of the world, the umbilical cord remains connected both to the baby and the placenta at least until the cord stops pulsating and sometimes longer. The practice of quickly clamping and cutting the cord within 20 seconds of birth is a common practice in most American labor and delivery rooms. Doctors do this so that other professionals can take charge of and examine the baby right away. However, recent research has had doctors wondering if this practice is beneficial for healthy and stable babies. While a baby is in utero, blood is circulated between the baby and the placenta via the umbilical cord. Once the baby is born, as much as one-third of the child’s blood volume remains in the cord and placenta. The cord continues to pump this blood to the baby for 2-5 minutes after birth. To ensure that the baby’s blood does not pump back into the placenta, a substance called Wharton’s jelly which is in the cord, responds to the change in temperature when outside of the womb and becomes gelatinous. The Wharton’s jelly thereby fills the cord and naturally occludes the blood vessels a few minutes after birth. When the cord is impulsively cut, the baby sustains an enormous loss of blood. This fact leads some pediatricians to advocate for “delayed cord
clamping,” to allow the cord to finish pulsating before it is clamped and cut.
Benefits of Delayed Cord Clamping A growing number of studies suggest that delayed cord clamping offers numerous benefits. It improves a full term baby’s blood count, improves oxygen levels in the brain, reduces the risk of serious bacterial infections, stabilizes blood sugar levels, provides the baby a six months to one year’s supply of iron, improves organ growth, and more.
According to Traditional Chinese Medicine, the blood circulating between the baby and the placenta after birth cleanses the baby from maternal toxins accumulated during pregnancy. By leaving the cord attached until pulsating stops, according to Chinese medical tradition, the baby is afforded added immunity to disease.
Modern Research Proving Traditional Practices At one time, the medical community believed, erroneously, that allowing all the blood to evacuate into the baby from the cord could cause jaundice. Doctors who continue to object to delayed clamping may just not want to try something “new” or may not have read the research (British Medical Journal 2007, August 17 18;335 (7615):312-3. Weeks, A. “Umbilical Cord Clamping After Birth”) on the topic. In fact, evidence to support delayed cord clamping is so strong that the Royal College of Obstetricians and Gynecologists now require delayed cord clamping in all hospitals in the UK. But American OBs have still not adopted this as a standard procedure, despite pediatric research in the US showing the benefits of delayed cord clamping. The American Academy of Pediatrics published an article in April 2006 recommending that clamping be delayed to reduce anemia and improve iron storage. It said that if cord clamping is done too soon after birth, the infant may be deprived of a placental blood transfusion, resulting in lower blood volume and increased risk for anemia. Additionally The Journal of Pediatrics, a publication
of The American Academy of Pediatrics, states that “Early umbilical cord clamping contributes to elevated blood lead levels among infants with higher lead exposure.” (November 2007) As a practical matter, most American OBs will not delay the cord clamping unless the request is clearly expressed by the mother, but others do routinely delay the cord clamping as long as the newborn baby does not need to be transported immediately to specialists or the intensive care unit. A mother who feels strongly about the issue should
discuss it with her OB before going into labor to make sure that her doctor is aware of her preferences. Delayed cord clamping is beneficial even in cases of complicated births. For example; if the baby is not breathing right away after birth, delaying clamping will allow blood and oxygen to continue to flow to the baby from the placenta until the baby’s lungs can take over.
Delayed Clamping Vs. Cold Storage and Donation Some parents choose to harvest the cord blood and bank it in private cold storage for possible fu-
DELAYED CORD CLAMPING • There are over 4.1 million babies born each year in the US • The average length of labor is 10.3 hours • 80% of mothers report using pain medication • Cesarean rate recommended by World Health Organization: 12% • Twins are 2.9% of live births http://www.transitiontoparenthood.com/ttp/ foreducators/ceinfo/stats.htm
Is Home Birth a Viable Option Today? Raquel Wildes one are the days when women who chose to give birth in their bedrooms under candlelight alone, were universally condemned for needlessly endangering their
women do have the opportunity to choose between natural childbirth in the comfort of their own home as an alternative to a hospital-monitored labor and delivery room. A recent CDC study found that U.S. home births— though slightly higher than before— still comprise less than 1 percent of all
newborns. Today, home birth has become much more fashionable in some quarters, and its advocates argue that
deliveries, but it is an option that more women today are considering. Of late, there has been much dis-
ture stem cell use for family members. This necessitates rushing to clamp and cut the cord early, to prevent those valuable stem cells from going into the baby in order to enable a beneficial procedure which is still relatively rare. The lifetime probability of undergoing a transplant of stem cells from a donor (such as a sibling) is 1 in 400. The overall odds of undergoing any kind of stem cell transplant are 1 in 217, whereas the benefits of delayed cord clamping to the baby are both clear and immediate. Dr. Alan Greene, a prominent natural-style pediatrician, calls the extra blood the baby receives from delayed cord clamping a “once-in-a-lifetim” gift of rich, umbilical cord blood. This blood is packed with an assortment of beneficial stem cells. He argues that it would be better to let these stem cells plant themselves in the baby as a last gift at birth, to grow within and carry out the purposes for which they were designed rather than to store them, perhaps needlessly, for many years. Research is just beginning to reveal the true value of this gift. By letting the baby receive the cord blood, the parents may be preventing the very diseases that would be cured by using the banked cord blood years later. Another alternative is cord blood donation, which is a very generous and altruistic deed on the part of the mother. Donated cord blood can aid in the treatment of leukemia and other life threatening illness. However,
one must realize that if the quantity of donated cord blood is too small for such treatment, it will be sold for research. About 50%-75% of donations are not large enough to use for human stem cell transplants. In such cases, the hospital takes the liberty of selling the donated cord blood sample, for thousands of dollars, to the highest bidder. This leads us to wonder whether a mother who has donated her child’s cord blood for virtuous reasons would approve of the hospital selling it for profit. If the cord blood donation sample is not large enough to be used for a stem cell treatment, it may wind up being used to promote government research on cloning or even the development of biological weapons. It may be a greater mitzvah to allow the child to receive its rightful cord blood at birth than to donate it to an anonymous party. Furthermore, it is still possible to delay cord clamping and then donate the stem cells that can be harvested from the Wharton’s jelly of the cord after the blood has finished pumping. A mother has a choice about what happens to her baby’s cord blood. She should let her OB know that delayed cord clamping might just be an important key to her baby’s health.
Esther Hornstein is a wife and a mother of 2. She holds a New York State license to practice acupuncture and is nationally board certified by the NCCAOM. She has participated
cussion and controversy in the media regarding the additional dangers of childbearing far from any hospital setting. However, it is important to distinguish between the increased risks of at-home labor and delivery and the sentiments surrounding it. It is not that home births are more dangerous than before, but rather, in response to those who are advocating it, more and more women are speaking up about the potential risks that it presents.. Medical experts disagree over the available scientific evidence regarding the dangers involved in home birth, which has added more heat to an already emotional debate. Since home births are not as closely monitored as hospital births, exact statistics are hard to come by. In fact, Eugene Declercq, an epidemiologist, professor of public health at Boston University, and co-author of the aforementioned CDC study, explained that
there are simply not enough intentional nationwide home births to be able to fully asses the actual risks. However, three other recent studies done in Canada, Great Britain and the Netherlands have found similar rates of newborn loss (around 2 per 1,000) no matter where the labor and delivery takes place. Even its advocates agree that home birth is not an appropriate choice for women who are not in the best of health, or who are having a high-risk pregnancy. But for the others, the choice is not necessarily clear cut. While it is clear that home births do pose potential dangers, there are risks involved with hospitalized labor, as well. If you and your partner are considering an at-home delivery, you should review the recent research and seek multiple opinions in order to make an informed decision, and to be prepared for any eventuality.
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Morning Sickness: Who’s to Blame? By Sara Ireland-Cooperman
lame Eve. That’s what women have been doing literally since the beginning of the creation of the world. Through every contraction, with gritted teeth and sweaty foreheads women have blamed The First Woman for all labor-related pains they endure. (“You just had to taste that fruit, didn’t ya?”) Fathers and husbands might be happy with that scapegoat, but who is to blame for all the other annoyances that come along with being a woman? PMS? Menopause? Superior intellect? (It’s a curse, really.) Who or what can we point a finger at? Pregnancy-related nausea or “morning sickness” is yet another female nuisance, and for many decades doctors and scientists have tried to figure out what is to “blame.” Though pregnancy and childbirth have been around since the beginning of mankind, scientists still seem to be grappling with the actual cause of morning sickness. Most pregnancy books admit there is no official known cause and Ob-Gyns will cite something
vague like “pregnancy hormones” as the cause for all the queasiness. While the jury seems to still be out on the origin of the misnamed condition (“morning” sickness? Try late afternoon, evening and weekend!), instead of trying to assign blame, perhaps we should be trying to figure out who to thank, as studies dating back to 1940, show there are many biological upsides to the food aversions and vomiting during gestation. After all, many a pregnant women has been told, “Be grateful for the nausea. It’s a good sign.” Really? Or is that something we are told to make us feel better? Actually, there is a correlation between gestational nausea and fetus viability. A 1940 study by Boston-based doctor Frederick Irving showed that women who indicated they had little to no pregnancy sickness in their first trimesters were more likely to miscarry. So even if we don’t know what is causing us to feel sick, we know it is normal and can indicate a healthy pregnancy. A 1993 study by biologist Margie Profet suggests an evolutionary upside to morning sickness that illustrates the innate subconscious
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concept of self-preservation and maternal instinct. Profet found that food aversions, nausea and vomiting may serve to protect the developing embryo by ensuring that certain chemicals found in raw eggs, undercooked meat, etc., which can act as abortioninducing agents, do not harm the baby. Biologists Sherman & Flaxman of Cornell University bolstered this theory by positing that the very foods pregnant women have specific noted aversions to (meat, vegetables, coffee, alcohol) can prove the most harmful to a fetus. So while our foremothers may not have had the opportunity to forego mochacinnos or eschew a spicy tuna sushi roll during their pregnancies, the idea is that the expectant mother has a basic evolutionary instinct, manifested by nausea and food aversions, to protect herself and her unborn child. This study, however, does not address the fact that morning sickness is not universal, and that there is no proof that women who do not experience sickness in pregnancy have an increased likelihood of having babies with birth defects. Psychologist Gordon Gallup further weakens Profet’s theory by stating that non-pregnant women cite the same foods as pregnant woman when asked about the most nauseating food options, thus leaving Profet’s evolutionary theory filled with proverbial holes. These holes ultimately lead Gallup to feel that “diet may only be a small part of the picture” when it comes to determining the cause for pregnancyrelated sickness. Gallup has another theory and he has announced that he will do a research study to prove it. He explains: “Because half the DNA the fetus is carrying comes from the father, the mother’s body may initially treat the organism as foreign tissue or an infection. This response… triggers an
immune reaction that is commonly experienced as nausea, vomiting and malaise.” Based on this, Gallup poses a solution to combat such symptoms. Much like an immunization or the concept of “hair of the dog that bit you,” Gallup seeks to prove that more exposure to the substance that makes her sick to begin with, should help decrease any symptoms that resulted from it. Gallup began forming this theory based on his previous work that showed a higher rate of preeclampsia and ultimately infant mortality rate, in fetuses conceived from “unfamiliar fathers” such as in cases of rape or infidelity. Therefore, he concluded that the stronger the genetic presence of the father in the mother’s physical make-up, the more “immunity” she builds up, and the less likely she is to exhibit symptoms of morning sickness. One can argue that Gallup’s study encourages monogamous relationships as his findings promote the biological benefit of a “familiar father” as a lasting, loyal and consistent male presence. To prove his theory, Gallup’s study must address and ultimately show that morning sickness should wane with each woman’s subsequent pregnancy, assuming each of the pregnancies is from the same father. If Gallup can successfully prove his theory, Eve will be taken off the hook, and women will be comforted to know that they will have a scientific basis for blaming their husbands for their pregnancy sickness—or thanking them for the lack thereof. Sara Ireland-Cooperman lives in Cleveland with her husband and her 10 month old son. She works in long-term healthcare and is the local coordinator for the National Jewish Council of Disabilities (YACHAD). She experienced normal amounts of morning sickness during her pregnancy but is always looking for someone to blame.
MORNING SICKNESS: WHO’S TO BLAME? • Between 80 and 90 percent of women experience morning sickness • For most pregnant women it starts during the 5th to 7th week of pregnancy • A few studies have shown how taking 1 gram of ginger can instantly alleviate its symptoms • The pregnant women will feel better only starting from week 12 http://www.whendoesmorningsicknessstart101.com/morning-sicknessfact/
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Osteoporosis By Leah Rothstein
t age 48 I was diagnosed with severe osteoporosis. Since then I have broken my foot and one finger in minor mishaps,” says Rebecca Cagle, a life coach and cancer survivor. “I lost my health insurance due to the cancer, and I live in fear of breaking a bone and not having the money to take care of the medical bills. My spine crunches like egg shells when I move around.” Osteoporosis is a bone disease, commonly associated with older women, in which low bone mass causes bones to become porous, fragile, and easily fractured. Such fractures, particularly of the spine, hips, and wrists, are among the chief causes of loss of mobility and a lowered quality of life in seniors. It had long been believed that the loss of bone mass, broken bones, and other symptoms of osteoporosis were just a part of aging, but in recent years, as our knowledge of the osteoporosis has increased, we have learned that there are many actions that can help alleviate, if not cure, the disease. Osteoporosis is most common in Caucasian women over age 50; but low bone density can affect men and women at any age- particularly men over age 70. In the US, of the estimated 10 million people who have the disease, 20% are men. It can be hard to detect osteoporosis in the early stages, since low bone density usually cannot be sensed by the patient. Many people only discover their condition after a fracture or break. There are several medications for osteoporosis, but they are not cures. They merely reduces the risk of fractures. There are hormone-based treatments including Calcitonin, Forteo, and Estrogen, but these can carry risks of side effects, especially for patients with a family history of cancer.
Another class of drug is bisphosphonates, which consist of both antiresorptives, which work against bone loss, and anabolic drugs which rebuild bone mass. However, they come with their own problems as well. “In recent years, there have been several reports of increased atypical fractures (subtrochanteric) in some patients who are on long term bisphosphonate use,” says Dr. Magdalena Cadet, Director of Rheumatology at New York Presbyterian. “I personally have seen more consults for osteoporosis management in patients who have sustained a new fracture while taking a bisphosphonate. These drugs have been very effective for preventing and treating fractures in some females, however, the length of treatment with these drugs should be limited and reevaluated from time to time.” Another approved treatment is Denosumab, which is injected twice yearly and has been shown in studies to reduce the likelihood of new fractures. However, this too has reported side effects, including hypocalcemia, jaw bone problems (osteonecrosis), serious infections of the urinary tract, abdomen, and ear, endocarditis, and musculoskeletal pain. Moreover, patients on any of these drugs can still experience fractures. Since the only real risk to osteoporosis patients is from bone fractures, injury prevention should take the highest priority. One strategy is to make changes in the home environment to reduce the risk of falls, such as clearing up clutter on the floors, making sure there is adequate lighting, especially on stairs, at night, placing rugs on slippery floors, and adding hand rails on stairs and in bathrooms. Outdoor safety is important too, especially during winter when there is a risk of falls on ice, but falls can also occur during any season. Other precautions can make a big difference, such as wearing low heeled shoes with good traction, checking the height of a curb
TIPS FOR PREVENTING OSTEOPOROSIS: • Keep active and exercise your entire body • Take vitamin and mineral supplements if you're not getting enough calcium, vitamin D, magnesium and other bone nutrients from your diet • Avoid smoking and excessive drinking - Learn about bone density tests before being tested • If your bone density is low, find out about low magnitude vibration therapy when it becomes available in your area http://avoidboneloss.com/
before stepping off the sidewalk, and using a shoulder bag or backpack to keep both hands free. If they are at high risk, patients should consider wearing hip protectors for added protection in case of a fall. “Having a diet rich in calcium and vitamin D and low alcohol intake will help with promoting good bone health,” says Dr. Cadet. Calcium strengthens bone density, and Vitamin D helps the body better absorb the calcium. Drinking a lot of milk and taking calcium and Vitamin D supplements does not eliminate osteoporosis risk, and taking additional supplements beyond the recommended daily dose does not provide any proven benefit. A family history of the disease, a small and light build, smoking or heavy drinking habits and other medical conditions can also be risk factors. Other recommended foods to provide the right nutrients include cheese, ice cream, leafy greens like spinach, low-fat milk, salmon, sardines, tofu, and yogurt. Osteoporosis patients need to exercise to further build up their bone strength. Bone is made of living tissue, and like muscle, can grow stron-
ger when used correctly. High-impact weight-bearing exercise is recommended only for prevention and not for those who have broken a bone. Low-impact exercises can help keep bones safe. Tai chi, yoga, Pilates, and the Feldenkrais Method are all recommended. Rebekah Rotstein, a Pilates instructor, warns, “What we call “flexion-based” exercises -- think situps -- are potentially dangerous for those with osteoporosis because they involve forward bending of the spine which could induce a fracture. What is useful is to strengthen the upper back and arms - and do isometric (static hold positions) of the trunk (like planks) as a way to strengthen the abdominals.” She adds, “People don’t understand that there is much that can be done still at any age to strengthen and safeguard their bones, stemming from diet and exercise.” The National Osteoporosis Foundation provides a lot of useful information about all aspects of the disease on their website, http://www.nof.org. Leah Rothstein is originally from Hillside, NJ and is a regular contributor to the Jewish Press.
Making the Multi-Generational Household Work by Yaakov Kornreich
s Rabbi Meyer Waxman discusses elsewhere in this issue, more elderly parents are being forced, by circumstances, to move in with their adult children, as are more young adults who find themselves compelled to move back into their parents’ home. More adults have become part of the sandwich generation, as members of the six million American households today that span three or even four generations. More than 70 years ago, this living arrangement was not uncommon, and was even considered to be something of an American ideal. Think of the multi-generational household that was depicted so nostalgically in the classic TV series, “The Waltons.” But after World War II, multi-generational living fell out of favor. In 1940, about a quarter of the US population lived in such households, but by 1980, just 12% did. Not coincidentally, this period saw the rapid growth of nuclear-families living in suburban homes, and the creation of huge retirement communities in the Sunbelt states. At the same time, the proportion of newly arrived
immigrants, who commonly adopt multi-generational living arrangements during the initial stage of their life in a new country, declined as a share of the total US population.
their eyes open and recognize that if the arrangement is to work, significant adjustments and compromises will be needed on all sides.
A necessity instead of a choice Today, most families adopt multi-generational living arrangements out of necessity rather than choice. When elderly parents can no longer live safely alone, loving family members may be unwilling to entrust their care to nursing homes or assisted living facilities. Young adult children find themselves with no choice but to move back into their parents’ home due to the breakup of a marriage or the loss of a job. Some young adults and their families move in with their parents voluntarily, because they prefer the conveniences that a properly structured multi-generation household can offer, but these are the exceptions rather than the rule. Most multi-generational households are created on the fly in reaction to an unexpected crisis. In such cases, the head of the multi-generational household must face two fundamental questions. First, what changes must be made immediately to make the living arrangements for everyone as convenient as possible in the short term? Second, are they willing to make the permanent changes in their home and lifestyle that will be necessary to make the new living arrangements practical over a more extended period of time? More simply put, it is one thing to put up your father-in-law on your living room couch for a few nights, or to ask one of your kids to double up with a sibling while grandma takes over their bedroom for a few weeks. But the natural friction from such extended, close interactions, under makeshift arrangements, will eventually start to wear on everyone.
No single formula for success There is no set formula for making multi-generational households work, because no two situations are exactly alike. Sometimes the problems may be insurmountable. The head of the household and all of the family members involved need to go in with
The first question to ask is often the most difficult – are the physical living arrangements available suitable to meet the minimum needs of everyone in the household? If not, what alternatives are available? How much time and money will it take to implement them? How will the household function before these solutions are in place? For example, take the case of an elderly parent who can’t climb stairs, who had been living in an elevator apartment building in Florida, and who now needs to be brought back to New York to be taken care of by their adult child who lives in a walk-up apartment. To make such an arrangement feasible, the adult child may have to ask their parent to sell their Florida apartment in order to provide the down payment for a new home in New York that would be more suitable for the entire extended family. Alternatively, if the adult child owns their own home, they may have the option of refinancing their mortgage to pay for the construction of an extra bedroom or bathroom or
other renovations (such as installing a wheelchair lift) needed to make the living arrangements more practical over the long term. Before making a final decision, the adult child should also consider whether the cost of the necessary alterations would ultimately be cheaper than placing their parent in a long term care facility. Performing the mitzvah of caring for an elderly parent personally is laudable, but don’t try to be a hero. If you are not physically capable of caring for your parent properly, you should not be ashamed to bring in outside help in the form of a home attendant or to ask the government or other family members to help pay for it.
Working out the costs It is also important to recognize that additional living costs will be involved, and to determine in advance who will be responsible for paying for them. Contrary to the cliche, it is not true that two can live as cheaply as one. Another person living in the household will inevitably increase overall food costs, and it is also fair to consider asking that person to contribute something to cover such regular overhead items as utility bills. Reaching a mutually agreeable financial arrangement from the outset
will eliminate a potential source of friction in the future, and help both sides accept the new living arrangement as permanently viable. There are also psychological considerations in making such an arrangement. It is important to help the newly arrived member of the multi-generational household to accept the change and truly feel at home. To accomplish this, invite them to bring as many as possible of their favorite household items when they move in. These include furniture pieces, framed photographs for display, favorite books, and even their silverware and dishes.
provide all of those functions. To keep the personal interrelationships fresh and healthy, it is also a good idea to arrange for members of an extended household to take separate vacations on a regular basis. For example, if your adult children have moved back in with you, you can arrange for them to spend one Shabbos each month out of the house, or perhaps you and your spouse will make arrangements to stay at a different family member’s house every now and then. These are ways to head off personal frictions before they can become a real problem.
Every needs their own space
Sacrifices and rewards
It is also important to make sure that each person in the multi-generational household can maintain their sense of privacy. Simply put, everyone needs their own space. For example, everyone must understand that grandma’s room cannot be entered without her permission. And if any person wants to be alone, for any reason, at any time, it is important that the new living arrangements make that possible. This may mean providing family members with their own personal TV, music player, laptop computer, or iPad, which can
You also have to be prepared to accept some personal sacrifices, inconveniences and compromises in order to make the new arrangement to work. Anyone inviting their grandchildren to live with them had better put the fine china away, and take all the breakable chachkas off the living room tables, permanently. Relearning how to live with a 5-year-old can be a challenge, especially if you haven’t done it for a few decades. You will probably have to give up some of the storage space in your closets, and learn to live with the
added mess and clutter that inevitably comes from living with another person, especially a younger one. It may be simpler all around to invest in using disposable plates and utensils during the week instead of dishes and silverware, and to hire a cleaning lady to come in as often as necessary to keep the home presentable. To be sure, there are personal rewards that come with the arrangement as well. There is the convenience of live-in babysitters and someone always being available to help a child with homework. And there is the boon of being able to look forward to getting up every morning to be greeted by your grandchildren. Most of all, it is important for everyone involved to want to make the new living arrangements succeed, and to be willing to make the necessary adjustments. As anyone who has ever lived in a multi-generational household can tell you, it is always a work in progress. Yaakov Kornreich currently lives in a multigenerational household with his wife of 41 years, his mother-in-law, and his married daughter’s family, including her husband and two young children, in his home in Brooklyn.
Profile of a Caregiver By Harriet Blank, LCSW OHEL Geriatric Program Director
uch has been written about the greying of America. The fastest growing segment of our population is over 85; there are more Americans turning 85 each day than there are newborns. This worldwide phenomenon of an aging tidal wave has implications for the Jewish community as well. The UJA-Federation population study reports that in 2002, 288,000 Jews were 65 and older. The current report notes 50,000 more Jewish seniors. In addition, the 2011 report notes that 15% of New York Jews are part of the “baby boomer” generation (55-64). What does this mean for many of us who are busy with our everyday lives? Simply put, if we are not already caregivers for an older adult, it is very likely that we will be in the future. In addition, most caregivers may care for several different family members, sometimes at the same time, which can further complicate their lifestyle. Are caregivers of older adults physically and emotionally prepared for the significant responsibilities that they will take upon themselves? Probably not.
Caregiving is often initiated during a crisis or an illness that mobilizes us into action. For many, a crisis can activate our ability to make good choices. This is not always so when a loved one is in a hospital and we are asked to make quick decisions in an environment that is as strange as any foreign country. Being prepared can help. It is important to be aware of our options and resources. Sometimes we even need help knowing which questions to ask. As our generation ages, we may all take responsibility in caring for someone, be it a spouse, parent, sibling, relative or friend. A wise mentor of mine taught me never to use the term ”caretaker,” because that is someone who mows your lawn. We are caregivers - assisting and nurturing the person who needs help. Help can be financial, physical or psychological/emotional, or all of those things. The person who needs your help might live nearby or across the country. The person may need homecare, transportation to appointments, help dealing with finances, government agencies, or other family members. The list often feels endless. As a caregiver, it is vital that you put yourself and your needs on that list. Statistics have shown that 40% of all caregivers are clinically depressed and rarely seek treatment or help. Caregiving
stress may, at times, lead to elder abuse. Caregivers often need “permission” to take a break, seek help for themselves or admit their stress and exhaustion. They also need to develop their own repertoire of coping skills. Most older adults are placed in long-term facilities, not because they have deteriorated physically, but because their caregivers can no longer fulfill their roles. In today’s world, we are often reminded of our rights and responsibilities. We know about the Bill of Rights to the US Constitution. The patient’s bill of rights in hospitals and health care facilities is an essential guide to patients and staff. Caregivers also need a “Bill of Rights” as they negotiate and renegotiate their caregiving “contracts” to remind them that they are important and need to think of themselves, too. Harriet Blank, LCSW OHEL Geriatric Program Director, has over 25 years of professional experience working with seniors. Harriet’s professional experience has been across the health care continuum, including hospital based and long term care settings as well as community based programming. Harriet graduated from NYU School of Social Work and has presented in numerous national conferences on topics concerning seniors and “best practices” Current new programs at OHEL include the OHEL Caregiver Helpline, The Geriatric Mental Health Initiative and NHTD.
Caregiver’s Bill of Rights I have the right: To take care of myself. This is not an act of selfishness. It will give me the capability of taking better care of my loved one. To seek help from others even though my loved ones may object. I recognize the limits of my own endurance and strength. To maintain facets of my own life that do not include the person I care for, just as I would if he or she were healthy. I know that I do everything that I reasonably can for this person, and I have the right to do some things just for myself. To get angry, be depressed, and express other difficult feelings occasionally.
To reject any attempts by my loved one (either conscious or unconscious) to manipulate me through guilt, and/or depression. To receive consideration, affection, forgiveness, and acceptance for what I do, from my loved ones, for as long as I offer these qualities in return. To take pride in what I am accomplishing and to applaud the courage it has sometimes taken to meet the needs of my loved one. To protect my individuality and my right to make a life for myself that will sustain me in the time when my loved one no longer needs my fulltime help. To expect and demand that as new strides are made in finding re-
sources to aid physically and mentally impaired persons in our country, similar strides will be made towards aiding and supporting caregivers Why do we become caregivers if the job is so challenging and difficult? Initially we might feel that we have no choice. The care recipient is family and we maintain our role out of responsibility and love. These are our parents, our spouse, our siblings and extended families. We are grateful for the care and love that was shown to us by the loved one who now needs our care. We follow the tradition we were taught, to show Hakarot Hatov (gratitude). There are times when we may be the only or one of the only caregivers available
for a person whom we don’t necessarily like. In such situations, we are often faced with mixed and complicated emotions. The Hebrew word for honoring our parents is Kavod, which sharesa the same root as the word Kaved or “heavy”. Our Torah acknowledges that honoring and caring for parents may be a difficult task. But in doing so, we teach an important lesson to our children and grandchildren, and hope that they will emulate it.. This valuable lesson in family history and honor needs to be experienced. When we do the best we can, despite mistakes and mishaps, our golden moments and memories prevail and we feel blessed in the knowledge that we gave it our all. Being a caregiver is one of the hardest jobs you will ever have. In a series of future articles, I will develop and explain various care plans, skill building and important questions you need to ask. One important word of advice: no matter how hard you plan, expect bumps and unexpected turns. Learn to embrace them, accept the difficult moments and hold on to and appreciate the good times. By Jo Horne
Understanding the Medicare Political Issue By Joel Mandel With the selection of House Budget Committee Chairman Paul Ryan as Mitt
Romney’s vice presidential running mate, Ryan’s controversial proposals for entitlement reform, and specifically his plan to reform Medicare, has became a central issue in the presidential campaign. Historically, protecting Medicare has been a favorite Democratic political issue. However, the Affordable Care Act (ACA), more popularly known as Obamacare, diverts $716 billion from Medicare’s budget over the next decade to help pay for Obamacare’s expansion of health care to millions who are currently uninsured. While Republicans contend that the cuts would inevitably hurt seniors dependant on Medicare, supporters of Obamacare respond that the spending cuts will all be at the expense of Medicare’s providers rather than eliminating current health benefits to seniors. But a study by Medicare’s actuary concludes that if the cuts in payments to Medicare providers go into effect, they will cause 15% of them to “become unprofitable” within 10 years. This will result in more small or independent hospitals closing their doors, and more doctors selling their practices, or refusing to accept new Medicare patients. Another provision of Obamacare sets up an Independent Payment Advisory Board, made up of 15 government-appointed medical experts who will decide precisely where the spending cuts in the current Medicare system will be made. Some fear that, in order to meet the goal of $716 billion in savings, the board might end payments for certain necessary but non-emergency operations, such as hernia repairs, or expensive procedures, such as joint replacement surgery, for seniors
above some arbitrary age. The cuts in payments to Medicare providers will accelerate a nationwide trend of large hospital/medical conglomerates buying up smaller hospitals and private medical practices. It will also aggravate a family care physician shortage that is expected as tens of millions of baby-boomers qualify for Medicare benefits, at the same time that more doctors are retiring or refusing to accept new Medicare patients. Obamacare’s opponents argue that this will ultimately result in extended waiting lists and the de facto rationing of health care for all Medicare patients. Obamacare’s supporters respond that the consolidation of health care providers is desirable, because those that remain will be more efficient, ultimately reducing total health care costs. They also point to the financial incentives in Obamacare to train more family care physicians to help alleviate the doctor shortage. Romney and Ryan argue that the benefits of Obamacare should not come at the expense of the health care for seniors, and that, if elected, they will eliminate all of the $716 billion in scheduled Medicare cuts. Ryan has been developing his plan to reform the Medicare entitlement since 2008. It would maintain the current Medicare system for all current recipients and everyone who will qualify for Medicare benefits over the next ten years. However, all those now under the age of 55 would be given a choice, when they reach 65, among private health care insurance plans providing the equivalent of existing Medicare coverage, along with a government payment to help pay the premium. Democrats accuse Ryan of trying to “voucherize” Medicare, and predict that the support payments would not keep pace with the increase in private insurance premiums. They cite an estimate by the Congressional Budget Office (CBO), that by 2022, the Ryan plan would cost each senior an additional $6,400 a year in out-of-pocket costs to maintain their current Medicare coverage. Republicans counter that the CBO estimate is now obsolete, because more recent changes that Ryan has made to his plan would protect seniors from increased premium costs, and give those now below the age 55 the option of enrolling in traditional Medicare when they reach 65.
In the current version of the Republican plan, Medicare premium support payments would be adjusted each year based upon the full cost of the second least expensive private plan in the program. The payments would be graduated to give lower income Medicare recipients more financial help, while reducing payments to those who are wealthier. As a result, most of those who choose one of the two lowest cost private insurance plans would not have any net out-of-pocket premium cost. Yet there are still unanswered questions about the Republican proposal. It does not address the problem of rising Medicare costs until the private insurance option is phased in as an option 10 years from now. Because it restores all of the $716 billion in planned Medicare spending cuts, it will do nothing to reduce the current financial drain on the Medicare trust fund. Republicans also do not say whether they would retain the popular changes that Obamacare makes to Medicare, such as the elimination of “donut hole” payments
by recipients of Medicare Part D prescription drug coverage. Furthermore, if they do retain those changes, the Republican plan has yet to explain how they propose to pay for them.
There are significant pluses and minuses to the Medicare plans of both presidential candidates. We hope that this summary gives seniors the information they need to make an intelligent choice when they vote for one of the two presidential candidates on November 6.
As the Medicaid and Medicare reduction debate rages,
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N. Y. Area Hospitals Tailor Services for Orthodox Jews By Mutty Burstein
etween 1850 and 1955, Jewish communities in 24 American cities founded general acute-care hospitals. With names like “Jewish Hospital,” “Mount Sinai” and “Beth Israel,” these institutions were often the local Jewish community’s most visible and impressive charitable enterprise. These hospitals’ first task was to provide care and comfort to sick Jewish patients, especially immigrants and indigents. Their larger mission was to help make America a more hospitable place for Jews by combating antiJewish stereotypes and hostility, and providing enclaves from anti-Jewish discrimination. The first Jewish hospitals in the United States were The Jewish Hospital in Cincinnati, established in 1850, as a result of the cholera epidemic and the need to treat poor Jews in Cincinnati, and The Jews’ Hospital in New York City, established in 1855, which changed its name in 1866 to Mount Sinai Hospital. From the outset, they met their Jewish patients’ distinct religious and cultural needs. This was the start of the long history of some of the larger New York hospitals and their close associations with Jewish social and community organizations. Many metropolitan area hospitals have instituted protocols and amenities that help ease the religious challenges to observant Jews who are being treated at their facilities and their family members. Some of these hospitals have gone far above and beyond the basics to reach out to and accommodate the special requirements of religious Jewish patients, which represent a far bigger challenge than appealing to other ethnic communities throughout the city. As hospitals expand and modernize, some of their new electronic security and automated amenities present halachic issues to the Sabbath observer. How does one use a bathroom on Shabbos when the toilets and sinks are controlled by automatic sensors? When a visitor comes into the hospital on Shabbos, how does he get past the automatic front door or use the staircases which may require an electronic pass to gain access? Several New York hospitals have taken action to address these problems, and others are actively looking into various solutions to resolve these issues.
Many New York area hospitals have added liaisons to the Jewish community to their staffs to serve as patient guides and advocates. In order to help religious patients and their families, these advocates help coordinate the hospital’s services with those available from local Jewish ser-
the hospital became an affiliate of the New York Hospital Cornell Medical Center and was renamed the New York Hospital Medical Center of Queens in 1993. Today, it is commonly known as New York Hospital Queens. It serves the communities of Queens which include the Jewish communities of Kew
care, Rabbi David Keehn, is a member of Health Care Chaplaincy, a national organization of chaplains with a focus on palliative care. He works closely with the Vaad of Queens, Bikur Cholim of Queens, Hatzolah, and Chevra Kadisha on many sensitive issues pertaining to patient care. The hospital is very proud that the Central Queens eruv system was recently extended to include the hospital and its surrounding buildings. There are now many Orthodox Jewish doctors on staff in the hospital and its emergency room. The hospital’s new West Wing entrance now includes a manually operated Shabbos door. Staircases are Shabbos friendly and there is a Shabbos elevator. Rabbi Keehn can be reached at his hospital office at 718 670-2615 or on his cell phone 917 863-8550. His e-mail address is email@example.com.
Beth Israel Medical Center
vice providers. Not surprisingly, the New York area hospitals with the most accommodations for the observant patients are those with Jewish roots. The others are catching up, however, and making encouraging progress in meeting the religious and cultural needs of patients from the Jewish community. New York City and the surrounding suburbs are home to some of the world’s finest hospitals. At this point, most of them can accommodate the basic religious needs of the observant patient. These are some of the hospitals that have stepped up to the plate to accommodate the needs of observant Jews in the New York area.
New York Hospital of Queens (NYHQ) NYHQ opened in Queens in 1957 as Booth Memorial Hospital. In 1992,
Gardens, Kew Gardens Hills, Hillcrest, Forest Hills, and Rego Park. NYHQ has a very close working relationship with the Jewish community. Its president and CEO, Stephen Mills, has worked hard to build that relationship. He has added a local rabbi to his community advisory council, strengthened the hospital’s relationship with Hatzolah of Queens, expanded the number of Shomer Shabbos doctors on the staff, opened a Jewish chapel with a Sefer Torah and a Bikur Cholim room providing coffee, snacks and emergency Shabbos provisions for patients’ family members. The shul and Bikur Cholim room are conveniently located on the main floor of the new West Wing building. A nearby apartment is available for patients’ families who want to be with their loved ones for Shabbos. The hospital’s director of pastoral
Beth Israel Medical Center is a fullservice hospital that was founded on Manhattan’s Lower East Side in 1889 by Eastern European Jewish immigrants. The founders’ mission was to serve both their own community and the community at large, with an emphasis on Jewish values and tradition. It is one of New York City’s premier hospitals, has three major divisions located in Manhattan and Brooklyn, serving the diverse populations of New York. Over the years, Beth Israel has been a leader and innovator in accommodating the needs of the Jewish communities in the metropolitan area. Beth Israel’s ongoing outreach efforts to the Jewish community are spearheaded by a program called The Heritage Initiative. Founded and managed by Dr. Richard Friedman, MD, its goals are to increase cultural sensitivity at all Beth Israel inpatient and outpatient sites to the Jewish community. It strives to better assist Bikur Cholim and Hatzolah ambulance volunteers in their efforts to save lives and provide appropriate care for ill individuals. Beth Israel is also striving to inform the members of the Jewish community of the culturally sensitive Jewish services and accommodations that it now provides. A key to the success of the Heritage Initiative is the role played by patient navigators who act as liaisons and advocate for Jewish patients with physicians and other medical staff,
while providing patients with information about Jewish resources and support services available to them and their loved ones. The two patient navigators at Beth Israel are Joseph Deutsch and Dov Jacob. Mr. Deutsch is a 20 year paramedic with Hatzoloh Volunteer Ambulance Corporation and lives in the Williamsburg section of Brooklyn. Mr. Jacob has been a EMT with Hatzoloh for the past 15 years, and lives on the Lower East Side of Manhattan. Beth Israel maintains separate apartments near their sites for men and woman who need to be with their loved ones over Shabbos. Prepared Shabbos meals are available. All food at the hospital, including its cafeteria, is under OU kosher supervision. CRC endorsed food is available upon request. The water in the hospital is also filtered. There is a shul and Bikur Cholim room on the ground floor of the Linsky building at the Beth Israel center on First Avenue and East 16th Street in Manhattan. That hospital complex has a Shabbos elevator and a manually operated door at the main entrance for Shabbos observers. The hospital even tries to have an observant Jewish nurse on staff in every unit. For more information about the
Patient Navigator Program, contact Dr. Richard Friedman, MD, at (917) 710-4896 or Patient Navigators Joseph Deutsch (917) 509-4441 or Dov Jacob (917) 886-3865.
Mercy Medical Center Mercy Medical Center in Rockville Center, N.Y. has been providing compassionate, state-of-the-art medical care to residents of Nassau County and the surrounding New York Metropolitan area since 1913. The hospital’s choice of Rabbi Dr. Aaron Glatt as their chief administrative officer shows their strong commitment to servicing the Jewish community. Rabbi Dr. Glatt is a Rabbi of a shul in the Five Towns community, and has authored many journal articles and books. One of his books is titled “Visiting the Sick; a Halachic and Medical Guide.” Mercy Medical Center, with the help of local community service organizations such as Chabad of Five Towns, Bikur Cholim, Hatzolah, and Achiezer, provides special services and amenities for observant Jewish patients, their families, and visitors. There is a Jewish Chapel with weekday mincha services. Glatt kosher and cholov yisroel meals are available. The hospital has two overnight hospitality rooms with twin beds, Shabbos lamps and other ame-
nities for visitors who need to be in the hospital over Shabbos or Yom Tov. There is a small kitchenette stocked with kosher food and snacks. A lounge with seforim is always available. Many diagnostic tests are available to be done on Sundays instead of Shabbos. The hospital chaplain is Rabbi Barry Dov Schwartz who recently retired after serving as rabbi for 32 years at Temple B’nai Shalom of Rockville Center. He is also the longest serving member of the board of directors of the hospital. Rabbi Schwartz can be reached at 516 766-8230. Mercy also has a highly respected rehabilitation program, led by Dr. Perry Stein, MD, a board certified specialist, and Dr. Marc Weber MD whose specialty is rehabilitation medicine. It utilizes the most advanced equipment and techniques to speed the recovery of patients from orthopedic and neurosurgery as well as catastrophic illnesses. The hospital is conveniently located for residents of the Five Towns and their family members making it easier for the families to be close by and allow for easy visitation, while offering them access to first class medical care.
is a community teaching hospital affiliated with New York-Presbyterian Healthcare System and Weil Cornell Medical College. It began in 1857 with opening of The New York Infirmary for Indigent Women and Children, near present-day Tompkins Square Park on the Lower East Side of Manhattan, and then moved to larger quarters on Stuyvesant Square. In 1991 New York Infirmary-Beekman Downtown Hospital affiliated with New York Hospital and was renamed New York Downtown Hospital. The hospital services the diverse communities of lower Manhattan including the Jewish community of the Lower East Side. To accommodate the observant community, they now have a fully stocked Bikur Cholim room, and have made Glatt kosher food available to its patients. There is a Shabbos elevator and hospitality rooms equipped for those who find the need to be with a patient on Shabbos. To increase the level of privacy for maternity patients, the hospital has renovated its labor and delivery rooms with the goal of making almost all of the rooms to single bed occupancy, affording a measure of privacy for everyone. The Wall Street Synagogue is right across the
New York Downtown Hospital New York Downtown Hospital
NY Hospitals continued on page 27
Parenting Parents While Caring for Yourself By Rabbi Meyer Waxman
born in 2010 by the time high school graduation rolls around. Those numbers are daunting for Millennials, some of whom will stay moored
mong those who love and respect life, it would be hard to argue that longer lifespans are not great. But clearly, with longevity comes great responsibility – and that responsibility frequently lands on the shoulders of children. In America, some 29% of the U.S. population – more than 65 million people – provide care for a chronically ill, disabled or aged family member or friend during any given year and spend an average of 20 hours per week providing that care according to a 2009 study by the National Alliance for Caregiving in collaboration with the American Association of Retired Persons. The prevalence of such caregiving is a result of many factors. We of course want to think that good child rearing – nurturing and loving parenting resulting in loving and responsible children committed to honoring aging parents – is a major contributing element. Hard to argue against that, but there are other factors as well; the high cost of health care and senior citizens, living longer, who are not fiscally prepared to adequately support themselves – financially, physically, socially emotionally etc. – and many combinations of and additions to these factors contribute as well. So while we hope that the role reversal children assume when they become the caregiver in the parent-child relationship is a labor of love, it is important to remain cognizant of the inevitable impact the caregiving responsibilities have on the life of the caregiving child. Caregiving children, even when they are not primary caregiver, of course need to live near their parent/s. When adult children are older, this may mean that which child becomes the caregiver is determined by who lives closest to parents. Other times it may require adult children moving closer to aging parent/s, or moving parents closer to, or into the home of the adult child. And for younger, single, less established adult children it may mean giving up an apartment – and a degree of freedom-if-not-independence to move back home with aging parent/s. Aside from the many stresses and responsibilities that come with caring for an aging parent, the impact living with parents has on pursuing marriage is significant. But it is far from just singles caring for aging parents who are affected socially by the task. In a Washington Post Op Ed, 27 year old Nona Willis Aronowitz suggested “The economic shift in the past couple of decades, accelerated by the recession, have led to 20 percent of young people putting off marriage and children because of their finances. And no wonder: According to the U.S. Department of Agriculture, a typical family with a household income between $57,600 and $99,730 will have spent $226,920 on a child
in low-wage service jobs or contingent contract positions a lot longer than we'd like.” And of course these daunting numbers are increased substantially when the cost of Yeshiva tuition is factored in. And while many Orthodox families’ reproductive patterns are not influenced by such mundane factors as the cost of child rearing, many experts, as well as subjective observance, suggest that many other young Orthodox families’ are. These scenarios are not yet the norm. According to the NAC/AARP survey, “The typical family caregiver is a 49-year-old woman caring for her widowed 69-year-old mother who does not live with her. She is married and employed. Approximately 66% of family caregivers are women. More than 37% have children or grandchildren under 18 years old living with them.” So the average caregiver has started a family of her own. While it is likely that her social world too is greatly affected by her caregiving responsibilities, albeit differently, perhaps it is the health impact which presents the most sobering picture. The National Family Caregivers Association has complied statistics from numerous studies, making it clear that the toll caregiving takes on the caregiver is significant: “Nearly three quarters (72%) of family caregivers report not going to the doctor as often as they should and 55% say they skip doctor appointments for themselves. 63% of caregivers report having poor[er] eating habits than non-caregivers and 58% indicate worse exercise habits than before caregiv-
ing responsibilities. 40% to 70% of family caregivers have clinically significant symptoms of depression with approximately a quarter to half of these caregivers meet[ing] the diagnostic criteria for major depression. More than 1 in 10 (11%) of family caregivers report that caregiving has caused their physical health to deteriorate. Family caregivers experiencing extreme stress have been shown to age prematurely. This level of stress can take as much as 10 years off a family caregiver's life.” So while care we must, it is important to approach this service with eyes wide open. Caring for anyone is a remarkable testament to the caregiver’s character. It is fulfilling, imperative, necessary and praiseworthy. But it is important for those who, by intention or by happenstance are embarking on this role, to be aware of the manifold hurdles and hardships that are apt to be encountered in following this noble calling. It can be heartening to know you are not alone; organizations such as the National Alliance for Caregiving, The National Family Caregivers Association and the AARP, as well as government bodies provide resources and support. And it behooves those of us who know such caregivers to be sensitive to and duly appreciative of the awesome role which they perform. Rabbi Mayer Waxman is a licensed social worker, holds a Masters in forensic psychology, and has served numerous roles in Jewish communal service. He served as a consultant for the Department for the Aging, and is the Manager of the Met Council Connect-to-Care program for Brooklyn; the UJA-Federation response to the recession.
TIPS FOR CAREGIVING • Learn as much as you can about your family member’s illness and about how to be a caregiver as best you can. • Trust your instincts. Remember, you know your family member best. Don’t ignore what doctors and specialists tell you, but listen to your gut, too. • Encourage your loved one’s independence. Caregiving does not mean doing everything for your loved one. Be open to technologies and strategies that allow your family member to be as independent as possible. • Know your limits. Be realistic about how much of your time and yourself you can give. Set clear limits, and communicate those limits to doctors, family members, and other people involved. http://www.helpguide.org/elder/caring_ for_caregivers.htm
The Future of Prostate Screening By Tzvi Leff
ew medical guidelines disseminated by a Washington task force are roiling the medical world. The US Preventive Services Task Force issued new guidelines regarding screening for prostate cancer. Their updated recommendations state that screening for Prostate cancer, or a PSA test, is unnecessary, and can even possibly be harmful. Their findings conclude that “There is no clear empirical evidence that PSA tests have any merit and should be discontinued.” This set off a massive controversy in the medical world towards the usefulness of prostate cancer screenings, or PSA. A Prostate Specific Antigen, or PSA test, is an exam that measures the level of prostate antigens in a person’s blood. Antigens from the prostate end up in the blood stream, and increased level of prostate tissue can indicate increased cell activity, or cancer. However, there are commonly many more factors that can cause a high PSA level, such as an enlarged prostate gland. Many false positives regularly turn up in a PSA test, resulting in a subsequent painful Biopsy. Statistics show that only 20% of all
NY Hospitals continued from page 25
street from the hospital. Rabbi Meyer Hager, the Rav of the synagogue since 1960, is also the hospital chaplain and is always available to help observant patient and their families. The hospital has strengthened its relationship with Hatzolah and has increased the number of Orthodox doctors and nurses on staff. The hospital’s patient advocacy department has been expanded to include an Orthodox Jewish advocate. Rabbi Hager can be reached through the patient services department at 212 312-5034. In addition to the hospitals discussed above, most other major hospitals in the area such as New York University Langone Medical Center, Mount Sinai Medical Center, North Shore Long Island Jewish Medical Center, Columbia Presbyterian Medical Center, Maimonides Medical Center and Methodist Hospital, among others, strive to serve the members of Jewish communities of the metropolitan area with various accommodations to meet their religious needs. We hope and pray that we should always be healthy and never need the
positives of prostate cancer are in fact accurate. In addition, even if one would in fact be possessing prostate cancer, it is doubtful that it would even be harmful at all. Most instances of Prostate Cancer result in it slowly being phased out of the body by the immune system. Only the finding of early onset cancer is not necessarily a positive development. Urologist Dr William Catalona is spearheading an effort reverse the panel’s findings. “Foregoing a test that can make a life-or-death difference just doesn’t make any sense to me, especially when we are making dramatic strides in narrowing the margin of error” he says. He, along with other prominent Urologists maintains that the exam’s cessation will harm the remaining 20% that the tests actually save. Newspapers are rife with stories of middle- aged men finding out the existence of prostate cancer during a routine test and undergoing life saving surgery. Even if not offering the test might prove convenient for 80% of the population, it would conversely endanger the remaining 20%. This amounts as anathema doctors, whose approach is to focus on saving the maximum amount of people, inconvenience be damned.
services of a hospital. In the event that you or a loved one is in need of medical care at any hospital, contact the hospital chaplain to ascertain what services can be provided to accommodate your religious needs. You might be pleasantly surprised. Mutty Burstein is the Education 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 mental health issues and patients with dementia, Alzheimer’s, and/or depression, as well as the developmentally disabled. Mutty can be reached at 917-2871636 or firstname.lastname@example.org for any questions regarding health care or eligibility for Medicare, Medicaid, and managed care.
The controversy reflects on a wider debate over the merits of cancer screening. An Elmore University study found that doctors ordered additional cancer screening treatment, be it a biopsy, an ultrasound, or additional X-rays—on sixty-four per cent of the women who didn’t have cancer. In addition, the presence of cancer does not always prove lethal. Autopsies done on woman whose death resulted of other causes found breast cancer in 40% of the women. However, breast cancer kills only 4% of women annually. A Swedish government study revealed that untreated breast cancer would result in the deaths of only 3.4% percent of sufferers. The very same US Task force committee waded into this issue in 2010 by delaying Mammograms until the age of 50, citing “unknown benefits.” Even the doctor who pioneered the test now calls it “a profit-driven public health disaster.” Barring a consensus deeming cancer screening unnecessary, it is unlikely that doctors will cease to provide such services to their patients. Patients feel safer when presented with the newest medical advances,
even when the validity isn’t known. After multiple years of this, patients get used to such services, and to stop offering it would be viewed as negligence, or at worse malpractice. This is one of the voiced for the high cost of health care. According to congressional budget director Peter Orszag, roughly $700 billion per year is spent on unneeded tests and procedures.
THE FUTURE OF PROS TATE SCREENING • New guidelines state PSA is unnecessary and possibly harmful • Only 20% of PSA positives are accurate • Controversy continues over whether to keep the test • The merits of cancer screening, and for breast cancer in particular, are currently being debated
Home Sleep Testing Has Never Been Easier! Do You Snore? Are You Tired During the Day? If So, Your Relief is Here By Dr. Jacques Doueck ho needs sleep testing: Many people that snore and find they are tired during the day never take the next step because they avoid sleeping in a hospital or sleep lab. Home Sleep Testing (HST) is a way for patients to be evaluated for sleep apnea, with the latest in sleep diagnostic technology, in the comfort and convenience of their own bed. There's no need for dozens of wires and electrodes, ap-
and those with OSA. The device is worn on the forehead, and is usually worn for one night. The small size allows the device to be comfortably worn in all sleep positions. The cost of home sleep testing is significantly lower, typically just a small fraction of what a more traditional procedure would cost in a sleep lab. Does this make Sleep Labs obsolete? There is still a need for testing in a traditional sleep lab for some kinds of patients. Home Sleep Studies are not suitable for children or for those with severe lung disease, or other critical illness that would prevent patient from
plied over most of the body — including the face, legs, chest and arms, body straps, video cameras, people watching and recording you while you sleep, or awkward situations with lab technicians walking in on you during the night. Patients are given an ARESTM device, the first FDA-approved wireless sleep test device for diagnosing Obstructive Sleep Apnea (OSA) while sleeping in their own bed. The easy-to-wear device is revolutionizing sleep testing for patients that snore
using the equipment, or in cases when the physician feels that a supervised sleep study would be more prudent. Saving Money: An in-lab Sleep Study costs up to $4,000. In many cases, health insurance will cover the most or all of the cost. But for those whose health insurance has high deductibles or a 20% co-pay, the high out-of-pocket costs could be substantial, more than many patients can afford.
On the other hand even without medical insurance, a one night home sleep study will only cost $200. For many patients, a home sleep study is both a more affordable and convenient option than going to a sleep lab. If you suspect you have sleep apnea but you don't want to spend a night away from your home with strangers, a home sleep study is a viable choice. According to the June 2012 issue of Journal of American College of Chest Physicians, Home Sleep Studies are an accepted alternative means of diagnosis for sleep apnea. With Home Sleep Testing, a polysomnography sleep technician scores your test and a board certified sleep physician interprets it and gives recommendations and diagnosis. The word "apnea" means "without breath" and can lead to serious medical conditions including death. Snoring can be a sign of sleep apnea, Half of the patients who snore have Obstructive Sleep Apnea (OSA), a serious condition in which the obstruction of the airway during sleep is so complete that the snorer quits breathing for 5 to 100 times every hour. OSA is caused when we lie down by the tongue falling back into the throat (due to gravity) along with the relaxation of the soft tissues. This blocks some, if not all, of the oxygen from entering our body. This can occur hundreds of times a night, leading to a potentially deadly condition. Most patients do not realize they have sleep apnea which is why more than 93% of women and 82% of men with the condition are believed to be undiagnosed. If you snore, or you are tired during the day, a compact dental appliance, whose cost is covered by most medical insurance policies, can help. The first step is an overnight sleep study. With the ARES™, you can do this in the comfort of your own bed! If you snore, you owe it to yourself and to your family to find out if you have sleep apnea. 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 American Dental Association. He enjoys “high tech’ dentistry and restorative dentistry at DentalOffices at 563 Kings Highway, Brooklyn NY11223 (718)339-7982
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For years there has been only one solution for treating snoring or sleep apnea is the use of a Continuous Positive Airway Pressure (CPAP) machine. It is basically a machine to help you breathe while you sleep. However, not every patient can use these contraptions. Every day, we hear from patients like you who have tried CPAP therapy and found it uncomfortable or unbearable, not to mention all the other inconveniences that go along with using or traveling with a CPAP. They simply HATE their CPAP for one reason or another. Oral Appliances offer the best alternative to CPAPs. These solutions are custom fit to the size and shape of your mouth. A dentist with advanced training in dental sleep
medicine can help you get rid of your CPAP machine and its inconveniences forever!
Medical conditions related to sleep apnea • • • • • • •
Stroke Heart Disease and Heart Failure High Blood Pressure Diabetes Depression GERD (Reflux Disease) Atherosclerosis
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from Sleep Apnea! Sleep apnea is a serious sleep disorder that occurs when a personâ€™s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain -- and the rest of the body -- may not get enough oxygen
Why is a Dentist treating Snoring and Sleep Apnea?
We are specially trained in dental sleep medicine . Using a Pharyngometer, a computerized airway PHDVXULQJGHYLFHZHGHVLJQDFXVWRPĂ€WWHGDSSOLDQFHIRU\RXUWHHWKWKDWZRUNVE\SUHYHQWLQJ\RXUWRQJXH DQGVRIWWLVVXHIURPFROODSVLQJDQGWKXVNHHSV\RXUDLUZD\RSHQZLOOVWRS\RXUVQRULQJDQGLPSURYH\RXU KHDOWKZLWKRXWWKHQHHGIRU&3$3:HYHULI\WKDWWKH6OHHS$SSOLDQFHLVZRUNLQJZLWKDIROORZXS6OHHS 6WXG\,QVWHDGRIZHDULQJDPDVNDQGKRVHÂ˛\RXU2UDO$SSOLDQFHLVWKHPRUHFRPIRUWDEOHRSWLRQ
If left untreated, sleep apnea can result in a growing number of health problems including: t)JHICMPPEQSFTTVSF t4USPLF t)FBSUGBJMVSF JSSFHVMBSIFBSUCFBUT BOEIFBSUBUUBDLT t%JBCFUFT t%FQSFTTJPO t(&3%(BTUSP&TPQIBHFBM3FGMVY%JTPSEFS t8PSTFOJOHPG"%)% Statistically, smoking will take ~ 7 yrs off your life, untreated Sleep Apnea will take 12-15 years!!
If you or someone you love SNORES It is critical to get Screened for Sleep Apnea and Snoring Today!
1-800-83-SNORING for an appointment with Dr. Jacques Doueck 563 Kings Highway Brooklyn NY
Health and Living continues after the Mind, Body and Soul section
Do I Need a Doula When I Give Birth? By Barry Katz
ne of the staples of television situation comedy is to have one of the leading characters give birth. While the screaming,
swearing, and overall chaos of childbirth can be very amusing when presented in fictional settings, real-life births are only slightly less hectic. For this reason, mothers-to-be will often
hire doulas to assist with their births. A doula is a coach who assists birthing women in non-medical matters, providing both physical and emotional support. While most doulas are hired to help during the labor, many are also present for aid pre-and postpartum as well. Currently there are no regulations regarding who can become a doula, although DONA International and the Childbirth and Postpartum Professional Association (CAPPA) offer training and certification. As of 2009, DONA International had 2,636 certified birth doulas. While the cost of a doula ranges from $300 to $1,000, Gittel Rubin*, a mother of three, thinks it is well worth it. “My husband was very helpful to me, but some just stand in the corner praying,” she says. Furthermore, a doula can hold your hand and rub your back, something a husband cannot do during labor according to Jewish nidda law. Perhaps the greatest advantage, according to Ms. Rubin, is helping avoid the need to perform Caesarian sections. “Many times doctors are quick to do a c-section,” she says. “They’ll say, ‘It’s taking
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too long, let’s just get it over with.’ A doula will help with the breathing and pushing to hasten the process of natural birth.” A 1991 study by the American Medical Association supports Ms. Rubin’s assertion, stating that 8 percent of women who used doulas had Caesarians, compared with 18 percent of women who did not have assistance. That said, health care professionals caution doulas to not overstep their boundaries. A 2004 Wall Street Journal article recounted how a San Francisco woman’s doctor advised her to take fluids, but her doula was adamant that the woman refuse. Later on when the doctor insisted that the woman drink, he found that she was severely dehydrated. The same article mentioned a baby who needed resuscitation after the doctors recommended a Caesarian, but the doula insisted on a natural birth. As a result, many hospitals insist that a doula sign a commitment that he or she will not interfere with any member of the medical team. Yet many mothers employ doulas to have someone in the room with them throughout the labor. Often doctors must go from one delivery room to another and perform multiple births throughout the day. Thus, they will ask for a quick update, and if the woman is not ready to give birth at that moment, they will leave. The doula, on the other hand, is hired to stay exclusively with the birthing woman. Frieda Miller*, a Brooklyn doula, says that doulas are especially helpful to first-time mothers. “They often have long labors, and an experienced doula can come to the woman’s home and listen to the contractions. This ensures that the woman gets to the hospital at an appropriate time,” she says. Another factor is psychological. “Knowing that there is someone who will be there to help can have an overall calming effect.” And Ms. Miller says that experienced doulas strive to work together and in harmony with the medical team, ensuring that things run smoothly. Those who would like to use doulas but find the costs prohibitive should contact their insurance companies, as some provide either partial or full coverage, Otherwise, many communities have volunteer doulas who work either for free or for a nominal fee. A doula can be a worthwhile investment even for mothers who will be using an epidural during their delivery. As one mother posted
on ImAmother.com’s message board: “The epidural does not replace the doula. A doula is a real live person who can talk to you, comfort you, advocate for you, help you relax, reassure you, get you ice chips, water etc... The epidural can not do any of those!” Being a doula can be a most satisfying and fulfilling way to make a living, but there are drawbacks. For one, a labor doula stays with the birthing woman the entire time, which can last much longer than the eight hours of a typical office job. Additionally, the woman can go into labor any time of the day, so being a doula is certainly not a 9 to 5 profession. And the doula must be available to join the mother in the hospital whenever she goes into labor. For these reasons, Ms. Miller is unable to hold down another regular job. Still, she says, she enjoys what she does because helping provide positive birthing experiences will make it more likely that these mothers will have more children. “And what could be better than that?” *Due to the sensitive nature of this topic, the names have been changed. 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 email@example.com
FACTS ABOUT DOULAS • Doulas are labor coaches who assist in the non-medical matters of childbirth. • Childbirth and Postpartum Professional Association (CAPPA) and DOLA International offer doula certification for anyone over 18, both male and female. • Doulas assist birthing women before, during, and after the birth. • Birthing women can have doulas alongside them throughout labor, unlike doctors who often must split their time between various delivery rooms. • Religious Jewish women who need the physical and emotional support that they cannot get from their husbands during labor can often get them through doulas.
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My Teen Is Stressed, But Is Treatment Necessary? By Mark Banschick
efesh International is an international organization of frum mental health professionals and we are currently celebrating our 20th anniversary. Over these past years, we have observed a significant change in how the community views issues pertaining to mental health. Despite the sophistication of the Jewish community in a multitude of ways, the area of mental health has been associated with stigma. While people seek help for a myriad of medical problems, they have been hesitant to seek professional help for emotional and psychological challenges. Over time, we have seen greater openness to the idea of seeking help from a psychotherapist. This process has an evolutionary component and we need to be patient and understanding of the very factors which cause people to be hesitant about this kind of professional help. The shidduch process is exemplary as it has a proscribed protocol and deviation from that process causes families to be concerned and anxious. How to share information about mental wellbeing is a dilemma for countless families. How much to share? How much to withhold? Will the information discourage the shidduch? Will withholding information be problematic if the couple gets married? The shidduch process is certainly fraught with anxiety. People often consult a Rav and a mental health professional to determine how best to approach the situation. Over the past number of years we have seen a proliferation in the number of public forums on matters pertaining to interpersonal relationships and the challenges faced by families. The effects of divorce on children, youth at risk, addictions, coping with ADHD,
having an autistic child: a decade ago the community would not have countenanced public discourse on these sensitive subjects. Today, virtually hundreds of people attend such forums and have the opportunity to gain insight and develop a comfort level with the idea of seeking help from a mental health professional. Concurrently, more and more Rabbonim have joined forces with therapists in addressing issues on the micro-level as when a family is confronting a divorce and all the ensuing challenges as well as on the micro-level when a community is under siege from a pedophile in its midst. Nefesh International has been in the forefront in demonstrating the courage to speak of the unspoken. It does so in ways which are cognizant of the pulse of the frum community and shepherds us to gently to uncover the darkness. Our annual conference is a crown which we wear proudly. It will take place on February 17 – 18, 2013 in New York. The conference offers a broad spectrum of subjects ranging from OCD, (Obessive Compulsive Disorder) to anxiety, from sibling rivalry to dementia. We have a stellar line up of speakers who are renown in their fields of practice. The conference chairpersons are two very talented therapists. Lisa Twerski, LCSW and Chaim Sender, LCSW are once again taking the lead in our plans for this conference. We invite you to visit our website at www.nefesh.org to learn more about our symposiums and our conference. Together we can travel towards greater understanding and appreciation of the human condition. B’virchos Kol Tuv,
Phyllis Mayer, LCSW Phyllis Mayer, LCSW
The Magical Relationship of Sisters By Hindie M. Klein, PsyD
Emotional Validation - Who, What and Why? By Aviva Biberfeld
Another Approach To Dementia By Leah Abramowitz
Why Won’t They Get Along? By Tali Moskowitz, LCSW
Perinatal Mood and Anxiety Disorders By Chana Simmonds
The Mind, Body Relationship By Dr. Judith Guedalia
Add A Minim Of Anger To Spice Up Your Life By Ed Yisroel Susskind
Anxiety: Can It Be Controlled? By Dr. Miriam Adahan
A Parent’s Guide to Sending a Child to Israel By Michael J. Salamon, Ph.D.
Helping Our Children Overcome their Fears By Robin B. Zeiger, Ph.D.
Sacrificing For One’s Parents By Rosalind Levine
On Value and Valuation: Uncovering Your True Worth By Yitzchak B. Rosman, Psy.D.
Living With Death Awareness By Aviva Barnett
Treating the Problem of Compulsive Prayer By Avigdor Bonchek, Ph.D.
The Shidduch Speed Bump By Howard Forman, M.D.
& MIND, BODY SOUL Is a publication of the Jewish Press Published since 1960 and in collaboration with Nefesh International
SUPPLEMENT COORDINATOR Alice Tusk, LMSW ARTICLE COORDINATOR Chaim Sender, LCSW SENIOR EDITOR Tzivia Emmer ASSOCIATE 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 • firstname.lastname@example.org & August 2012 MIND, BODY SOUL
My Teen Is Stressed, But Is Treatment Necessary? By Mark Banschick
tress is unavoidable in life. As good parents we want to shield our children, but we also know that we can only do so much. Stressful situations come in many shapes and sizes and affect our teenagers, whether we like it or not. Moving from one city to another or one yeshiva to another; the illness of a parent or a sibling; a parental psychiatric disorder like depression or anxiety; a difficult divorce; a parent losing a job and worried about finance; being victimized by a bully or an authority figure; and even the rejection of friends can all be significant sources of teenage stress. Children, especially teenagers, are easily affected by the environment they’re in and can reflect their surrounding conditions in their moodiness, oppositional behaviors (like defying religious requirements in your home), depression or drug use. But don’t let these symptoms fool you. Teen angst is prevalent for many kids at some point during their adolescence. Normal teens are entitled to be moody, questioning, inconsistent and troubled with the status quo. So here is the question at hand. Your teenager is stressed, that’s clear, but is an assessment and treatment needed? First, three important points about normal teen development: ➊ The teenage brain is a rapidly and unsteadily developing organ. Most people are not truly their adult selves until they are twenty five or so. I often tell parents that maturation will serve their teen as a healthy tail wind, and the key is to guide them sufficiently not to make big mistakes along the way that can hurt their relationships, progress forward or self esteem. But during this period, your teen has to deal with increased moodiness, impulsivity and irritability that can make life miserable for all. ➋ Teenage cognitive development shifts to abstract thinking. The teen may challenge the way the world is presented, either directly to you or privately. Often, we as parents, rabbis and teachers lose our respected status. The normal outcome is often satisfactory when teens are then engaged on their level and have a sense of being respected, yet understand what is required of them. A special mentor, coach or therapist often can help an oppositional teen find a middle path. ➌ Teenage sexual development is powerful and confusing. Their bodies develop 4 MIND, BODY SOUL &
in ways that affect how they feel - and how others perceive them. Sexual attractiveness is confusing, no matter where a teen grows up. How the immature teenage brain deals with the powerful sexual urges at this stage of life is a challenge at best. How can you tell the difference between a normal stressed-out teen and a stressed out teen who is in trouble? Here are five important questions. ➊ Does your teen show evidence of extreme moodiness, anxiety, or the like? A teen may complain, for instance, of being “depressed,” but talk constantly
for example, who is preoccupied by his new life - or a mother who is too depressed to pay much attention to her child’s needs. These kinds of stressors will always make matters worse. ➍ Is your teenager selfmedicating with drugs or alcohol? The frum community is not immune to drugs and alcohol. When a teen is actively abusing drugs or alcohol, this needs to be dealt with head on, because it’s next to impossible to treat the underlying hurt, depression or anger while a person is numbing his or her mind. ➎ Are you, the parent, vis-
with friends, enjoy life and look forward to going out. Assessment: probably teenage angst. But if she doesn’t want to go to school, is avoiding friends, can’t find a way to feel good, sleeps too much or too little, or shows evidence of self harm, you don’t have to be a doctor to know that she needs to be seen professionally, and soon. ➋ Did the teen’s symptoms precede the stressful situation they’re now going through? Some psychological problems are not directly related to the stress. Do you have a family history of depression or anxiety? If so, your teen may be developing a problem that is more or less inherited. Once again, if the symptoms interfere with functioning, getting a professional opinion is probably a good idea. ➌ Has the teen’s condition worsened? Even if your child has a pre-existing issue like anxiety, an eating disorder or moodiness, ask yourself if it’s worsened because of the stress. Divorce, for instance, can force kids to take sides, or expose them to terrible fights between their parents. They can feel abandoned by a father,
ibly stressed or irritable about a troublesome situation that is beginning to affect your teen? Are you unhappy in your marriage, angry, or just not yourself? Your teen will experience this as a real stress. Parents burdened by a divorce, a medical problem, unemployment, or worries about a sick relative may help their child by getting support themselves. Now that you have a better handle of whether or not to get a consultation, let’s talk about how to go about it. In most communities the pediatrician is a good source for an initial consult. Bring your concerns to him or her, based on the five questions above. If drugs are major presenting problem, a drug treatment counselor is the next place to go. Your pediatrician or a knowledgeable rabbi in your community may know who is best. If the issue is more family related, such as a divorce or a broken relationship within the family, have a consultation with a social worker or a psychologist who specializes in family therapy. If one or both parents are bringing stress down upon the teen,
the family therapist should make sure they get the help needed. Believe me, it feels good to tackle your problems – and teens respect parents who are getting their act together. If your pediatrician thinks the problem is more complex, she may want you to see a child and adolescent psychiatrist. This referral is often obvious, because if the symptoms are truly getting in the way of functioning, a more thorough assessment will be needed. It may be that your teenager is struggling with an underlying anxiety disorder that has worsened because she’s been bullied. The problem: She won’t go to school and is having panic attacks. A child like this may need a combination of therapy and medication. I know that talk of medicine makes parents anxious, and you have that right. But, don’t be too frightened, because a good doctor knows how to minimize risks, and a child who responds to treatment is a child who has been spared much pain. To review: The first stop is the pediatrician, who may reassure you that teenage angst is teenage angst, and not to worry. If more is required, a pediatrician can help you find the right professional to consult. Whether you end up working with a drug counselor, a social worker, psychologist or psychiatrist, I would encourage you to ask for a diagnosis and a treatment plan. Sometimes different professionals help in tandem with each other. For example, in the case of the girl with panic attacks and bullying, a social worker may help her deal successfully with the bully, while a psychiatrist may temporally medicate the constant anxiety. And, with the social worker using CBT or another contemporary technique, that girl may eventually learn to manage her anxiety without the need for medication. Ultimately, teens usually respond well to proper treatment. And stress is almost always a part of the problem. My advice is to be attentive, ask the five questions, and when in doubt, get a consultation. The biggest mistake parents make is usually waiting too long. Ultimately it is a special experience to have your teen back. Mark Banschick, MD is a Child Psy-
chiatrist and member of The Young Israel of Stamford. He is the author of The Intelligent Divorce and writes a weekly blog for Psychology Today. His parenting course for Divorcing Parents can be found at: www. familystablizationcourse.com. On the radio at: http://www.divorcesourceradio.com/ category/audio-podcast/the-intelligent-divorce/. Contact: email@example.com.
The Magical Relationship of Sisters By Hindie M. Klein, PsyD
hey are born of the same parents, yet they are so different. They are loving and petty, helpful and hurtful, envious and generous, confidantes and rivals. With just one look, they can be giggling uncontrollably and with another, they can hurt coldly and squarely. They are bound forever, in times of happiness and in pain. And even if they don’t particularly like each other, they love each other. They are sisters. I recall my conversations with a sweet elderly woman, Hedy, a Holocaust survivor. Her older sister was everything to her, closer to her than her mother. “She would wake me up in the morning, and put me to sleep at night. She would always watch over me.” When Hedy was 19, she and her sister went to Auschwitz together. Hedy’s sister never left her side. After 14 months of agony and torture, as liberation came near, Hedy contracted typhus and was near death. “She nursed me and cared for me, she wouldn’t let me die. And I survived.” But her beloved sister did not. Tragically, Hedy’s sister caught the typhus and died shortly afterwards. Years later, in painstakingly retelling this story over and over again, Hedy speaks of her sister lovingly and sadly. “My sister told me so many times that if she could think of only one purpose of her life in Auschwitz, it was so that she could save me, it was that I should live. I will always love her. She will always be with me.” And indeed, she is. Hedy’s sister lives on, in the form of Hedy’s daughter who bears her sister’s name. Sisterhood is such a powerful relationship. And perhaps more than other relationships, it is exquisitely complicated. Sisters can be mentors, but also rivals. They can be loving, yet filled with resentment. Often this is affected by memories of early childhood, of realizing which was the favored child, or the more gifted, and later in life, who was the more fortunate, more talented, brighter or wealthier. There can be periods of great closeness, but also periods of distance and strife. But almost always, no matter how different sisters are, or how varied their life experience, the bond of sisters remains unique, almost indestructable. Years ago, I met two sisters who seemed so different. The elder was very serious, quiet, reserved and intellectual. The younger was bubbly, colorful and charming. One would never
have thought they were related, much less sisters. When I discovered that they were sisters and noted how they seemed so different, the older sister paused for a moment and stated quietly, “We’re really very much the same, just inside out.” Theirs was a unique understanding -- no matter what their differences, they were bonded by a spirit that was entwined both externally and internally. It reminded me of a quote by the American writer and poet Toni Morrison: “A sister can be seen as someone who is both ourselves and very much not ourselves—a special kind of double.”
plores the complicated relationship of sisterhood and the familial forces that shape it. In her attempt to study this important relationship that she feels has not been addressed in a serious way, Millman interviewed nearly 100 women of diverse backgrounds from around the country, and in many cases, more than one sister from the same family. Millman writes about the unique ways sisters can help each other overcome the sorrows and disappointments of childhood, offering insights into why often sisters never feel close. For many sisters, what must be over-
In a book of essays titled Sisters, author Carol Saline notes that although most sisters want what they perceive as an ideal relationship, what most sisters have is a relationship flawed by conflict. Saline chose to focus on sisters who genuinely liked each other, but also included essays on sisters who did not get along. In the latter case, the common feelings centered on a sense of loss. With sadness and some embarrassment, these sisters spoke of what the world thinks a sister should be and how they wished for that type of relationship. This reminded me of the countless stories I have heard of sister relationships. Sisters who have given generously but who have not been given to in return. Sisters who have been resented for always being the better, or brighter, or more favored sibling. But also and ultimately, sisters who have stood up for one another and loved one another, no matter how much they disagreed. In her book The Perfect Sister: What Draws Us Together, What Drives Us Apart, sociologist Marcia Millman ex-
come is their tendency not to see or accept their sister for who they really are, but rather see the “imagined sister,” the sister they wish for. Millman addresses issues of early childhood experiences, parental favoritism, the role of the older sister as caretaker, and the role of one sister taking on the role of parental confidante, which affects her relationships with her other sisters. Many adult women also fail to recognize the differences in how they and their sisters grew up. Instead, they fall into the trap of expecting their sister to behave or respond exactly as they would, an expectation that fuels misunderstanding and disappointment. Later in life, sisters often come together around shared experiences, such as childbearing and caring for elderly parents, Millman observes. And after parents die, sisters can become even more important to one another emotionally, since they are their only tie to early memories and to the ultimate legacy of their family. This is particularly poignant when observing sis-
ters who are the children of Holocaust survivors. As the exceptional generation of Holocaust survivors diminishes daily, their children, grandchildren and great grandchildren remain, each with their unique experiences of the trauma of their elderly loved one. Depending on how they have been raised or how the Holocaust has been spoken about or experienced during their lifetime, second-, third- and fourth-generation Holocaust survivors are affected in very personal and nuanced fashions. What often remain for sisters, particularly those who are children of Holocaust survivors, is to share their experiences, their stories and their link to their past. It binds them in a way that other experiences cannot, and it paves a path for their future relationship. Is there an ideal relationship in sisterhood? As in any good relationship, sisters must acknowledge and accept being the same yet different. If there has been trauma with one or both of the sisters, such as the death of a loved one, divorce, financial stress, a child with a developmental disability or mental illness, there needs to be an acknowledgement that each person experiences and digests trauma in different ways. One sister may be proactive and seek professional help while the other may not. Each is exhibiting their distinctive strength and resilience in their own way. At OHEL, we see many traumatized individuals of all ages. Some come alone; some come as families. We often see how siblings—particularly sisters—experience their trauma. No matter the case, sisters who respect the fact that their experiences are individual to them will fare better in empathically relating to one another. The relationship between sisters must contain strong elements of respect and dignity, of effective communication, and of collaboration and commitment. There is also a spiritual and familial bond fueled by childhood memories and the mutual goal of perpetuating a family legacy. And when all goes well, the relationship of sisters can transcend the ordinary to the point of being magical. Dr. Hindie M. Klein is the Director of
Clinical Projects at OHEL Children’s Home and Family Services. Dr. Klein, a psychologist and psychoanalyst, also maintains a private practice specializing in the treatment of children, adolescents, adults and couples. Dr. Klein in on the Board of Nefesh International. She can be reached at hindie_klein@ ohelfamily.org. & August 2012 MIND, BODY SOUL
Emotional Validation - Who, What and Why? By Aviva Biberfeld
a, I’m hungry.” “Don’t be silly, you can’t be hungry, we just ate lunch.” “I don’t like that shirt. It has too much black in it.” “What do you mean you don’t like the shirt, of course you do.” “Boy, I am really hot” “You are not hot. You can’t be hot, it’s a perfect temperature in here”. Do any of these lines sound familiar? Or do they just sound ridiculous? I am willing to bet that at some point in our lives we have done the same thing: We have invalidated the feelings of the person we were talking to. You might say, “What’s the big deal?” But according to Marsha Linehan, an internationally recognized expert in the treatment of Borderline Personality Disorder and the creator of Dialectical Behavior Therapy (a skills based treatment being used successfully in many emotional disorders), one of the factors that contributes to the development of certain disorders is living in an invalidating environment. And just as important, one of the factors that can aid a child in growing up with a healthy sense of self is the ability of the child’s caretakers to see the child as a separate person with his/ her own thoughts and feelings, and to convey that understanding and acceptance of who the child is. In other words, validating the child’s thoughts and feelings contributes to the child’s emotional health. One may ask, isn’t it enough that I love my child? Do I have to agree with them all the time? How can I discipline them if I am so busy ”accepting” them? Let’s be clear on what validation is and what it is not. Validation is the ability to accept another person’s thoughts or feelings, even if they are different from yours, and to convey that to the other person. Validation is not the same as agreement or approval. Going back to some of our examples, if children say, “I’m hungry,” they are describing an internal state that they are experiencing. Maybe you doubt they are really hungry; maybe you think they just want a nosh or are bored. You cannot know for sure what’s going on inside of them. Validating them would be saying something like, “Hmm, you are hungry. That’s interesting, we just finished eating a few minutes ago.” Then you can follow up with a question, or just for their response. Validation is a great way to open up 6 MIND, BODY SOUL &
a dialogue rather than shut it down. Let’s say your child says, “Yes, I am hungry, I want a nosh.” You can then respond, “Oh, so you want a nosh, you know what the house rule is? No nosh right after a meal.” “But it’s not fair, I am hungry.” “Ok, if you are really hungry you can have either fruit or some cut up vegetables, but I’m sorry, there is no nosh now.” You have validated their feeling without giving in to what they want. Let’s take one more example. You are shopping with your child and you pick out a shirt you like and you are pretty sure they will like. Your child says, “I don’t like that shirt, it has too much black.” While you might be confused
feelings (even not nice ones), and their experience is their experience. Giving them “permission” to have their own thoughts and feelings over the course of time helps them build confidence in their own perceptions and builds the belief that they are okay and it is safe for them to express their feeling or state an opinion. You can validate and disagree. You can also validate a request and still say no. You can tell your teen that you hear that going shopping with her friends is really important to her and she feels that if she doesn’t go, she will be the only one, and you feel for her, but you are not comfortable with the plans as they are and you are not letting her go. No, your teens will not
because yesterday all they wanted was black (fashion trends change very quickly sometimes!) you can say, “You really don’t like that shirt? I thought you would, but I guess I was wrong. Do you want to pick something from this rack that you like better?” You have validated their opinion; you have not made any promises about what you will or won’t buy, but you have conveyed the message that they are allowed to have different opinions from yours, and that is okay. I am often asked by parents that I see in my practice, “Won’t my child think that everything they think or feel or do is okay?” The answer is that you do want to convey the idea that they are allowed to have their thoughts and
jump for joy that you “get it.” Actually, they are likely to be pretty upset. But, hopefully, they will not feel that you are totally out of touch with their feelings or don’t care. Validating your children (or spouse, friend, or coworker) lets them know they are important to you, that they are allowed to exist independently of you, and that even when you don’t agree they can still feel that you “get” them. Let’s return to the question of action. Should we be validating all actions, even those we feel are inappropriate? The answer is no, don’t validate the action, but if you show that you understand the underlying feeling, that goes a long way toward helping to stop the
undesirable action, without making your child feel bad for having angry thoughts or feelings. “You must be so frustrated that your brother keeps knocking down your Legos, but hitting is never acceptable. Let’s talk about what else you can do when you are angry or frustrated.” Let me share some of what I see in my practice when emotional validation is not present. When children are not “seen” and accepted for who they are, when their feelings are continuously discounted or considered “wrong” or “bad,” they learn not to trust their perception of the world. These children are often lacking positive self esteem, they have difficulty in maintaining quality friendships because they are very unsure of themselves, and have difficulty expressing their thoughts and feelings. On a more serious level, some children learn that their feelings are not okay, and they repress them; they ‘turn off ’ their feelings and don’t have conscious access to them. Later on in life, these people are often very out of touch with their own emotional lives; they no longer know what they think or feel, and they often have difficulty trusting others. These scenarios are extreme and develop as a result of continuous invalidation, along with other factors. But it is important to know that practicing validation with your children, your spouse, and your friends can deepen your relationships, inject confidence in to the people you care deeply about, and invest the next generation with the emotional building blocks they need to deal confidently and successfully with the challenges they will face. The next time your child or spouse expresses an opinion or feeling that may not match your own, start your sentence with “You feel … (tired, stressed, nervous, angry, excited, upset),” or, “So you are saying that….” Watch how the conversation flows and how people who may not normally talk openly might just share the things that are important to them with you. Dr. Aviva Biberfeld is a licensed psycholo-
gist, with over twenty years experience, in full-time private practice in Brooklyn. She sees children, adolescents and adults, and has a sub-specialty in parental counseling and working with young adults. She lectures to professionals and lay audiences on a wide variety of topics of clinical interest and on Torah topics. She is a member of the Board of Nefesh International. She can be reached at 718.437.6995.
Another Approach To Dementia By Leah Abramowitz
he very words put fear into the hearts of everyone who hears them: dementia, Alzheimerâ€™s disease, cognitive decline, organic mental illness. We live in a generation when the number of people affected by dementia has ballooned beyond imagination. Everyone knows someone who suffers from a progressive deterioration of the mind: memory decline, inability to learn, impaired judgment, distorted orientation to time and place or behavior aberrations. More money is presently being put into dementia research than into any other disease except cancer, yet at present there is no cure â€“ only some medication that in the early stages helps to arrest the progress of diseases such as Parkinsonâ€™s disease, Alzheimerâ€™s, Pickâ€™s Disease, Jacob Croetzer Disease, and the effects of stroke. In the early stages, the patient is usually aware that something is amiss. In later stages, thankfully, he is released from self-awareness-but then it is the family members who become the real victims. Spouses, adult children and even grandchildren are affected, each in his/ her own way. The sudden role reversal, the need to do the family wash, cook or look after the household, for men in their advanced stage in life, is sometimes almost as devastating as losing their life partner. For the wives who are themselves usually aging, suddenly being in charge of finances, house repairs and car management can be as difficult as dealing with aggression, confusion, withdrawal, hallucinations or paranoiaâ€”all common symptoms in dementia. Moreover, spouses are less likely to admit to their problems, know less about their government rights, and are loath to take help. Adult children, on the other hand, have less time and energy to devote to their ailing parents. They are torn between their conflicting responsibilities, resentful and angry at the change in their parent, and perhaps also fearful of what might happen to them when they get to that stage of life. Amid the care of demented fathers or mothers, sibling rivalries and quarrels can break out which often cause havoc and longterm splits in family unity. But there have been some hopeful breakthroughs in the care of dementia patients. According to recent literature, there are a growing number of services for dementia patients and their families. A recent article in the New York Times stated that environmental manipulation is sometimes as
beneficial to these elderly as medication. Participating in a day care center for Alzheimerâ€™s patients or being stimulated by special computer programs has been shown to improve the quality of life of participants and provide
brought about in their relationship. â€œOnce I got over the false expectations that I can talk to him logically, I learned to flow with the tide. Itâ€™s not important, I now realize, to make him realistic. Itâ€™s more important to make
him feel accepted and loved.â€? Another man quipped, â€œThe advantage of Alzheimerâ€™s Disease is that you can easily divert her attention. She may be fixated on getting dinner ready for the children (whoâ€™ve been out of the house for 25 years), but I can show her a photo album and sheâ€™ll forget all about it.â€? Also, pain, anger, distress and other negative emotions are readily forgotten, to the extent that a physiotherapist told me, â€œGetting a demented patient after hip replacement to start doing physiotherapy is easier than with others because they donâ€™t remember that it hurts.â€? No one chooses to become a cognitively impaired patient, just as nobody chooses any of lifeâ€™s difficulties. But with understanding, fortitude, faith and a little creativity, this state can also be dealt with positively by learning from the experience of others and maintaining the close family ties that provide the motivation to make it all work. Leah Abramowitz, MSW, is co-chair of
Nefesh Israel, coordinator of the Institute for Studies in Aging of Melabev at Shaare Zedek, and co-founder of Melabev.
essential respite for family caregivers. Professional counseling for family members is another service that has proven essential. Support groups for either spouses or adult children have also proven to be helpful. Itâ€™s not only that â€œmisery loves company,â€? but that when people in this situation meet others in the same boat they find relief in many ways: the ability to open up and share their problems and feelings with people who will understand them; the chance to learn about methods of coping that have helped others; and an opportunity to offer support to one another. At a recent support group for spouses, one woman complained that it was very difficult to get her husband to bathe. She received three or four suggestions from other participants for how to overcome his reluctance. When one member expressed her concern that she had to leave her ill spouse because she was going into the hospital for a procedure, another woman whom she had befriended offered to have him stay with her and be looked after along with her own husband who was also suffering from dementia. Family members have shared with us their observations about some of the positive changes that dementia has
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Why Won’t They Get Along? Insights about Sibling Rivalry By Tali Moskowitz, LCSW
magine your boss has sent out an email with the intention of motivating his employees. There will be a productivity competition, and the winner will receive a monetary reward. This may bring out a competitive part of you and motivate you to win the prize. How do you think this competition would cause you to feel toward your co-workers? Perhaps you would be tempted to hide your knowledge and strategies to give yourself an edge. You may begin to feel negatively toward coworkers with whom you previously enjoyed working. Most likely, this project would likely foster a negative energy among all the employees and create a rigid and hostile working environment. Now, imagine that your boss has sent out a different email with the same intention-- to motivate employees to be more productive, but this time the task is to pool together the resources and specialties of each individual, with a monetary reward given to each employee as long as the overall productivity of the group reaches a certain level. How might you feel toward your colleagues under these circumstances? Working together toward a common goal might lead you to feel warmer toward, them and even feel better about yourself. It would likely change the work environment and foster a friendly and positive feeling toward your coworkers. Friendships might form or strengthen. Let’s now turn our attention to parenting. It is very tempting for parents to motivate their children by unintentionally encouraging competition among siblings. When children are young, parents may be tempted to motivate their children by involving them in a “race” against their siblings: “Let’s see who can brush their teeth and get into bed first,” or, “Let’s see who can get their shoes and jacket on first.” This works in motivating the children to do what is expected of them. On the other hand, it causes the child who did not “win” to feel disappointed and discouraged, and could lead to anger or jealousy toward the other sibling. Another way that parents inad-
8 MIND, BODY SOUL &
vertently encourage competition between siblings is by comparing them. This may be done outwardly and openly, or more subtly. One child may be easier to raise, have an easier temperament, or have an easier time in school. Parents may talk about one child’s achievements to the other, or directly to the sister or brother who
study was conducted in a boys’ summer camp setting by arranging conditions that fostered either competition or cooperation between two groups of boys. To produce friction between the groups, the researchers arranged a tournament. They found that when one group could only achieve its goal in a game at the expense of the other,
is not achieving in the same way, saying, “Why can’t you be more like your brother?” or the like. Many factors contribute to sibling rivalry, such as birth order, temperament, stage of life, age difference, and sex of the siblings and sibling roles. Nevertheless, parents can encourage cooperation instead of rivalry in order to improve sibling relationships. Although we live in a culture that values competition, research shows that competition can produce negative relationships. Muszafer Sharif, one of the founders of Social Psychology, conducted an experiment to determine which conditions lead to harmony or to friction between groups of people. The
the two groups became hostile toward each other. Within each group, however, solidarity and moral and cooperation increased. The study showed that just as competition generates friction, working toward a common goal produces harmony. During the second phase of the study, after the groups had already developed hostility toward each other, both groups were set up to cooperate by needing to solve a series of crises together, such as needing to fix a breakdown in the water supply. When the boys on the two teams had common goals, which they could only resolve by working together, they were no longer hostile toward each other and they started to get along. The boys
then began to form friendships with the boys from the “opposite” team. The results of this experiment can be applied to siblings. When children compete, it creates hostility. On the other hand, when brothers and sisters are encouraged to work together to achieve common goals, they get along better. Here are some tips borrowed from Siblings Without Rivalry by Adele Faber & Elaine Mazlish, along with others that I have found helpful in working with kids and in raising my own children: • Resist the urge to compare: Instead of comparing one child unfavorably to another, communicate the behavior you see and what you expect from the child. • Children don’t need to be treated equally--they need to be treated uniquely: Instead of giving equal amounts, give according to each individual need. Show each child that he or she is loved uniquely. This will give them the message that they don’t need to compete with each other to receive love. • Avoid setting up competition between kids: It may motivate them in the short term, but can lead to hostility and cause them to feel like there are “winners” or “losers.” Instead, have them race against the clock or race as a team against you. • Encourage cooperative activities: The goal is to help kids work together as a family. You can set up group activities that encourage cooperation, such as group chores: i.e.: setting the table together or doing group projects that encourage them to work jointly. • Encourage siblings to resolve their own conflicts: Try not to get involved in children’s arguments. If the situation is heating up, intervene by encouraging them to work together to find their own joint solution. Most importantly, enjoy your children. Children can be a lot of fun -and childhood is so short. Tali Moskowitz is a Licensed Clinical Social Worker and has been providing psychotherapy to children, adolescents and families for over 16 years. She has a private practice in Hewlett, NY.
Perinatal Mood and Anxiety Disorders By Chana Simmonds othering is a sacred and demanding role…a mother and her body and her mind – especially her mind – are the center of the family; they are its source, its foundation.” -- Anna Blackmon Moore in Between Depression and a Hard Place Perinatal Mood and Anxiety Disorders (PMADS) is a clinical term that means depression and/or anxieties that women might experience during pregnancy or postpartum. These feelings often conflict with assumptions and fantasies of how a woman should feel. A pregnant woman and her husband can be at a loss as to how to understand what is happening and how to cope. PMADS is triggered by dynamic and profound hormonal and physiological changes that begin with pregnancy and continue through labor, delivery and the first postpartum year. Every woman is unique in her capacity to tolerate and cope with hormonal changes. This is due to genetic and psychological makeup, learned expectations, life situation and availability of a good social support system. The examples that follow focus on postpartum experience, but the feelings described may also be experienced during pregnancy. At one end of the spectrum are the
common form of mild anxiety and depressive mood. For example, a new mother, ecstatic that she has given birth to a beautiful, healthy baby, might worry that something is wrong when she feels moody, weepy, irritable or frightened. These feelings may alternate with emotions of joy and serenity. These experiences are known as the “baby blues,” and usually resolve within two to three weeks. One in five new mothers experience more severe symptoms of anxiety and depression. These may manifest as persistent sadness, irritability, anger, or difficulty taking care of herself or her baby. Some new mothers report upsetting and unwanted thoughts or images that express fears that harm may come to herself or her baby. Some women even experience panic attacks. At the opposite end of the spectrum, a small number of women suffer a postpartum psychosis. This is a medical emergency requiring imme-
diate medical and psychiatric attention. Symptoms include agitation, inability to sleep, paranoid or delusional thinking, hallucinations and suicidal or homicidal thoughts and feelings. It is crucial that women who suffer with any of these feelings or symptoms, and the people who are around them, recognize that these experiences are not signs of weakness, character flaws, or moral failings; nor are they self induced. They are reactions to hormonal and physiological changes. Pregnant and new mothers, as women in general, can empower themselves to cope with the dysregulations triggered by hormonal changes: First, know the importance of valuing yourself and honoring your needs and feelings. Second, learn and practice mind/body skills that help with regulating the impact of hormonal and life challenges and promote ongoing well-being. These skills help provide nurturing and soothing selfcare. They include relaxation breath-
ing, meditation, imagery, guided visualization, journaling, exercise, music, good nutrition, prayer and cognitive restructuring. Of utmost importance is a woman’s emotional and social support system. It is both folk wisdom and scientific knowledge that “a new mother needs to be mothered.” Not enough can be said about the importance of having a loving connection with her husband. In addition, family and friends can provide nutritional meals and create opportunities for rest, sleep and respite from stress. Pregnant and postpartum moms should not hesitate to ask for help when it is needed. Good resources include mental health professionals who specialize in PMADS and local maternal/child health consortiums and organizations. Good intervention brings relief, facilitates recovery and wellbeing, and helps new parents find the support they need to successfully negotiate the transitions from couplehood to parenthood and a happy and healthy family life. Chana Simmonds, MSW, LCSW, special-
izes in PMADS, Couples and Sex Therapy and Parenting. She has a private psychotherapy practice in Teaneck, New Jersey.
& August 2012 MIND, BODY SOUL
The Mind, Body Relationship By Dr. Judith Guedalia
fter more than 30 years in the psychology “business,” I have learned a lot about the mind-body interaction in medicine, specifically the role of resilience and self-help. I’ve learned this not only from my university training and work experience with trauma patients, but primarily from my own experience as a patient, having had four births by Caesarian section, thyroid cancer, and now endometrial/uterine cancer. What is the science behind the Mind Body Connection? Research at the David Geffen School of Medicine at the University of California Los Angeles reveals how stress makes people more susceptible to illness. The findings also suggest a potential drug target for preventing damage to the immune systems of persons who are under long-term stress, including caregivers to chronically ill family members, astronauts, soldiers, air traffic controllers and people who drive long daily commutes. Rita Effros is a professor of pathology and laboratory medicine at the UCLA medical school, concludes: “When the body is under stress, it boosts production of cortisol to support a ‘fight or flight’ response. If the hormone remains elevated in the bloodstream for long periods of time, though, it wears down the immune system. We are testing therapeutic ways of enhancing telomerase levels to help the immune system ward off cortisol’s effect. If we’re successful, one day a pill may exist to strengthen the immune system’s ability to weather chronic emotional stress.” Today there are many mind-body interventions that help patients and “pre-patients” reduce stress. While the study just mentioned reflects today’s cutting edge thinking, I have strongly, interestingly, relied on the work of the French psychiatrist Andre Coué, who worked in the early 1920s. (See The Birth of Autosuggestion (http://en.wikipedia.org/wiki/Autosuggestion.) The Coué Method The Coué method centers on the routine repetition of a particular expression (i.e. “Every day in every way, I’m getting better and better”) according to a specified ritual, in a given physical state, and in the absence of any sort of allied mental imagery, at the beginning and at the end of each day. Unlike a commonly held belief that a strong conscious mind constitutes the
10 MIND, BODY SOUL &
best path to success, Coué maintained that curing some of our troubles requires a change in our subconscious/ unconscious thinking, which can only be achieved by using our imagination. Although emphasizing that he was not primarily a healer but one who taught others to heal themselves, Coué claimed to have effected organic changes through autosuggestion.” Self-conflict Coué believed a patient’s problems were likely to increase if his willpower and imagination (or mental ideas) opposed each other, something Coué
ered that they didn’t make 150mg pills but rather 100mg and 50mg. So I was now taking two pills a day. I began to notice I felt sad and somewhat depressed. I felt “sicker” than I had felt in the States. I tried to figure out why. It slowly came to me that the fact that I was taking two pills instead of one made me feel ‘sicker’ than when I took the one pill. “Wait a minute,” I told myself, just do simple math. One hundred plus 50 is equal to 150. So I am no more ill than I was. The reason they don’t make 150 mg here in Israel, I ascertained, was
would refer to as “self-conflict.” As the conflict intensifies, so does the problem: The more the patient tries to sleep, the more he becomes awake. The patient must thus abandon his willpower and instead put more focus on his imaginative power in order to fully succeed with his cure.” Here are a few examples of what I experienced and how I tried to understand the mechanisms of what was happening, and talk myself through in order to work on the mind-body relationship that was affecting how I felt and how I was healing from the ”assaults” on my body. About 16 years ago, two weeks before Shabbat Hagadol, I had a thyroidectomy. My thyroid was surgically removed as a result of cancer, and so began the daily taking of thyroxin pills to replace my thyroid function. No big deal. Interestingly, I began taking them in the U.S. where my prescription was 150mg, one oval greenish/ blue pill. When I got to Israel I discov-
purely an economic decision by the drug company. As soon as I made this connection I felt okay, not sad, and the “sicker” feeling diminished. Recently, with my present bout of cancer, there have been many such experiences and instances where I employed a “wait, watch and listen to my mind/body reactions” strategy. Once I thought about my feelings and from whence they may be coming, I tried to reframe the situation, and it indeed made a difference. Most recently, I underwent a series of radiological interventional therapy. In the vernacular, the cancer cells were being zapped by pinpoint radiologic beams. Yes, I thought about Darth Vader and the whole Star Wars, and visualized Hashem giving these “guns” to his minions/shelichim, the doctors and technicians, to fight and kill my enemy within. But something was still not right. I was feeling helpless and did not feel a
part of the curative process, something that even with the chemotherapy I had undergone for over a year I had been able to experience. Being a part of the process, and not just a “piece of meat” that things were being done to, made me feel the difference between being in a “butcher shop” and being part of a team that was going to cure me -- or at the very least lengthen my life on earth. I definitely felt better when I was a part of a team doing something to fight the disease and help the professionals and myself. I began to pay attention to the process, the technicians, the line of people waiting for their turn waiting to be laid on a cold hard surface, the area of cancer to be zapped laid bare, measured against an earlier ‘staging visit’ and then the 10 -15 minutes of treatment, then getting dressed and out so the next “victim” could come in and receive treatment. I noticed that the technicians had a breakneck schedule: one patient after another every 10-15 minutes from 7 a.m. till after 3 p.m. I mentioned to the technicians that I really appreciated their hard jobs, and the fact that they even found time to smile (not really). The next visit (my treatment was five days a week for five-and- a-half weeks) I brought a small gift to every one of the technicians as recognition of their hard job and wonderful demeanor (so I lied!). You will never believe what happened. They offered me an extra pillow under my head to make me feel more comfortable, but more importantly, they gave me a sheet to cover my ‘bareness’. I treated them like humans with basic needs for actualization, recognition and positive regard, and lo and behold I became a person to them, too, someone whose need for modestly and comfort was no different from their own. So the mind-body relationship can work for us in many ways. My best wishes to all for good health and strong connections between your minds and bodies for your own good health and that of those around you, which I might add will only enhance your own life. The author is the Director of the Neuropsychology Unit; Chief Psychologist at Shaare Zedek Medical Center; Licensed Supervisor and Specialist in Medical, Rehabilitation, and Developmental Psychology; EMDR Certified Practitioner: Supervisor; Co-Chair Nefesh Israel. Dr. Guedalia can be reached through her website: www.drjudithguedalia.com.
Add A Minim Of Anger To Spice Up Your Life By Ed Yisroel Susskind
or years, I have taught clients that Torah forbids us from acting and speaking in anger. We have a right to take unilateral action to protect our legitimate needs; that action should be done with calmness, courage, determination and forcefulness; but without anger, hatred, resentment or vengeance. People need to communicate their hurt, clearly and directly, and that communication is obscured when they speak in anger. Some secular psychologists and marital therapists agree with this viewpoint. However, there are many other counselors who disagree; they propose that the cathartic venting of anger “clears the air” and makes for a more honest relationship. I felt proud that the Torah offeres a healthier viewpoint in urging that a person totally minimize their anger -- in action, in speech, and even in thought. Anger is permitted by Torah in situations such as that of Pinchas, where one faces an enemy who deserves to be destroyed. This article, however, addresses close relationships such as those within a family, where Torah absolutely discourages rage. Some years ago, a world-famous marital counselor, Australia’s Rabbi Leibl Wolf, asked an audience, “When is it appropriate for you to speak angrily to your spouse?” He answered, “Never!” At first, I saw that position as rather extreme, but then I realized that Torah views anger as a dangerously addictive feeling. Thus, once a person is comfortable with an occasional outburst of anger, the frequency of these outbursts is likely to grow. Anger is like an infectious virus that grows once people, chas v’ sholom, allow some anger into their system. There are many negative emotions used by our yetzer horah to manipulate us into harmful activity, including depression, fear or envy. Of all of these, Torah views anger (and its companion emotion of arrogance) as the most treacherous. However, I have recently accepted a nuance. I came across a Torah learning that suggests there may be times when direct expression of anger is appropriate, provided that that aggressiveness constitutes a very small fraction of the couple’s overall communication. Our Sages teach that Hashem gets angry for a very brief fraction of a second every day (Sanhedrin 105B). This view is based on the verse in (Tehillim,7:12) “Hashem is angry in every day.”
The Talmud, as well as later commentators such as Rabbenu Tam, makes significant efforts to quantify the exact duration of that moment. Further, our Rabbis note a contrasting verse (Tehillim, 52:3), “The kindness of Hashem is all day long.” Here, our Rabbis make a second quantitative observation. Hashem’s anger lasts only a part of the day, whereas his kindness lasts the whole day. One might ask: Why is Torah bothering to tell us these two quantitative
serious enough to warrant it, in order to prevent the matter from recurring.” (Chapter 1, Halacha 4) “..Anger is also an exceptionally bad quality. It is fitting…that one move away from it and adopt the opposite extreme…even when it is fitting to be angry.” (Chapter 2, Halacha 3) So, there may be moments when anger is “fitting.” But anger always poses a threat. How can we minimize this hazard in our close relationships? By allow-
ing ourselves to engage in anger only when it comprises a fraction of a fraction of our interaction with another person. Should we engage in a caustic exchange with a loved one, we need to neutralize its toxic effect on ourselves and on that person; we do so by engaging in a far greater number of acts of nurturance and affirmation. The yerida (the spiritual descent caused by the antagonism) then becomes a yerida l’tsorech aliya (a temporary descent that causes the relationship to grow to a yet higher level). May it be that we use anger only very sparingly. A minim is a drop, technically 1/60th of a fluid ounce. It comes from the Latin root meaning “least.” May it be that we overwhelm those we care about with a liter of irresistible chesed. And that in doing so, we elicit the ultimate chesed from Hashem. Dr. Yisroel Susskind, Ph.D., is a clinical psychologist who practices locally in Monsey, New York, and internationally by telephone. He lectures on Torah and Family Psychology worldwide. Dr. Susskind can be reached at firstname.lastname@example.org Work 845-425-9531; cell 845-304-5481.
details? We already know from many places in Torah that Hashem experiences something that we humans can best understand as “anger.” Torah is not a generic psychology book, or a historical text, or a mathematical treatise. If Torah includes such a detail, that detail must have some instruction for us. Perhaps that message is that our path as Jews is always complicated by our struggle between two poles of a dialectic; for example, when should we use chesed [kindness] and when should we use gevurah [severity]? On the one hand Torah warns us ad infinitum of the spiritual and practical dangers of anger, and of the blessings that come to someone who avoids rage, revenge and resentment. Yet there may be those moments when we need to use our God-given ability to be angry for the good: e.g., in order to find the energy and courage to protect our legitimate rights, and to express our true feelings. The Rambam expresses this dialectic in two contrasting statements in his Hilchot Day’ot: “[A person] should not be wrathful, easily angered; nor be like the dead, without feeling, rather…he should display anger only when the matter is & August 2012 MIND, BODY SOUL
Anxiety: Can It Be Controlled? By Dr. Miriam Adahan
s a teenager, I suffered from occasional panic attacks, social anxiety, and more than the usual amount of teenage angst. In today’s drug-obsessed society, I would certainly have been given psych meds; thankfully, back then, it was expected that maturity would bring greater resilience and awareness. And so it was. Over the years, I developed numerous skills to help calm myself. I also learned that all normal people have ups and downs and worry at times about their health, relationships, finances, and major life changes.. This is because the amygdala, a walnut-sized area located deep within the primitive brain, is forever busy alerting us to possible dangers, both internal and external. On the positive side, the amygdala is what tells us to wash our hands to stay healthy, to drink water to stay hydrated, to stay away from dangerous people, to make sure that we lock our doors and to get to a doctor if we suffer from worrisome physical symptoms. On the negative side, it can take control of our minds so that we can do nothing but obsess about everything from whether Iran will attack Israel to petty fears concerning our looks or clothing, to whether we will be rejected for not living up to the impossible standards of various relatives. No one is born knowing how to manage life’s stresses. We must acquire skills that help us face the failure, criticism, betrayal, frustration and disappointment with faith and fortitude. Until we acquire these skills, our level of anxiety can cause us panic, confusion and despair. Unfortunately, the medical profession has pathologized feelings. While pills can provide temporary relief, they do not teach us how to think. They can create dependence on external substances or cause severe side effects. In anxiety-ridden people, the amygdala is in a constant state of hyper-alert, causing them to feel stressed. As they continue to entertain fearful thoughts, the amygdala actually grows larger. By contrast, the amygdala in criminals is generally unusually small. Criminals can commit horrific crimes and feel no emotion, no regret or remorse or pity for their victims. Their brains automatically minimize, deny, excuse, justify, defend or trivialize their crimes. So, if you have anxiety, it’s highly likely that you are responsible and conscientious and will not become an exploiter of others! The second piece of good news is 12 MIND, BODY SOUL August 2012 &
that the brain is “plastic,” i.e., it can be taught new tricks, and the amygdala can be reduced to normal size. When we try to control something not in our control, we feel helpless and anxious. When we think about things we can change, we feel empowered. Thus, our task is to take control of what is within our control, i.e., our beliefs and behaviors. The more we control what can be controlled, the more we calm down. You can start taking charge today. For example: ➊ Get adequate sleep. Except for the one percent of the population
make sure it is over 40 IU. ➌ Get busy. Many anxious people are narcissistically obsessed with themselves. To get your mind off yourself, get busy with chesed projects, exercise, work, crafts or other creative projects. Daily exercise is also very important to help you work off the dangerous level of cortisol which accumulates in your bloodstream when you are under stress. ➍ Recognize the “toxic ten” thoughts which keep you in a state of fear, shame and guilt. You cannot bear the discomfort of anxiety unless you
who can function on four to six hours of sleep, we need between seven and nine hours to avoid becoming agitated and anxious. Very few people get adequate sleep today. Many think of sleep as unnecessary or even a sinful waste of time. In truth, the nervous system relaxes and is rejuvenated during sleep. The immune system is also strengthened, helping us avoid illness. Anxiety-ridden people need a great deal of energy to “battle” their negative thoughts and stay positive, especially in the beginning of this learning process. So adopt a disciplined sleep regimen, going to sleep and getting up at more or less the same time. ➋ Eat only nutritious food. Every nerve cell is surrounded by a protective shield called the myelin sheath. It is composed mainly of Vitamin B. You lower your B levels every time you ingest white flour, white sugar, drugs, food additives such as diet sugars and other junk substances. Therefore eat plenty of fruits and vegetables and healthy proteins. It is also essential to check your level of vitamin D and
figure out what tricks it uses to “kidnap” you. Although the brain is only two percent of the body’s weight, it takes about 20 percent of our energy and oxygen – and more in those who suffer from anxiety. At any given moment, some 100 million bits of information impact on the nervous system from organs including our ears, eyes and skin. Most people shift 99 percent of this information to the “junk mail” section of their brain before they are conscious of its existence. But in anxiety-ridden people, this screening apparatus is defective, allowing too much information to flood the mind. This is what causes the person to feel overexcited and overwhelmed. They must make a conscious effort to do this shifting process until it becomes automatic. For example: Stop looking for perfection: Forget about looking perfect, making perfect food or being the perfect child/parent/ teacher/worker, etc. Strive to be “high normal.” It’s not only humbling but also calming for the nerves. Stop obsessing about what others
think: People’s feelings and opinions are not in our control. We cannot attend all the social events, help everyone who asks for our help or win everyone’s approval. We cannot force anyone to give us love, understanding or respect. We cannot get anyone to stop an addiction, to become more/ less religious, to be less lazy or more aware. We can do our best to be polite, kind and caring, but no power in the world can get people to change their feelings or beliefs unless they want to do so. We are all limited. People – especially the demanding types - will always be disappointed and frustrated. Don’t confuse danger with discomfort: Life’s discomforts are not dangerous. We will experience endless physical and emotional discomforts – accidents, spills, messes or missed opportunities. Think, “If there is no true sakana (danger) or real avaira (sin), then it is trivial.” Tell yourself, “I can cope with this and find solutions.” You missed the simcha? It’s a discomfort, not a danger. Your house is not perfectly neat and clean at all times? It’s a discomfort, not a danger. Things break, get lost and get ruined? It is uncomfortable to be hungry; but it is not dangerous unless you are starving. It is uncomfortable for your relatives to dislike you, but it is not dangerous unless they are truly abusive. Don’t second-guess God: You might think, “I momentarily lost my concentration during prayer and will suffer some terrible punishment.” Can you know that God has not forgiven you? Be responsible and conscientious, but realize that uncontrolled anxiety is an insidious form of self-torture. Avoid “victim” thoughts: Toss thoughts such as, “I’m a victim of my moods and cravings.” “I have nothing to contribute to the world.” “Hashem is out to get me.” “No one could possibly love me.” “I’m a failure because I’m not ____ (rich, beautiful, always cheerful, good at math, organized, etc.)” “I can’t change, because my parents were….” Avoid “what if…” scenarios: Since the future is in Hashem’s hands, refuse to torture yourself with questions such as, “What if Iran attacks?” “What if my in-laws/children don’t like me?” “What if I get fired from my job?” “What if I never get married or I get married and my spouse suddenly leaves me or becomes abusive?” “What if I lose my mind and go insane?” “What if I go to shul and no one greets me?” “What if I make a fool of myself in public?” Continued on Next Page
Flipping Out: A Parent’s Guide to Sending a Child to Israel By Michael J. Salamon, Ph.D.
any parents whose children have graduated from high school are busy preparing them for a year or possibly two or more years in Israel, where they will be studying full time in a seminary or yeshiva. This event has, in many circles, come to be seen as both a developmental requirement and a defining event for teens in their transition to adulthood. This progression from high school to a higher level of Jewish learning in Israel has been in place now for at least four decades. Most parents who send their children to Israel have themselves been there to learn. Originally, graduating seniors would not go directly to Israel but would spend a year or two learning and/or going to college in the United States before going to study in Israel. That has changed, and as these younger individuals leave, parents are increasingly expressing some concerns about sending their children off. The greatest fear that I hear from parents is not what some might expect. The concern parents seem to voice most frequently is that their child will not adjust but will be homesick in Israel. Most students are homesick initially, but the overwhelming majority of them adjust to their routine and life in yeshiva by Chanukah time. While that may seem quite a long time to adjust, it makes sense when looked at from the perspective of the chagim. Until after Simchat Torah, the yeshiva schedule is not fixed into a daily routine. Once the daily schedule becomes routine, the adjustment process begins. Many parents are concerned that there is a lack of supervision and that their child might be exposed to some
very negative influences even though they are in a learning environment. This is a genuine concern, which is why I tell parents that they must know their child and the school the child will be attending. The teen years are defined by experimentation and rebelliousness. It is for this reason that some parents opt not to send their child to Israel and, if they do send them, it is not until the child is a little more mature. Teens can get into trouble anywhere -- at college, in Israel, even at home. A child who is an enthusiastic risk taker
Adahan Continued from Previous Page
“What if I get caught by the police and get falsely accused and imprisoned for something I never did?” “What if I don’t pass the test?” There is no end to the possibilities which a fear-mongering amygdala can imagine. When anxiety arises, do not try to control it. If you feel cold, you cannot will yourself to feel hot. You can only change actions, such as putting on the air conditioning or a sweater, or bear the discomfort until it passes. You cannot force yourself to love everyone, but you can be compassionate or stay away. Trying to force the anxiety away only makes it worse. You can only think “secure thoughts” or take positive actions. You can breathe calmly, clean the house, pray, sing,
may get into more difficulties than one who is less open to new experiences. The school that the child attends in Israel should have some awareness of the child’s personality, and it is the parents’ responsibility to let them know if there are concerns. Many schools know how to handle all kinds of personalities and are not turned off by the extrovert who likes to party a bit. If a parent has true reason for being worried, then a seminary or yeshi-
va that monitors their students even on their days off should be selected. Remember, though, that ultimately it is the child who is responsible. For some children who are troubled, Israel seems like a perfect opportunity for parents to hand the child over to someone else for a period of time and see what others might do to help the child. Unfortunately, this does not often work. Every summer, when I begin to refer some of the students I work with to psychologists and other mental health specialists in advance of the teen’s year in Israel, I hear from my Israeli colleagues the same refrain: “Please do not send us your problem cases.” It is not that they do not want to be helpful. They are always willing to work with someone who can benefit from their help; they are simply saying that sending a child with serious behavioral or emotional problems may not benefit the teen. In some situations, the experience in Israel for that particular teenager may even cause their symptoms to worsen. A library of opinions has been written about the concern that both parents and teens have about the possibility of “flipping out” – the experience that some American students in Israel seem to have when a radical shift in their religious observance is observed. A number of teens return from Israel
with an apparent increase in religious observance and spirituality, and an increasingly conservative approach to piety. There is concern that some of these students may have been “brainwashed” by their teachers or have hidden insecurities that cause them to affect an attachment with a lifestyle that allows them to withdraw from the responsibilities their parents expect of them of living in the modern world. Rarely discussed is the student who “flips out” in the other direction, and uses his or her time in Israel to move away from religious observance. There are no data to define trends for flipping out. There is no measure of its frequency, intensity, how long the “flip” lasts, or if it is due to a hidden psychological disturbance. What is known is that parents retain responsibility in this area as well. Before sending the child off, a complete and frank discussion is in order. Parental expectations as well as what the teen seeks to gain from the time in Israel should be discussed. Expect there to be changes in your child, and be prepared to discuss them in a supportive and non-judgmental manner. Most of all, remember that the overwhelming number of students who spend a year or more in Torah study in Israel hit a few bumps while they are there but end up growing from the experience.
write, learn, go shopping, or do something else that distracts you from that pesky amygdala. When you find yourself worrying, ask, “Is there something I can do? If not, I toss it.” Examples of actions one can take include avoiding white flour and sugar and exercising if I’m worried about diabetes and heart disease; avoiding criticizing, hitting and screaming if I’m worried about a child’s mental health; following safety precautions if worried about being in a car accident. As you learn to avoid hoarding all the junk mail that come into your brain’s in-box, you will gain a sense of detachment from your overly active amygdala and begin to feel calmer. As you go through the day, be proud of your ability to distinguish between
truly important and necessary information and junk thoughts. A good therapist will help you identify toxic beliefs and replace them with “secure thoughts.” At first, this might be difficult, as you may be used to thinking, “My thoughts are absolute truths which I must accept.” Keep a list of your beliefs and figure out which ones you truly want to keep. The next step is to think “SECURE THOUGHTS.” For example: • When you contemplate the future remind yourself, “Hashem will only give me what I need for my tikkun and whatever he sends me is out of love and is meant to help me discover my inner strengths.” When you contemplate the past, tell yourself, “I trust that the events in my life and the mistakes I made were educational and taught me
what not to do in the future. The pain humbled me, gave me strength and made me more aware and sensitive.” • Hashem created a very tentative and insecure physical world for a reason- to force me to turn to Him and overcome my addictions, obsessions and illusions. • My self-esteem is not a balloon which others can inflate with praise or deflate with their critical words or eyes. I can create a strong sense of self-worth that is maintained no matter where I am or who I am with. As a child, I didn’t know how to think, but now I am a grown-up; I can choose what to think, and so can you.
Dr. Michael Salamon is a fellow of the
American Psychological Association and is the author of numerous articles and several psychological tests and books including “Abuse in the Jewish Community, The Shidduch Crisis: Causes and Cures and Every Pot Has a Cover”.
Dr. Adahan can be reached at 718.705.8404 or email@example.com.
& August 2012 MIND, BODY SOUL 13
Helping Our Children Overcome their Fears By Robin B. Zeiger, Ph.D.
n my practice s a clinical psychologist, fears often enter my office. It may be the child who is convinced something is under the bed; it may be the teen who is anxious about taking a test, or it may the father who worries whether his ADHD son will succeed in life. To adults, fears often appear unfounded and frustrating. For example, we may become frustrated trying to convince our children there are no monsters under the bed or in the closet. Sometimes fears make a whole lot of sense. The child become anxious about a stomachache after a loved one suffers from cancer. And there are times when the stated fear is just the tip of the iceberg and it takes sleuthing to unearth the real cause. Case in point: A child is extremely anxious about riding the city bus. The parents, who do not own a car, alternate between being perplexed and annoyed. The child reveals to the therapist that one of his classmates lost a mother to a terrorist attack that involved a bus bombing. Suddenly, the symptom makes a lot of sense. SO WHAT TO DO? ➊ Accept that some fear is good. It is protective. The world can be a dangerous place. Parents breathe a sigh of relief when children finally understand not to run into traffic. We appreciate a healthy respect for safety when hiking close to cliffs, diving into the ocean, or encountering dangerous animals. That being said, it is best to try to protect children from being inundated by too much danger and fear. Rather, it is best to help them learn about fear and safety little by little. A young child reaches for the medicine bottle. It is our job to make sure the bottle is childproof. It is our job to watch the bottle. But it is also our job to begin to say, “You need to ask adults for medicine. It can make you very sick if you take too much medicine.” We learn about how to handle and master the world, step by small step. ➋ Mastery helps. Control and coping skills often provide the key to unlock the door. We all remember the fire drills we endured in school. Having safety tools in our pocket makes us calmer because anxiety and fear are fueled by the belief that there is nothing we can do. Most of the time, it is possible to exert some con14 MIND, BODY SOUL &
trol. For example, a child may exhibit anxiety about smoke and fire after witnessing a blaze. Sometimes, providing the child with lessons in fire safety is enough to diminish that anxiety. Likewise, if a child is frightened of snakes, we can teach him or her how to recognize dangerous snakes and what to do if there is a snake in the path. ➌ Faith helps. Research shows how much having a faith system helps. We can teach even young children to reach out to Hashem and develop a personal relationship. Giving tzedekah, praying, and saying Tehillim are a few examples of tools we can use to face problems and big fears. ➍ Art, play, and other creative endeavors help. It may be particularly hard for children to put their fears into words. Sometimes we are teaching our children the language of feelings. At other times, we are presenting children with a safe and acceptable medium for expressing feelings. We encourage the use of language rather than acting out. Children are often great at using art or play to communicate. For example, we can encourage a child to draw a scary dream. Children who have experienced a traumatic event and/or who are anticipating a difficult situation often use play to work through their feelings and fears. ➎ Stories are a window into a child’s world. There are some wonderful children’s stories. Parents are encouraged to find just the right story to address their child’s situation. Reading stories aloud, even to older children, is a great way to discuss a problem. When children are touched by a story on a deep level, they often ask us to read them the book over and over again. This is a way of learning and working through an issue. It is also an invitation for dialogue with our children. ➏ Relaxation training is good even at a young age. Life is often intense, hurried and stressed. Even little children are swept along in the intensity of adults’ lives. Children, too, can benefit from learning how to slow down and relax. It is important to teach them to recognize and begin to manage their own internal responses to stress. For some children, it may be a warm bath. For some it may be retreating to their room to
draw. For others it may be listening to soft music. Sometimes children need their own small, quiet place. It may even be a corner of their room or a small play house made out of a cardboard box. ➐ Hugging and holding helps. As parents, we often work hard to take away pain and make things better. We rush to kiss the scraped knee. But we can’t always fix problems. Nor should we always try. I am reminded of a deep and painful encounter with my eldest daughter, now 20. When she was a young child, we made an emergency trip to Israel to visit my deathly ill father-in-law. My daughter prayed for her grandpa to get better and, miraculously, he got a bit better, but he soon relapsed and died. One fateful day, my daughter sat with me on the couch and tried to understand death. She wanted me to promise her everything would always be okay. And of course I couldn’t. I could only hold her; together we shared the pain. Sometimes that is all we can do, to be there for each other. The Role of Psychodynamic Therapy. There are times when we cannot conquer or manage fears on our own. Then the choice is made to consult a psychotherapist. There are many types of therapy, with many various approaches. I am a big believer in the power of the past and the power of the unconscious. Often enough, if we attempt to rid ourselves of one problem, another comes in its stead. One anxiety is replaced by another. This is because we have not fully understood the root cause of the problem. If someone is fearful of the dark because they were sexually abused, it does no good to just attack the fear of the dark. We also need to uncover and work through the trauma. Genetics vs. Environment Modern psychology and psychiatry often discuss the genetic components of a disorder. Some people seem predisposed from an early age to anxiety. The modern response is sometimes to jump immediately to medication to make it all better. Sometimes medication is in fact called for, and we are fortunate that some good medications are available. But the magic pill is not the final answer. Research often finds
that psychotherapy is more effective than medication. (See the APA reference below.) In addition, for those individuals that require medication, the marriage of medicine and therapy is often the most effective response. The medication helps to calm the individual enough to make good use of therapy and learn tools for the future. Therapy for Children with Anxiety – Are We Just Playing? Children often do not come into the therapist’s office, sit down, and begin to outline their fears. They may be unaware of their fears. They may be too young to engage in or benefit from just talking. Play therapy, sand-tray therapy, and art therapy are some of the tools of choice for children. Parents may come into a child therapist’s office and wonder if this is just an expensive excuse for play. Yet, play and creation is the work of children. This is the way children communicate, express themselves and work through trauma. The therapist, as an unbiased observer, can allow the child to work through all types of issues. In addition, her or his experience with developmental issues and a wide variety of psychological problems allows for a much deeper understanding of the play. The therapist serves as witness and facilitator. In addition, he uses this understanding to consult with parents and sometimes with teachers about the child Parents Who Worry Too Much One of the necessary jobs of parents is to worry about their children. Like a mother hen, we work to keep our children safe and we teach them how to cope in the world. Hopefully, as parents, we keep many of our worries to ourselves. Or we share them with our spouse or friends. But sometimes we are overwhelmed with worry. Maybe our own parents worried too much. Or maybe we suffered trauma in our own life. Or maybe there are some a reason to be very concerned -- for example, about a child who has serious special needs or is sickly. Sometimes it is hard to contain our anxiety, and we may fear burdening our children with our own neurotic behavior. This is the time to seek out personal assistance in therapy. The author can be reached at rbzeiger@ yahoo.com or in Israel at 052.420.3535.
Sacrificing For Oneâ€™s Parents By Rosalind Levine
arents sacrifice for their children - giving up their time, money and sometimes their own dreams - in order for their children to have the best life possible. Children, too, sacrifice for their parents. Consider this: A child grows up in a family with parental conflict or divorce, or with mental illness, or with a sibling off the derech, or with a parent who yells and hits. Children absorb the tensions in the family, taking on the role of protector, caretaker, appeaser, surrogate parent and/or surrogate spouse. Children instinctively begin to learn the art of sacrificing for the sake of their parent in the face of turmoil. Adapting to family problems helps maintain a status quo within the family and maintains the familyâ€™s appearance of functioning well. But at what cost to the child? Children, sensing that things are not right, even if they are unable to articulate it, will likely feel scared and confused. What will happen to their parents? What will happen to them and maybe to their younger siblings? They are worried, fearing the worst, ambivalent, and confused. They suffer these thoughts in silence. And they silence their own feelings with shame and doubt. When consumed by their own problems or those of the family, parents cannot give unconditional protection and nurturing to their children. The childâ€™s sense of safety and security erodes, and the child becomes overly vigilant, ever alert to little changes in the precarious family balance, anticipating signs of trouble and fighting, figuring out how to stay safe and protect others. The sense of danger is heightened. The child may feel guilty for not rescuing the family. When children, albeit unconsciously, lay themselves down to serve as the sacrificial lambs, they are prone to fear, confusion, ambivalence, shame, doubt, hypervigilance and guilt. Soon they will begin to act differently as well. In suppressing their needs, not daring to rock an already shaky foundation, children might become anxious, depressed, and withdrawn. They may develop fears or rituals, or have difficulty concentrating in school. They may cut themselves off from their family or friends. They shut down, adopting an â€œI donâ€™t care attitude,â€? partly because they care so much and partly because they learn to numb themselves. Helplessness and hopelessness may set in. Such children do not make trouble. They simply accept their self
sacrifice or suffer in silence. Alternatively, some children will act out. They may show irritability, anger
self mutilation. Any sense of security is shattered. The self is crushed, and it is not unusual for such children to cut
themselves, turn to drugs or even attempt suicide. Future relationships will equate violence and aggression with love, and so the hurt will only continue. The person feels damaged, and survival becomes the only goal. Ultimately, by keeping the family secrets and playing the role of appeaser or protector of the parents, the child is left to carry an unspeakable burden that wears away at the self. What gets sacrificed is the childâ€™s well-being, sense of security and trust. And without these, a child cannot grow into a healthy adult. It is incumbent on those coming in contact with children -- family members, educators and medical professionals -- to recognize the signs of distress and to take action. Getting these children to licensed mental health professionals is critical. The cost of covering up family problems is too great for any child to bear without professional help. Dr. Levine is on staff at Maimonides Medical Center, in the Child and Adolescent Outpatient Clinic, where she works with children and their families. She also has a private practice in Boro Park and in Manhattan.
and disrespect in the home and/or in school. It would not be surprising to find involvement in drugs or prohibited relationships. These children may escape or even leave the family, not necessarily from a desire to be bad, as is often thought, but in an attempt to find support in the world or to assert their own selves apart from the problems that surround them. Such responses to family problems serve an ulterior purpose: by drawing attention to themselves, these children take the focus off the real problems in the home. The acting out mode entails selfsacrifice in that children end up hurting themselves. They are not willing to remain passive but do not know another way to survive what they see as an impossible situation at home. Unlike those children who sacrifice for the benefit of parents (as they believe), these acting-out children are sacrificed because of the parents. In families where the problems are more severe, where abuse - - psychological, physical or sexual -- dominates, the childâ€™s reactions will be most impaired. Trust is broken, and there is no refuge in the home. Fear turns into terror. Confusion turns into losing sight of what is real. Self-blame turns into
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4362 Northlake Boulevard, Suite 109,Palm Beach Gardens, FL 33410 August 2012
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On Value and Valuation: Uncovering Your True Worth By Yitzchak B. Rosman, Psy.D.
can give you $3,800, but can’t go any higher.” My stomach dropped. How could he only offer $3,800? I bought the car three-and-a-half years ago for roughly $16,000 and, while it now had a few dings and scratches (and was in a couple of minor accidents), it still worked as perfectly as the day I was first handed the keys and title. How could he not see the value?! I was having my subcompact car appraised for trade-in because I needed to upgrade to a fourwheel-drive SUV for the commute to my new job. Truthfully, I wished I could have kept the car, which was surprising to me since I was never someone who cared what kind of car I was driving. I learned how to drive on my parents’ mini-van, which ended up being my mode of transportation throughout high school and college. But this car was different. To me, it represented independence (it was the first car that I purchased with my own money), family (it was the car in which I drove my eldest son home from the hospital), professional success (I drove the car to and from graduate school, externships, internships and conferences), and my overall personality (when I bought the car, everyone’s comment to me when they first saw me driving it was “that car is so you!”). Trading in this car felt like me giving up a piece of myself—and he thought I would be willing to accept $3,800!? I stared blankly at the car appraiser. His response seemed tailored to my thoughts: “I know that $3,800 doesn’t seem like a lot, but there are a number of criteria that I use to evaluate a car’s worth and, unfortunately, sentimental value is not one of them.” Intellectually, I understood his explanation. Make, model, year, mileage and wear-and-tear were relevant to the car’s value; my emotional connectedness was not. I begrudgingly accepted his offer. Sentimental Value Certain objects have high subjective worth even when they have limited objective value. This worth stems from an individual’s personal or emotional associations with the object rather than its actual material worth. Interestingly, while human beings seem innately hard-wired to sentimentally connect to objects, places or even other individuals, they often have difficulty realizing their own sentimental value. This discrepancy is, to a large degree, a function of the “value messages” that people are exposed to through interactions with family members, the media and society at large. Messages such as “You are what you drive… where you work… who you know… how much money you make… “and so forth all serve to subvert the seemingly obvious sentimental connection to an individual’s own intrinsic worth.
As people learn to rate themselves based upon their external accomplishments, material possessions or social standing, they inadvertently discount the possibility that their worth is innate and ever-present. An object that is perceived to be worthless is rarely paid the attention necessary for it to achieve subjective worth. Consequently, an individual who believes that his unadorned self bears no inherent value unknowingly undermines the basic building blocks necessary to form a sentimental connection with his own self. In essence, the individual takes on the role of the appraiser in the story that began this article, rather than the role of the car owner. Unhealthy Self-esteem As one encounters significant life-experiences he begins to solidify, consciously or subconsciously, the external categories upon which to stake his selfesteem. Success or failure in these particular areas determines the person’s sense of self-worth. As a result, the individual tends to actively pursue validation of his self-worth by expending great efforts in the domains in which his self-esteem is invested. Such an expenditure can, at times, have unwanted negative results. An individual who stakes his selfesteem on professional success, for example, may choose to work long hours at the office even if doing so has limited professional impact and results in negative consequences with regard to family life. Within the context of unhealthy self-esteem, this work ethic may be understood as the individual’s attempt to exercise control over his level of self-worth by exerting excessive effort in the “employment category” of his self-esteem rating formula. Interestingly, because professional success hinges upon many variables that are not within the individual’s control, pursuit of enhanced self-esteem by way of success in this area often results in feelings of anxiety, depression, and fluctuating levels of self-esteem. Healthy Self-esteem If unhealthy self-esteem is categorized by taking the appraiser-role rather than the owner-role, then healthy self-esteem can be understood as an individual sentimentally connecting with himself. It is the acceptance of self-worth and self-esteem as inherent in a person’s being rather than based upon one’s rating within a given external category. This acceptance validates a person’s inherent value, laying the foundation for him to sentimentally connect with himself. For an individual to accept his innate worth and integrate such acceptance into his life, however, it is important that he have a justified reason to believe that he is genuinely and unconditionally worthwhile. Just as one would be hard-pressed to fabricate a sentimental connection to an object, it is impossible to
“Healthy self-esteem comes about when one is able to harness the belief to elicit the feeling.”
“The Torah provides a basis for the sentimental connection with one’s self.”
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Continued on Next Page
Living With Death Awareness By Aviva Barnett
ersonally, I believe that when I make choices and take responsibility for my life, I am living with my eyes wide open. When I have death in mind, I try not to take my loved ones for granted. If I had death in mind when I say goodbye to my husband at the start of the day as we leave home for work, I would realise that there is a possibility that either one of us may not come back. Death is always a possibility. I want to be open to life and open to possibilities, and I believe that I can only do this if I am aware that one day I will no longer exist. I see that some people reach middle age, or are struck by illness, and at that point death seems to be apparent. So why is death a topic that holds relevance for me? Death is significant for me because I value and treasure life and want to get the maximum out of each experience I enter. I want to accomplish many things while I am alive, and therefore want to have the time on this planet to do so. Life is precious, but it can be taken away from me at any moment. As I am so enthusiastic about getting the most I can out of life, death holds great meaning for me and must be acknowledged as a part of my journey. I see from my clinical work that when people become aware of their own mortality, a shift occurs. People become more alive, willing to take more risks, more appreciative of nature and love. They view life differently, incorporating all the different colours of the rainbow. This leads me to believe that death awareness is the gateway to life. Just as I have seen in my clients, I also personally feel that I can live more
freely and passionately when I have an awareness of death. I think a lot of people are afraid of dying, but I think it could be worse not to live. I also acknowledge that it is impossible to live every moment with aw are n e s s of death, but rather we can oscillate in and out of awareness -- which can help us to adjust our lens on life. I think that one powerful way we can take charge of our lives is by acknowledging our limitations. A major limitation of being human is the awareness that one day I will die. However much I may want to control my death -- for example, when I die or how I die, death is something that will happen, whether I like it or not. I need to accept that along with my other limitations. My possibilities and opportunities will not go on forever, they are limited. My work with clients diagnosed with cancer has allowed me to experience many of the ways in which death may affect a person’s existence. I have worked with clients who were confronted with the death of a loved one, or/and had to face their own finitude. So let us take the opportunities we receive today seriously, and live passionately as life is worth living purposefully.
Rosman Continued from Previous Page
Working to strip away the external domains upon which one stakes self-value provides a starting point for the disintegration of unhealthy self-esteem and the development or strengthening of healthy selfesteem. In doing so, one enables the ever-present, intrinsic, human value infused in mankind at the time of Creation to surface. This provides the foundation for an individual to embrace the owner-role, sentimentally connect to his innate value, and develop a self-worth that is immeasurable, unwavering and truly healthy.
“I want to be open to life and open to possibilities, and I believe that I can only do this if I am aware that one day I will no longer exist.”
“However much I may want to control my death -- for example, when I die or how I die, death is something that will happen, whether I like it or not.”
manufacture a basis for inherent self-worth. The Torah provides the basis for the sentimental connection with one’s self. Healthy Self-esteem based on Tzelem Elokim In the first chapter of Bereishit (1:27), it is written: “And God created man in His image, in the image of God He created him; male and female He created them.” Rabbi Akiva, in Pirkei Avot (3:14) expounds upon this verse, stating, “Beloved is man for he was created in the Image. It was an act of special favor that it was disclosed to him that he was created in God’s image, as it said: ‘For in the image of God did he create man.’” Believing that human beings are created in Hashem’s image is different from genuinely feeling that one is created in His image. Healthy self-esteem comes about when one is able to harness the belief to elicit the feeling.
Aviva Barnett is an existential psychotherapist and coun-
sellor. She works with individuals and couples, and facilitates support groups. She works face to face, by phone and Skype. Aviva is accredited with the UKCP, United Kingdom of Counselling and Psychotherapy. She holds a Postgraduate Diploma in Psychotherapy and Counselling, and a Masters of Arts in Existential Psychotherapy and Counselling. She can be contacted by email at firstname.lastname@example.org.
Yitzchak (Tzachi) Rosman lives in Teaneck, NJ and works as a psychologist on the Substance Abuse Treatment Program-Residential unit (SATP-R) at the VA Hudson Valley HCS in Montrose, NY. He has presented on the topic of developing healthy self-esteem to middle-school students and postgraduates, alike. Dr. Rosman has a particular interest in the impact of unhealthy self-esteem on addiction, bullying, and emotional discomfort. He may be reached at yitzrosman@ gmail.com. August 2012
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Treating the Problem of Compulsive Prayer T
he topic of obsessive compulsive disorder (OCD) has received much media coverage over the past decade. This is because we have recently seen remarkable progress in the treatment of this serious, debilitating, psychological problem, which for centuries had defied attempts at treatment. The progress in treating OCD can be attributed both to medical advances (treatment with anti-depressants) and to cognitive behavioral therapy (CBT). CBT treatment has formulated clear, easy-to-understand treatment protocols. Sensitively following these protocols with consistency and compassionate understanding has proven remarkably successful in helping sufferers overcome a life ruled by their compulsions to be able to live a life free from them. Compulsive Prayer One area that affects religious Jews in particular – compulsive prayer -- has not received the attention it deservers. This is certainly because most OCD sufferers in the world aren’t concerned with prayer, but another reason is because the CBT treatment formula of Exposure and Response Prevention is not applicable to this type of compulsion. Exposure and Response Prevention Briefly, Exposure & Response Prevention means that, for example, if a person suffers from compulsive hand washing, the treatment would be to expose him to touching “dirty” objects and then preventing him from washing his hands. While this seems quite simple-minded, its success can be explained by the way we learn to overcome anxiety. The apparently simple procedure can be remarkably helpful in reducing or stopping compulsions in a relatively short period of time. But this cannot be applied to compulsive prayer. Compulsive prayer means that individual, because of doubts, feels he must repeat certain words until he “gets it right.” The repetitions can go on and on, causing a very painful and prolonged prayer session. Shemoneh Esrei, which normally can be said with normal concentration in five to seven minutes, may take a sufferer half an hour or more. The reason ordinary CBT has not been helpful is that while the therapist can stop excessive hand-washing by turning off the faucet, he cannot stop the urge to repeat the words of prayer. It happens so quickly there is not way to “take the word out of his mouth” to prevent repetition. I will describe a treatment technique that has proven successful in treating this problem. The Treatment Protocol For treatment, we need a kitchen timer that tracks times forward and backwards, and a buddy. The buddy is someone who can stand next to the sufferer as he prays (not in a synagogue) and who will both monitor and direct the sufferer to follow the instructions. Let us say the person gets “stuck” at certain “hot spots” in the daily prayer. He cannot say the Shema without many torturous repetitions. Shemoneh Esrei is likewise a problem; usually the first brocha is the hardest. We first analyze the problem by recording baseline data. We will take as an example treating compulsions in Shemoneh Esrei. We time him with a precise stop watch (not a wrist watch) as he says the first brocha of Shemoneh Esrei. We also note and record the number of compulsive repetitions he makes as he goes through
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By Avigdor Bonchek, Ph.D. the first (hardest) paragraph. We can also time his completed prayer. All these observations must be made when he prays within the halachic time for davening. Then we discuss with the person our first goals. We may set our sights at having him overcome all repetitions in the first brocha only. We will deal only with the first brocha, whatever happens in the rest of his Shemoneh Esrei is of no concern at this stage. Our goals are graduated and always arrived at through discussion with the sufferer. If he thinks our suggestion is too difficult, we try to accommodate his preference, with the proviso that we must always move forward. He sets the pace, but goals must show forward movement. ‘Go-Back-To-Start’ Rule We tell him that if he repeats, we will say stop and ask him to go back over the whole previous first brocha. He is to read that brocha from the beginning. If he says the first bracha this time without repetition he continues on to the rest of Shemoneh Esrei. Since we are focusing only on the first bracha, we pay no attention to his compulsions in the rest of the blessing. If he repeats, we have him go back to the previous bracha as many times as it takes until he can say the particular bracha we are focusing on consistently with no repetitions. This will happen if the buddy is both firm and encouraging. Once this is accomplished, we then focus on the next bracha. The “go - back – to- start” rule now applies to any repetition he makes within any of the brachos up to the one in focus. This procedure - with much verbal encouragement – proceeds to the next stages only after the person freely and consistently reads the previous stage with no compulsive repetitions. As can be seen, we continuously increase the length of his Shemoneh Esrei because he has proven he can say the earlier brachos without repetitions. We are strict, so that even if he got all the way to Retzei with no repetitions, but in Retzei he made one compulsive repetition, he goes all the way back to the beginning. This may look harsh, but as he progresses, so does his confidence. And as he progresses so does the challenge progress. He is able to take it. In addition to a written record (of time and number of repetitions), it is helpful to make an audio recording using an mp3 recorder so that both the buddy and the sufferer can hear how he sounded at the outset. The changes are often dramatic. Although the treatment may be done with a nonprofessional as buddy, it should be done under the supervision of a professional who understands the treatment. Obviously, as in all treatment there are good days and bad days, but the record should show constant improvement. If worked with at least three times a week, dramatic improvement should be seen within a month, although total relief will take longer. Avigdor Bonchek, Ph.D. is a clinical psychologist and behav-
iorally oriented psychotherapist practicing in Jerusalem, and a retired lecturer at Hebrew University in Jerusalem. His book “Religious Compulsions and Fears: A Guide to Treatment” is published by Feldheim. His article “Compulsive Prayer and its Management” appeared in the Journal of Clinical Psychology (volume 65 no. 4 pp 396 404). He also published on the topic “What’s broken with CBT Treatment of OCD and how to fix it” in American Journal of Psychotherapy (v.63, no.1 pp 69 -86).
The Shidduch Speed Bump R
I was also able to tell her that her experiencing these symptoms only in one area of her life is not surprising. Many of the people who have Social Anxiety Disorder are incredibly high achievers in areas that do not trigger their symptoms, as is the case with Devorah: The fact that she has many girlfriends and speaks without any fear in front of large audiences at work does not mean that she does not have the condition. It simply means that it is limited to a narrow slice of her social interactions. More important than any fact about the condition, I was able to tell her that Social Anxiety Disorder can be treated successfully through psychotherapy, medications or, optimally, a combination of both. Devorah chose to try a combination of therapy and medication. The therapy focused on reversing some of the negative thoughts she began to experience from the moment she was told about a potential shidduch, which would escalate until the first date was over. (There were no second dates). We rehearsed the feared situations and, most importantly, I made a contract with her that she was not to refuse any dates that her mother, who was working with her during the dating process, believed were appropriate. This way her anxiety would no longer lead her to avoid her fears as she began to see how she could manage them more effectively. With respect to medication, I helped her choose an anti-anxiety medication with very limited side effects. In the four months since Devorah began treatment, she reports that although she is nervous on dates, she is able to enjoy aspects of the experience and she no longer experiences the terror she did before beginning treatment. She has had the experience of being asked on second dates, some of which she has accepted, and some of which she has declined. Her friends have shared with her that she just seems much more like the upbeat person they grew up with. I hope that I will soon be able to write a letter to the Jewish Press with the good news of her wedding, im yirtzeh Hashem. *The name and personally identifying information have been changed to protect patient privacy Howard Forman, M.D. is a psychiatrist specializing in psy-
chotherapy and medical treatment of anxiety and depression. A graduate of Columbia University and of the Albert Einstein College of Medicine, Dr. Forman’s practice is specifically tailored to the needs of the frum community. He can be reached at 212.960.8171.
SF Designs 917-416-6952
ecently a young patient began her first session with me, “Everyone tells me all the time what a great girl I am and how they cannot figure out why I am still single and about to turn thirty.” As I got to know Devorah* a little more, I learned that she is welleducated, professionally successful, has a wide-network of friends and involves herself greatly in chesed. I was able to observe at that first session that she was smart, of reasonable good looks, and presented herself both stylishly and modestly. After reviewing with her the symptoms of some broad conditions that psychiatrists are often called upon to treat, there was nothing to suggest that Devorah had any psycholog ic a l condition that would benefit from therapy. Although disap p o i nt e d to be neither married nor a mother, she was not depressed, and to my knowledge, there is no medical treatment available for someone who is so far unlucky in the dating parsha. I asked my new patient, “Can you tell me about your last date?” She responded, “It has been a while because I really turn down most offers because I find going on dates so stressful. The last time I went out on a date was eight weeks ago and from the moment the boy arrived at my parents’ home, I was sweating, my heart was beating so quickly, I felt my mind going blank, and when he would ask me questions, I would get even more nervous and would have difficulty speaking. I just could not wait for the date to end.” “How often do you get this nervous feeling with the sweating and your heart racing?” I asked. “Only when I am on dates. It never happens at work and in fact people at work come to me with their problems, because I am known as the level-headed one.” After a little more discussion, I was able to inform Devorah that she had Social Anxiety Disorder, defined as an ongoing “fear of one or more social situations in which the person is exposed to unfamiliar people or to possible scrutiny by others” and a condition in which “the individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.” I also told her that this is not an uncommon condition, that one out of eight Americans experience it, that it is most likely to appear during the period when someone in our community is looking for a shidduch, and that although not uncommon in men, is more likely to affect women.
By Howard Forman, M.D.
a free service provided by the organization for Orthodox Mental Health Professionals
PO Box 3027 Teaneck NJ 07666 T:201-384-0084 F:347-342-3046 E:email@example.com www.nefesh.org Join Nefesh: http://www.nefesh.org/members/join.cfm
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20 MIND, BODY SOUL &
By Ita Yankovich
Approvals Insomnia is good for the pharmaceutical business. An estimated 70 million Americans have sleep issues, which is why the market for drugs such as Ambien and Lunesta is expected to reach $3.5 billion by 2019. A new insomnia drug being developed by Merck called Suvorexant works a little differently. It is designed to turn off wakefulness rather than to subdue the brain into slumber. According to results from two Merck-sponsored clinical trials, patients taking the medicine fell asleep faster and spent less time awake at night than those on a placebo. The most commonly reported side effects in the trials were sleepiness upon waking up and headaches. In an earlier study, patients on Suvorexant did better on a driving test taken the next day,
and were able to stay in their lane more than patients on eszopiclone (the generic name for Lunesta). Merck believes that the drug may be beneficial for patients who are suffering addiction problems on the current sleep drugs, or for those who suffer from sleep apnea because, unlike current sleep therapies. Suvorexant does not suppress respiration. The company plans to seek FDA approval of the drug this year. Merck will also have to gain approval from the Drug Enforcement Agency, because the pill is classified as a controlled substance.
News Johnson & Johnson and Bayer have failed to gain FDA approval to expand the use of their blood thinner Xarelto to prevent heart attacks and strokes in patients with serious chest pain or a previous heart attack. Doctors had hoped that the new drug would prove to be a safer and more convenient replacement for the standard blood-thinning drug, Warfarin, which requires constant monitoring and dose adjustments. The Food and Drug Administration de-
clined to approve the treatment now because too many patients dropped out of a late-stage trial of the drug, requiring the trial to be repeated, which could take as long as a year.
Cancer That Killed Ted Kennedy Attacked With New Drugs In 2008, Sen. Edward Kennedy was diagnosed with a particularly deadly form of brain cancer known as glioblastoma multiforme, Despite receiving the best available treatment available at that time, he died 15 months later, which was close to the median survival time for the disease. Now, researchers at two California-based biotechnology companies are leading an effort to create new drugs and treatments which use specially modified viruses and the body’s immune system to attack the tumors. Scientists believe that the new form of treatment could more than double the life expectancy of 10,000 individuals who are newly diagnosed with that deadly and fast spreading condition annually. The new approach may have broad implications for patients with other forms of cancer that have few current treatment options.
FDA Testing a Surgical Cure for High Blood Pressure By Aliza Levinger Going through life with the same high blood pressure that caused one parent’s fatal heart attack and the other’s series of fatal strokes is no picnic. For three decades, Gael Lander – a 68 year-old, retired teacher from Melbourne, Australia – has faced these grim prospects until 2007, when she underwent an experimental surgical procedure that helped get her blood pressure under control. This 20 minute procedure, known as renal denervation, has given her life back to her. “I was a walking time bomb,” she said. “I now have peace of mind.” In this operation, doctors slid a catheter produced by Medtronic Inc., into an artery that is connect-
ed to one of the kidneys. Then the catheter seared the nerves in the artery wall with radio frequency energy. This suppressed the production of hormones that raise blood pressure by contracting blood vessels and promoting fluid retention. Since Gael’s groundbreaking surgery, mostly positive results have been seen in the additional 4,000 hypertension patients in Europe and Asia who have undergone this procedure after unsuccessful drug treatment. However, this operation has not yet been approved in the U.S. One in three adults in the U.S., more than 76 million people, suffer from hypertension. Renal denervation is particularly exciting hope for the one-third of hypertension patients for whom drug treatments have failed, and who therefore face
L L A C E R
Sedona Labs is a issuing a voluntary recall of their iFlora® Kids MultiProbiotic® and 4-Kids Powder Dietary Supplements due to possible contamination of salmonella. Salmonella is an organism which can cause serious and sometimes fatal infections in young children, frail or
a heightened risk of crippling illness and early death. Studies on patients in Australia and Europe showed that 71% of hypertension patients were helped by the Medtronic catheter within six months. The first two-dozen patients, including Lander, were followed for three years. All eventually responded to treatment, achieving normal or near normal blood pressure readings with less medication. The next stage in the Food and Drug Administration’s approval process for the Medtronic catheter is a study to be carried out at the hypertension center at the University of Chicago. It will involve 532 patients whose high blood pressure is not easily treatable by drugs. The results of this study are expected to be released next year, and Medtronic Inc. hopes to re-
elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in more severe circumstances. Customers possessing these products should immediately discontinue their use. No other Sedona Labs products are involved or impacted.
ceive FDA approval for the catheter by 2015. Additional studies will examine if this procedure can also succeed in lowering blood sugar levels, controlling sleep apnea, as well as easing heart failure and kidney disease. Despite the excitement over this surgery, it is not without risks, and doctors don’t know if the cauterized renal nerves will grow back with time. Dr. George Bakris, who is directing the University of Chicago study, cautions that it is far too soon to look at the surgery as an easy onetime fix to eliminate the need to take blood pressure medication. “You do this when no drug can control the hypertension and you don’t want to have a stroke, kidney failure or heart failure,” he said.
Consumers may return iFlora® Kids Multi-Probiotic® or iFlora™ 4-Kids Powder to the place of purchase for a full refund. Questions may be directed to the company at 1-888-816-8804, Monday-Friday between the hours of 7:00 AM and 3:00 PM. Bedford Laboratories has issued a recall of Leucovorin Calcium Injection due to the discovery of visible crystalline particulate matter in a small number of vials. Adverse reactions may include vein irritation and phlebitis, severe breathing difficulties, blockage of capillaries and arteries, anaphylactic shock and death.
The Changing Face of Medical Care By Yaakov Kornreich
ramatic and fundamental changes have been taking place transforming the way that individuals receive their medical care, and in the ways that health care professionals provide it, and are paid for it. This new approach is often referred to as the “personal medical home.” It is a work in progress. Various groups of medical professionals have been working to define a new set of principles, goals and standards for the practice and delivery of family care, and these ideas are being put into practice in pilot programs across the country. The medical home concept was first introduced in 1967 by the American Academy of Pediatrics as a way to coordinate care for children with special needs. In 2002, seven family medicine organizations created the Future of Family Medicine Project to study the current system and find ways to improve it. In 2004, the Project recommended that every American should have a “personal medical home” through which to receive his or her acute, chronic, and preventive services. In 2007, several American medical associations issued a set of “Joint Principles of the PatientCentered Medical Home” calling for a coordinated care approach emphasizing quality, safety, enhanced access and fair payment for the services rendered. For generations, Americans have received their health care services piecemeal, from independent family physicians, medical specialists, hospitals and diagnostic labs, working in loose consultation with one another, and paid for on an individual fee-for-service basis. The health care community has come to the realization that the fee-for-service model is inefficient and needs to be phased out in favor of a new approach which rewards medical practitioners for achieving better outcomes from the overall patient treatment. There is also a growing recognition that doctors need to be able to take more time and effort to tailor
each patient’s medical treatment for their specific situation. Family physicians are being urged to practice “evidence-based medicine,” in which their treatment decisions are based upon the latest clinical research, rather than blindly following the “standard care” for various conditions that they were taught in medical school, or as outlined in medical reference books. At the s a m e time, new te c h n o l ogy has made it possible for providers to work more efficiently and collaboratively with their professional colleagues, the patient and interested family members, to create a team approach to health care. Under the 2007 guidelines for the medical home, “the traditional doctor’s office is transformed into the central point for Americans to organize and coordinate their health care, based on their needs and priorities. At its core is an ongoing partnership between each person and a specially trained primary care physician. This new model provides modern conveniences, like e-mail communication and same-day appointments; quality ratings and pricing information; and secure online tools to help consumers manage their health information, review the latest medical findings and make informed decisions. Consumers receive reminders about necessary appointments and screenings, as well as other support to help them and their families manage chronic conditions such as diabetes or heart disease. The primary care physician helps each person assemble a team when he or she needs specialists and other health
care providers such as nutritionists and physical trainers. The consumer decides who is on his or her team, and the primary care physician makes sure they are working together to meet all of the patient’s needs in an integrated, ‘whole person’ fashion.” This is in sharp contrast to the sharply narrowed range of choices and providers epitomized by the HMO approach to providing health care. There is also a recognition that physicians need to be paid separately for the additional technical infrastructure, equipment and management services required to make the personal medical home concept work. As a result, the pilot programs implementing the medical home approach are paying participating physicians a permember per-month care management fee in addition to traditional feefor-service reimbursements. As of the start of 2010, there were at least 26 pilot projects operating in 18 states, with over 14,000 physicians caring for nearly 5 million patients. They are being evaluated for clinical quality, cost, and for the experience and level of satisfaction of both patients and care providers. Community Care of North Carolina (CCNC) consists of 14 community health networks that link approximately 750,000 Medicaid patients to medical homes. It is funded by North Carolina’s Medicaid program, which pays $3 per member per month to the networks and $2.50 per member per month to physicians. CCNC claims that it has measurably improved healthcare for its patients
with asthma and diabetes, but it is not yet clear whether the North Carolina program has actually reduced health care costs. The Rhode Island Chronic Care Sustainability Initiative (CSI-RI) was launched in 2008. Its goal is to improve the care of those with chronic diseases. Today it includes 13 primary care sites, 66 providers and 68,000 patients. In 2009, the New Jersey Academy of Family Physicians and Horizon Blue Cross and Blue Shield of New Jersey launched a pilot project involving more than 60 primary care practices and 165 primary care physicians. Individual elements of the medical home treatment and health care management approach are also being implemented piecemeal by family practices across the country. They are enabling patients to text or send e-mails directly to their doctors, use their smartphones to make office appointments and view the results of their lab tests on line. Written drug prescriptions are now being replaced with e-mails sent by physicians directly to the patient’s pharmacy. Insurance companies are changing their payment policies to encourage the spread of medical home practices. They are becoming part of the treatment team, using their oversight function to spot developing problems before they become critical. For example, some Medicare Part D prescription drug insurance programs make reminder phone calls to members when their monthly medication purchases fall behind schedule. Physicians are encouraging family members to get more involved in the patient’s treatment, providing patients with more information to help them make better decisions about their own medical care, and urging them to take advantage of all available community resources. Doctors in private practices are adopting these changes to help them deal with the increased pressures they now face due to increased administrative and paperwork requirements and deep cuts in reimbursement rates Continued on page 34
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Changing Face Continued from page 32
from Medicare, Medicaid and insurers. In order to keep the doors of their practices open, many family doctors have been forced to increase the number of patients they see, while reducing the actual amount of time they spend with each patient to just 8-10 minutes during an office visit. A nationwide survey has found that because of these changes, and more to come due to Obamacare 83 percent of American physicians have considered leaving their practices. There is already a shortage of primary care physicians in the U.S. With Obamacare increasing the number of people with health coverage seeking services, that shortage is expected to increase to at least 90,000 doctors by 2020. Some doctors have responded by limiting their practices to patients willing to pay directly, or to those with private insurance, and are now turning away new Medicare or Medicaid patients because the reimbursement rates from those programs are too low. Up to an estimated 5,000 other private practices nationwide have converted themselves into what are known as concierge or boutique medical practices, which are strictly limited to patients willing to pay a monthly or annual retainer in return for a higher quality of service, including unlimited face time with their doctor during office visits, same-day or next day appointments, and customized patient wellness programs. In its purest form, a boutique practices do not accept any insurance payments, thus avoiding the need to deal with all of the paperwork and delays in seeking insurance reimbursements. Patients pay a yearly retainer fee which may vary according to their age or current medical condition, and which can range up to $20,000 a year, in return for a premium level of health care. A hybrid form of concierge care reduces the membership fee for patients who are also covered by health insurance. The retainer fees for joining such a practice are designed to be more affordable for middle class patients. For example, an individual may be charged $1,200 per year or $100 per month; couples would pay $1,800 per year or $150 per month, and families $2,400 per year or $200 per month, in addition to the usual insurance reimbursements and patient copays for office visits and procedures. Dr. Jennifer Chilek, who has been in private practice in Montgomery, Texas for eight years ago, recently changed over Stone Creek Family Medicine to this modified concierge care model. She believed that she had no choice, because the current “health care system is destroying the doctor-patient relationship. I couldn’t have kept going the way that it was.” When Chilek sent out a letter to the 3,000 people in her medical practice announcing the change, and informing them that they would have to pay a retainer to remain under her care, she admits that some of them were understandably shocked. “Some patients were angry and frustrated and thought they were losing their doctor. Others said, ‘Hey, I’m on board. Sign me up now.’” Nearly 400 of her patients eventually signed up for the registration fee, some of them, enthusiastically. “I was 100 percent for it,” said Donald VanOrden, who is a small business owner. He said that the fee was well worth it to him because it meant that he would no longer have to show up on time at the doctor’s office for his appointment and then spend
hours waiting to be seen. In addition, because of the retainer fee she receives from each of those 400 patients, Dr. Chilek can now afford to spend 30 minutes or more with each of them during a typical office visit, while earning at least the same amount of money from her practice. A Florida-based medical consulting firm called MDVIP has helped 500 physicians to convert their private practices to this kind of concierge medicine. Mark Murrison who is in charge of marketing for MDVIP, said that the primary care doctors whom he deals with were “really frustrated with what has become conveyer belt medicine. They were seeing 30, 35 patients a day, and spending less and less time with each one.” These doctors now limit their practices to no more than 600 people, and the patients seem to be as happy as the doctors. The annual renewal rate for members of each practice averages 92 percent, which he attributes to the emphasis on preventive medicine, which saves money by keeping people in good health. Murrison claims that the proof of that is in the growth of the paid membership in the medical practices it serves, and the reduction in the hospitalization rates of their patients. After being in operation for five years, the total MDVIP membership has tripled to 180,000 patients, with an average age of 55. Murrison claims that the annual hospitalization rate for these patients is more than 70 percent less than comparable non-MDVIP patient populations. Houston internist Dr. John Burpeau became an MDVIP doctor five years ago because he had felt that he was on his way to burnout. He was also tired of shortchanging his patients with office visits that had to be too brief to properly diagnose and treat them. He said, “I think people are used to the old way and think of doctors the way they used to be, like Marcus Welby. They don’t exist anymore. They have been driven out business, because to take your time with a patient financially doesn’t doesn’t work. You can’t run a business like that.” Dr. Burpeau believes that the retainer he now charges his patients, which works out to $4.25 per patient per day is both affordable and fair, but understands that it is a financial choice that may be difficult for some people to make. There are many variations of concierge or boutique care available for those willing to commit themselves to paying the monthly or annual retainer. All of them promise more timely and convenient care than typically provided by practices operating on a traditional insurance-covered fee-for-service basis. Portland, Oregon-based GreenField Health caters to younger adult patients with a sliding retainer fee based on the age of the patient. Beginning at $120 a year for youth under 18, the annual retainer increases by age in 5 year or 10 year steps up to $755 a year for patients 70 or older. There is also a cap on the registration fee for multiple members from the same family. It accepts insurance payments for office visits and procedures from more than 20 private plans and Medicare. One Medical Group operates chains of concierge clinics in San Francisco, Washington DC and New York City. The retainer is $149 or $199 a year, depending on location, and several popular private insurance coverages are accepted. To attract younger members, it offers retainer discounts to students. For those members without any insurance, it charg-
es $150 for an initial primary care office visit, and $100 for follow-up visits at its offices in Manhattan. The passage of Obamacare in 2010 merely accelerated the fundamental changes in the delivery of health care in this country which were already well underway. In metropolitan areas, larger, universityaffiliated hospitals have been buying up smaller local hospitals which were no longer able to compete effectively in the medical marketplace. These large hospitals have also started buying up private medical practices of physicians in their area. These are doctors who are tired of dealing with the hassles and reduced payments from private insurance companies, Medicare and Medicaid, and who do not want to take the financial risk of turning themselves into concierge or boutique practices. As a result, an increasing number of doctors around the country are become health care system employees instead of independent small business owners. Other private practices are joining together into large networks in order to keep a semblance of independence, while pooling their resources in order to compete with the big hospital conglomerates. For example, the Florida Hospital Medical Group, based in the Orlando area, currently includes 108 separate practices covering the broad range of medical specialties, and expects to add another 100 doctors to its ranks this year. Existing small private practices still operating on the traditional fee-for-service payment model, and in isolation from other physician groups and hospitals, will find it increasingly difficult to survive financially as private insurers, Medicare and Medicaid increasingly adopt the treatment standards and payment models of the medical home approach. Once fully implemented in our health care system, the personal medical home approach promises to improve the efficiency of the medical care we receive, but in a more institutionalized setting, from doctors who will be part of much larger health organizations rather than independent practitioners. However, the growth of concierge and boutique practices across the country proves that there are still ways for patients to obtain more convenient and personalized attention from their primary care physician, if they are able and willing to pay a little more for the VIP service which we used to take for granted from our family physicians.
THE CHANGING FACE OF US MEDICAL CARE • Health care payers are paying more attention to the overall outcome of patient treatment, rather than each doctor visit, etc. • Insurance companies are changing their payment policies to encourage the spread of medical home practices. • There are many variations of concierge or boutique care available for those willing to commit themselves to paying monthly or annual retainer. • The passage of ObamaCare accelerated the fundamental changes in the delivery of US healthcare which is already underway.
THE GENETIC FRONTIER
Genetic Lessons from the Ashkenazi Population
By Dr. Inga Peter
his year marks the 80th anniversary of the influential paper published by a Mount Sinai physician, Dr. Burrill Crohn, and his colleagues that for the first time characterized adisease associated with severe inflammation of the intestine. Patients with what was later named Crohn’s disease develop diarrhea, fever, stomach pain, and often lose weight. Crohn’s is now classified as an autoimmune condition in which the immune system attacks its own healthy tissue in the gastrointestinal tract, causing chronic inflammation. It affects young individuals, and, even though it is not curable, it can be treated and controlled by medications and surgery.
Epidemiology and origination of Crohn’s Disease Crohn’s is considered to be a complex disease with both genetic and environmental risk factors. There is extensive evidence to support the role of genetics in the development of Crohn’s disease. Having a relative with Crohn’s disease is the greatest risk factor for other family members. Also, studies of twins have shown that identical twins, who share almost 100% of their genetic information, were more likely to both have the disease than fraternal twins. The differences in the prevalence of Crohn’s in various racial and ethnic groups further indicate that genetic factors contribute to the risk, even though shared cultural factors, such as diet and lifestyle, might also explain these differences. Specifically, the prevalence of Crohn’s disease in European countries ranges between 1 and 12 per 100,000 individuals, whereas this disease was until recently virtually unknown in the developing countries. The major genetic risk for Crohn’s disease identified so far is conferred by 3 rare mutations in the NOD2 gene. NOD2 plays an important role in the immune system, as it enables immune cells to recognize bacterial molecules and stimulates an immune reaction. While the frequency of these mutations ranges between 1% and 4.5% in the general population, about 40% of Crohn’s disease patients carry at least one copy. This translates to a 2 to 4-fold risk of developing the disease in carriers of one copy and a 10 to 40-fold risk in those who carry multiple copies of these mutations. Recent advances in the field of genetics have allowed identification of an additional 160 genetic variants associated with Crohn’s disease in individuals of European ancestry. However, a sharp increase in the occurrence of the disease in children of immigrants from the developing countries who move to Western countries, as well as the well- established effect of smoking on Crohn’s disease risk, suggest a prominent role for environmental factors as well, most likely diet and lifestyle.
Crohn’s Disease in the Ashkenazi Jewish Population Interestingly, Jews of European descent (Ashkenazim) have a 4 to 7-fold increased risk of developing Crohn’s disease compared to non-Jewish Europeans. Genetic risks alone could not explain why the prevalence of Crohn’s disease is so much higher in Ashkenazim than in surrounding populations. To investigate this phenomenon, researchers from the Mount Sinai School of Medicine have recently conducted the largest study which compared 1,878 Ashkenazi Jews with Crohn’s disease to 4,469 Jews without the disease, using DNA samples to evaluate their genetic make-up. They discovered five new genetic risk regions associated with Crohn’s disease in Ashkenazim. Armed with this new information, they can begin to pinpoint additional causal genetic mutations, discover the nature of the malfunctions they create, and hopefully eventually develop new treatment approaches. That study also demonstrates the value of genetic studies in isolated populations, like Ashkenazi Jews.
The Role of Commensal Bacteria in Crohn’s Disease Risk One possible explanation for the origination of Crohn’s disease is the hygiene hypothesis which suggests that a lack of early childhood exposure to infectious agents causes the immune system to wrongfully recognize its own non-pathogenic microorganisms as imminent risks and to act against them, causing substantial damage. This notion is particularly interesting in light of accumulating evidence suggesting that the identity and relative abundance of members of bacterial communities, or microbiota, normally residing in the human body and referred to as “commensal”, or non-harmful, bacteria, can be associated with different disease states. Microbial cells that live on (skin, eyes) and inside the human body (digestive system) may outnumber the quantity of human cells by 10-fold. This means that we may be carrying more bacterial genes than our own. Some commensal bacteria are essential for our health and provide a wide range of metabolic functions that the human body lacks. They help break down, absorb and store nutrients that otherwise cannot be digested, fight pathogenic bacteria, and play an important role in the development of the immune system. While we know that exposure to pathogenic organisms can cause disease (e.g., stomach flu), little is known about whether there is a common core set of microbes (microbiome profile) that is shared between healthy people or individuals with the same disease. We already know that changes in diet, antibiotic treatment and various conditions, including obesity, may shift our normal bacterial balance. Small studies have shown a lower diversity of the gut microbiota found in Crohn’s disease patients compared to unaffected individuals, raising questions about the possible role of commensal bacteria in disease development. Moreover, the
fact that the major genes found to be associated with Crohn’s disease are involved in the processing of microbial antigens and immune response further implicate commensal bacteria in the Crohn’s disease risk. Despite preliminary data indicating substantial differences in gut microbial content between healthy individuals of different racial and ethnic backgrounds, no studies have compared a composition of the bacteria between Ashkenazim and non-Jewish Europeans. It should not be surprising if such differences exist, given the unique dietary and lifestyle traditions observed by Jews including kosher food and a mandatory hand-washing before meals (“netilat yadaim”) that could reduce exposure to infection. Therefore, under- or overrepresented microbiota in this population may help guide future efforts in developing novel treatments targeting commensal bacteria. The use of isolated populations in genetic research has been demonstrated to be of special value by revealing how small inter-individual differences in their human genome sequence increase the chances of detecting mutations that are disease-associated. Therefore, to help advance our understanding of complex diseases, the Ashkenazi Genomic Consortium was established. The “Ashkenome” is a new collaborative initiative seeking to identify how the unique genetic make-up of this population contributes to various conditions, including diabetes, Parkinson’s disease, schizophrenia, or aging. This information, along with microbiome data, can be used in future studies of more diverse populations and help lead to early diagnosis, a better means of prevention, and novel treatments for complex diseases such as Crohn’s. Inga Peter is the Associate Professor in the Department of Genetic and Genomic Sciences at the Mount Sinai School of Medicine. Her research interest is to identify variations in the human genome that can explain susceptibility to common diseases such as obesity, diabetes, and Crohn’s disease that can lead to early prevention and personalized treatment of these conditions. She graduated from Tel Aviv University and completed her training at Tufts University in Boston. She lives in Westchester County, NY with her husband and 3 sons.
• Crohn's is a complex disease with both genetic and environmental risk factors • Ashkenazi Jews have a 4 to t-fold increased risk of developing Crohn's • Lack of early childhood exposure to infectious agents may causes the disease to originate • Thus far, no studies have compared the bacterial composition between Ashkenazim and non-Jewish Europeans
Weight Loss Needs More Than Willpower
f you care about losing weight, you’re not alone. Each month there are over 11 million Google searches for weight loss, trouncing those searching how to make money – a measly five million. Medically, Americans are more overweight than ever before, causing a decrease in the average life-expectancy, according to the National Institute of Health. More than half of American adults are obese or overweight, with over a third being obese, according to the Centers for Disease Control and Prevention (CDC). Besides the general discomfort that
comes with being overweight and the appearance issues, the CDC notes it can lead to serious health issues including heart disease, diabetes, high blood pressure, certain cancers and other conditions. There’s a lot of science involved in successful weight loss, and a lot more is needed than just psychological willpower. Dr. Sue DeCotiis, founder of Manhattan Medical Weight Loss Physician, said that all of her new patient get a body composition analysis to determine the percentage of body fat and how many calories the body burns
each day. It’s also important to know if any medications could be adding to the weight issue, such as antidepressants, diabetes medications and more. “The state of being overweight is truly a physiologic one that affects the brain, fat cells, digestive organs, gut and brain hormones,” she said. “In the obese state, one feels hungry after meals, sluggish, frequent food cravings and out of control. The results of the obese state have strong psychological consequences such as depression, apathy, loss of self esteem and more.” Dr. DeCotiis often recommends a meal replacement program for those with significant weight to lose, in order to fully control the nutrients and calorie intake of the person. For long-term maintenance, Dr. DeCotiis said that studies have shown that the
Compiled by Rachel Wizenfeld
Weight Loss Needs More 34 Than Willpower Requires 35 Success Lifestyle Changes 36 Straight Talk on Bariatric Surgery 37 Team Support Leads to Success 37 Natural & Holistic Treatments Best Fitness & 38 Weight Loss Regimens that Promote 39 Diets Healthy Metabolism 39 In Closing…
best eating plans for most people are ones with plentiful protein, a variety of vegetables, some fruit and healthy fats such as nuts, avocado and olive oil. “The ‘low fat’ higher-carb diet did not lead to any significant reduction in cholesterol, triglycerides, hypertension or significant fat loss,” she said. “We also believe that grains are probably not as important as we initially thought. Cutting back on these in the beginning of a weight loss program is essential for many very heavy people to lose - as many have impaired insulin function. Even ‘whole grains,’ although supposedly healthier, are poorly metabolized by those who are insulin resistant - the majority of obese people.” Orthodox Jews in particular are a subject of concern. In Israel, the Health Ministry claims that the strictly Orthodox are seven times as likely to be obese as the average Israeli. Dr. DeCotiis believes that much emphasis is placed on Shabbat and holiday celebrations in the Orthodox home, in particular the culinary part of the celebration, and less emphasis on exercise and physical activity. This can partially explain those findings. Most experts interviewed for this segment are in agreement that weight loss is best obtained through gradual lifestyle changes – choosing nutritious, lower-calories foods and incorporating moderate exercise into your daily life. But for many people who struggle with overeating or who suffer from other medical conditions, different treatment is needed. And this is where other options like bariatric surgery, i-Lipo and others come in. There are also natural treatments and fad diets that help you to shed pounds fast, though many experts warn that fad diets rarely have lasting value with regard to weight loss. And never underestimate the power of the group – sharing your struggles with a supportive team is a proven way to keep you on track for reaching your goals. We hope this section both informs you about the wealth of weight loss options available and inspires you with motivation to find a program that’s right for you.
Rachel Wizefeld, with additional reporting by Leah Rothstein and Karen Greenberg.
By Leah Rothstein
s cliché as “make lifestyle changes” sounds, experts agree that it’s the most reliable, lasting and healthful way to achieve weight loss. The key to changing your behavior is not forcing yourself to utilize lots of willpower, but rather to manipulate your circumstances so that success comes easily. Yaffa Hollander, a private nutritional counselor based in New Jersey who deals with disease and weight o management, believes the key to d diet success is behavioral and lifestyle changes. e “With fad diets, people n just bounce back- in the long term, itt doesn’t work out,” she explained. Instead, Hollander encourages her patients to make lifestyle modifications so that healthy habits become part of their lives in a painless, practical way. She recommends that clients aim to lose two pounds a week for steady weight loss. Since a pound is about 3500 calories for most people, to lose two pounds a week you’ll need to subtract 500 calories a day from your diet. What to eat? Hollander doesn’t advocate a formal diet plan for her clients. “I tell them that half the plate should be salad, a fourth should be protein, and a fourth should be starch. People need carbohydrates and proteins.” The simplest food is often the best,
including plenty of vegetables, fish, chicken, turkey, whole grain bread, and 20-30 grams of fiber daily. The recent rise in popularity of Greek yogurt offers a great new way to add dairy to your diet, she noted, saying it beats regular yogurt with double the protein as well as lower sugar content. Nutritionally, it is better to use the plain version and add in your own fresh fruit or nuts to avoid red the added sugar in flavored yogurts. O n e
o f the most common reasons for diet failure is feeling hungry, she said. Often, eating too quickly will cause hunger pangs later. It can also cause overeating - since it can take
up to twenty minutes after you start eating for you to feel satiated. The solution? Get your digestion in gear so that you don’t feel the need to keep on eating. Eat 5-6 small meals a day instead of skipping meals early on and then eating a super-sized dinner. Also, eat something light at the beginning of your main meal. Drink two cups of water and have an appetizer of salad or so p and you’ll start to fill soup, up before piling o on the c cal-
ories. E v e n when not hungry, mindless eating brings down many well-intentioned dieters, Hollander said. “People sit at the table and talk, and keep serving themselves food
without being aware of how much they’re eating.” Instead, she recommends serving food only in the kitchen rather than the table to make it more difficult to add on more helpings. Another big diet DON’T is eating in front of the TV or in the car. She also recommends using a cake-sized plate, not a dinner plate, which you can feel comfortable filling up knowing that your portion size is reasonable. Similarly, exercise can be incorporated into anyone’s lifestyle by making it a natural part of your routine. While it’s hard to make the time to g go out to the gym every day, addin ing exercise in other forms will h help your metabolism stay in b better shape. Shari Marks, a health coach from San D Diego, recommends d deliberately parkiing your car farther aaway in the parking lot so you g get some extra w walking time, aand then taking the stairs instead of tthe elevator. W Walking and light swimming are other easy and effective forms of exercise for those without the energy for more high-intensity workouts. It’s important to set healthy habits in place as early as possible. Marks warns that many patients don’t take action until they’re scared into dieting by a health crisis, whether it’s heart attack, diabetes. “It’s almost like they’re waiting for something to go wrong with them before they act on it,” she said. Leah Rothstein is originally from Hillside, NJ and is a regular contributor to the Jewish Press.
Fad Diets Be Gone: Success Requires Lifestyle Changes
Cut the Fat: Straight Talk on Bariatric Surgery By Rachel Wizenfeld
h, bariatric surgery. Staple your stomach in half, halve your calorie intake and a thinner, healthier body will be yours. It’s not so simple, warn leading doctors, saying the procedures carry risks and should be used as a last resort for obese people who are unable to lose weight through other methods. The two primary bariatric surgery options include the gastric bypass, which is a major abdominal surgery, and the lap band, which is a less invasive procedure. Both reduce the stomach’s size to help create the e feeling of fullness with less food, d, and help reduce absorption n of calories and nutrients,, according to Dr. Georgee Fielding, associate e U professor at the NYU Langone Medicall Center, who has performed thousands of these operations. He said that typically 2/3 of patients for either procedure will achieve l a s t i n g weight loss and 1/3 will fall back to their previous weight levels. The FDA currently recommends bariatric surgery for people with a BMI (Body Mass Index) of 35, or 30 if the person has associating diseases such as diabetes. “Bariatric surgery, be it the gastric band, Sleave procedure or intestinal bypass should be reserved for the morbidly obese,” agreed Dr. Sue DeCotiis, a physician at the Manhattan Medical Weight Loss Center in New York. She pointed out that 10-year results from the surgery are disappointing in that most people regain the weight they lost, and very few reach their ideal weight with surgery alone. Another prob-
lem that she often sees are patients resorting to eating rich, liquidy foods that can make it through their decreased stomach size, which means fewer vegetables and meats and more soft, high-calorie food. Similarly, Dr. Leonard Grossman from the New York Center for Plastic Surgery and Spa in Brooklyn, NY, said that good eating habits are the single most important aspect of a healthy weight, and that bariatric surgery is not an end-all solution. “[It] is definitee ly a succ
patients who had bariatric surgery usually require additional plastic surgery to tailor all the extra skin after weight loss. However Dr. Grossman does recommend the surgery for people who overeat consistently paired with low daily activity levels. “For many people, bariatric surgery is a quick fix in the war against hypertension, heart disease, diabetes and sleep apnea,” he said. Potential risks for the surge gery include b bleeding, u l -
cessf u l procedure, however many people who have had the procedure are still overeaters in their minds and continue to eat unhealthy food products,” he said, adding that
c e r s and infection, but such cases are extremely rare. The increased safety for the surgery has spurred a huge increase in popularity, jumping from 23,100 patients who had
undergone bariatric surgery in 1997 to approximately 250,000 in 2010, according to Dr. Grossman. An alternative treatment that he recommends is i-Lipo, a laser treatment option in which pads are placed on any specific problem area and signal the fat cells to release stored trigylcerides before they are burned off through exercise. An alternative to liposuction, Dr. Grossman said it’s a way to achieve inch loss, body contouring, cellulite loss and stretch mark erasing with no anesthesia, no pain, no needles and no down time. The 20- to 30-minute noninvasive procedure carries no risks or recovery time, he said, and just one treatment ccan cause up to 30% reduction in th the fat layer depth. There are no m medical risks for i-Lipo, which rruns between $350-$650 p per treatment. Approxim mately 200 physicians aand certified laser ttechnicians currently provide i-Lipo in ttheir daily practtices. Dr. Cotiis p prefers a simillar procedure ccalled Liposonix, which generates h heat through powerful ulttrasound to dissolve fat in the abdomen. It’s currently FDA-approved for the belly area and she expects it to be approved soon for trouble spots all over the body. “If you can ‘pinch an inch,’ you could benefit from Liposonix,” she said in an email. “You will lose one dress size after only ONE treatment. This is noninvasive, safe and accurate fat cell removal. Liposuction is invasive and depends on the human eye to determine how much to remove and where…[but] Liposonix, along with a medically supervised meal plan, supplements and guided exercise is a great way to go.”
Expert advice provided by Christie Korth, a holistic nutritionist and founder of Happy and Healthy Wellness Counseling in Long Island, NY Many people have food intolerances that are like mild allergies and affect the body’s ability to break down foods - the three most common are gluten, eggs and dairy. A food intolerance is often an unknown component that is causing bloating, hormone imbalance and weight gain, and can be determined by a simple blood test. Korth recommends this test for nearly all patients that come to her for weight loss, since she has found that seven out of ten people desiring weight loss treatment have a food intolerance. Other signs include constipation, diarrhea, and rashes or bloating right after a meal. Lifestyle is another factor contributing to unhealthy weight gain, whether it’s eating on the run, which often means unhealthy, unsatisfying meals or skipping breakfast which throws off the metabolism. Eating wholesome, regular meals can contribute to a healthier weight. Drinking cold water raises metabolism by 25%, as does eating a teaspoon of mustard. Increasing nutrient-dense foods, like dark, leafy vegetables (kale), quinoa, buckwheat and parmesan cheese, will satisfy the brain’s cravings for nutrients and help stave off uncontrollable hunger. Multi-vitamins and supplements will have the same effect, especially those with B vitamin components. Green tea and white tea extracts also raise the metabolism, as does Ashwagandha, a root extract. Chromium, a mineral, helps regulate blood sugar for those with serious sugar cravings who have problems with bingeing.
By Karen Greenberg
ith the wide world of diet and exercise plans out there, it’s hard to tell what will work for each individual person. Every case is different, and people need different types of support in order to reach their goals. However, in recent years, a popular weight loss phenomenon has been systems that rely on group meetings and social support to help clients lose and keep off the extra pounds. According to the American Psychological Association, it’s easier to stick to a weight loss plan when you have group support. Commercial programs, clinic based groups or simple social support among family and friends all contribute to a more successful rate of keeping weight off. In a 2003 study by the Journal of the American Medical Association, researchers compared weight loss achieved through self-help versus weight loss through a structured commercial program. After a twoyear period, researche r s concluded that comm e r c i a l weight loss programs provided more weight loss than self-help methods. Those who participated in Weight Watchers “lost more than three times the pounds of the self-help group the first year,” according to the study. According to Lisa Levy Shaub, a Weight Watchers leader in Manhattan, “you have other people to bounce things off of, so you don’t feel that you’re at sea by yourself. There is both motivation and accountability, and that is something that helps everyone lose weight at the end of the day.” As a leader, Shaub credits the group dynamic as a core part of the support system. “In the discussions, all of the solutions come
from within the group. It’s a safe environment, and when you have others on the ride with you, it makes it easier to continue the journey,” she said. Participants agree. As one former member explains, “when you’re doing it by yourself and you have a bad week, there’s no one to lift you up. If you have a good week, there’s no one to celebrate with. The group helps to push you forward.” The Weight Watchers program includes periodic “weigh-ins” at group meetings. These provide support and motivation and prevent dieters from using the meetings as a way to rationalize each other’s slip-ups. In addition, the prospect of facing the weekly weigh-in keeps participants in check during the week. Another program, Overeaters Anonymous, uses a group format to address physical, emotional and spiritual wellbeing without promoting a particular diet. Using the Twelve Step method, the organization treats overeating like an addiction and emphasizes on their website t h a t members “a r e united by [a] comm o n d i s ease.” Similarly, Jenny Craig hosts an online community with forums for participants to discuss their progress and celebrate milestones. Celebrity spokespeople and everyday dieters all post their success stories to inspire those who may be struggling. The network of support works hand in hand with the overall program to provide lasting results. So when it comes to losing weight, don’t try it by yourself. Whatever weight loss methods you choose, make sure you have a solid support system to keep you motivated and committed for the long-term.
“…Group meetings and social support to help clients lose and keep off the extra pounds.”
Karen Greenberg is from Queens, NY and is a regular contributor to the Jewish Press.
Natural & Holistic Treatments
Team Support Leads to Success
Best Fitness & Weight Loss Regimens By Rachel Wizenfeld
et off that treadmill. Strength training is the new aerobics, according to fitness experts who say that high intensity workouts actually increase the body’s metabolism and ability to burn calories, even after the workout is long gone. “If you go on the treadmill and just do an aerobic base, you u burn X amount of caloriess for 40-50 minutes. Once e you’re off the tready mill, your body adapts quickly y to go back to o your original s t a t e … i t ’s not becoming more e e f f i c i e n t ,” said Mark Merchant, a fitness exper t who is coowner with G e o rg e Vafiades of AS ONE, a fitness facility in Manhattan. In contrast, by stimulating muscle growth through strength training, a person will stimulate metabolic growth. “For every individual pound of muscle, more calories are burned,” he said. “In addition, after working out at a high intensity people often experience what is called an ‘afterburn.’ For the next 24-25 hours your body is operating at a higher metabolic rate, trying to restore itself.”
High intensity interval training is another newer trend specifically for weight loss, Merchant said. Interval training consists of a high intensity work period, whether it’s one, two five or eight minutes of workout, followed by a corre corresponding rest st period. d.
said, including squats, pushups, deadlifts, split squats, situps and pull-ups, “things that people can be very successful with quickly, so we’re not spending so much time to learn techniques.” Once they master those techniques, they’ll move to higher-intensi sity vari-
The exercise, length of duration and level of intensity varies according to the individual’s capability and the program goals. The basic exercises that he uses with clients are simple, he
ations or greater durations. He also includes rigorous cardiovascular activity to spur that “after-burn” effect and really get the heart going. However, don’t think that high intensity workouts give you li-
cense to eat whatever you want. “I have coached sports athletes and a big misconception for people doing marathon training is they think they can eat whatever they want,” he said. It doesn’t matter if you walk or jog for even 10 miles – if it’s not high intensity, your body goes back to the status quo once you’re done and those calories don’t get burned. Doug Graham, a NJ-based fitD n ness expert, echoed that iidea. “A guy that can run a four minute mile is b burning more than a an eight minute m mile due to the intensity,” he ssaid. He also disa agreed that strength ttraining is tthe only w way to lose weight, and said that high intensity cardio, whether running, rowing, bicycling or swimming can be just as effective. However, both agree that more important than an occasional high intensity workout is the commitment to a healthier lifestyle. Whether finding a healthy eating plan that works or joining a group fitness program where members keep each other accountable to their goals, internal commitment is the overwhelming factor in creating sustained weight loss.
By Leah Rothstein
MEDIFAST & TAKE SHAPE FOR LIFE Take Shape For Life is a weight-loss diet combining Medifast meal replacement products with free health coaching. The unique aspect of the program is its emphasis on support and a personal touch to guide dieters through the challenges of losing weight and keeping it off for the long term by counseling clients over the phone to help them create an overall plan and answer day-to-day diet questions. Founded by Dr. Wayne Scott Anderson, author of Habits of Health, the program is based around “5 and 1”five Medifast meal replacements and one home-prepared “lean and green” meal per day. Studies of the diet conducted by Johns Hopkins Medical Center have shown significant results for participants in reducing weight and increasing muscle mass. Each of the meal replacements has matching nutritional value and many of the products are safe for diabetics to eat. Options include everything from oatmeal and soup to brownies and pancakes, all enriched with vitamins and minerals. Many (though not all) of the meals are kosher, and some are pareve. The once-a-day non-Medifast meal should contain vegetables and protein to provide an added source of nutrients.
“…personal touch to guide dieters through the challenges of losing weight…”
In Closing… By Rachel Wizenfeld
THE 80/10/10 DIET The 80/10/10 diet is a raw vegan diet made up of fresh, unrefined, plant-based food. Dr. Doug Graham, a NJ-based fitness and nutritional consultant, came up with the diet plan about twenty years ago when he noticed three patterns developing in health studies: oxygen delivery to the cells is optimized when fat consumption is below 10%; blood sugar management is best when fat consumption is less than 10%; and according to numerous studies by sports scientists, athletes perform best when carbohydrates make up 80-90% of calories consumed daily. Dr. Graham adapted this ratio to fit with his belief in the health qualities of raw food and a vegan diet. Raw food advocates believe that the traditional ways of eating practiced in ancient societies are much closer to what the human body needs to maintain good health, and that the cooking process alters or destroys many of the natural nutritional benefits contained in plants. The name 80/10/10 refers to the balanced nutrient intake of 80% carbohydrates, 10% protein, and 10% fat. Fruit is a foundation of this diet, providing most of the calories, as well as large quantities of greens for their mineral content. The 80/10/10 meal plan encourages eating to satiation since the food sources are providing the body’s fuel. A fitness plan is essential for 80/10/10 success. Exercise routines to accompany the diet are customized for each individual based on their fitness goals, whether strength, flexibility, or cardio. The routine can consist of many small intervals of movement throughout the day rather than a sustained workout; any and all activity counts towards better fitness.
here Do I Start? One thing from all these articles is clear: weight loss is best tackled with support. Whether you want to try a change of diet, new fitness routine, alternative medicine or surgery, it’s wise to chart a plan with professionals and create a support system to make sure you follow through on your goals. Fitness experts interviewed in this segment agree that the biggest factor in achieving weight loss success through exercise is a lasting commitment, which often comes with peer support and a group program. The diet and health experts agreed that what-
Diets that Promote Healthy Metabolism
ever nutritional path you choose, you need regular support (as well as a balanced meal plan) to ensure you stick to your daily eating regimen. And of course more medical options, whether natural or surgical, should only be pursued after thorough research and discussion with trusted medical professionals. The Jewish community is as affected as the rest of the nation by increased overweight and obesity at all ages, if not more so. Let’s each make a commitment to use the information in this segment to help ourselves, our family members and friends to achieve better health. Rachel Wizenfeld is a frequent contributor to publications like The Jewish Press, The Jewish Journal and the New York Blueprint. She lives in Los Angeles.
Acupuncture: A Prime Alternative By Esther Hornstein, L.Ac.,Dipl.
he Alternative Way is an informative column devoted to Complimentary and Alternative Medicine which teaches about the alternatives available to our community and their benefits. This installment will focus on what I know best, Acupuncture.
What is Acupuncture? Acupuncture is based on traditions in Oriental Medicine. It consists of the insertion of thin, hair-like needles into the skin at locations called acu-points, which are located throughout the body, from head to toe. Acu-points connect to each other through pathways, called meridians, which ultimately connect to organs. Each acu-point has one or more specific function and can be used alone or in combination with other acu-points to treat a specific illness, or improve some aspect of the patient’s overall wellness. Acu-points can also be stimulated without needles. Sometimes acupuncturists use a warmed herb called mugwort near the acu-points. This process is called moxibustion. Acu-pressure, which is pressure or massage of an acu-point or area, also activates the healing properties in the body.
What Does Acupuncture Treat? 42
Acupuncture is effective at treating everything from ankle sprains to anxiety, infertility to insomnia. Acupuncture is even used to treat pediatric disorders and addictions. Dr. Wendy Wang an acupuncturist/herbalist practicing in Brooklyn with over 20 years of experience spoke with me about what she felt acupuncture ex-
COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) Approximately 38 percent of U.S. adults and approximately 12 percent of children engage in some form of Complimentary and Alternative Medicine (CAM). In 2009, U.S. adults spent $33.9 billion out-of-pocket on visits to CAM practitioners and purchases of CAM products, classes, and materials. What exactly is CAM and why are so many Americans using it? Any medical system, practice, or product that is not thought of as standard care COMPLEMENTARY MEDICINE A CAM therapy used along with standard medicine ALTERNATIVE MEDICINE A CAM therapy used in place of standard treatments INTEGRATIVE MEDICINE An approach that combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness
cels at treating and why. EH: What can acupuncture treat and what do you most commonly see in your practice? WW: Acupuncture can treat actually everything. Pain relief is the most common thing people think about when acupuncture is mentioned, but it is successful at treating much more. Women’s issues are my specialty. Acupuncture really helps regulate period, ease into menopause, and treat infertility especially as a support with IVF. EH: Are there any conditions, in your opinion, that can Acupuncture treat more effectively than conventional methods? WW: Western medicine is great. I was a medical doctor in my country (China). The technology is has really evolved, for example in the area of surgery. However, acupuncture stands out in terms of treating certain conditions such as complicated digestive problems and disorders, chronic nausea, chronic infections, colitis, crone’s disease, IBS (irritable bowel syndrome) and PCOS (poly cystic ovarian syndrome). I had one patient who was on antibiotics for 30 years for UTI (urinary tract infection). With that sort of drug use, the antibodies don’t work anymore and the liver becomes damaged. This patient received acupuncture and herbal treatments for one month and her painful and urgent urination disappeared. Acupuncture often surpasses conventional methods in dealing with chronic problems. Often MD’s are limited in cases where the patient has allergies or develops intolerances to medication. Another patient of mine had Crohn's disease. She was married and could not get pregnant. She became very skinny and stopped getting her period. Even though she was treated with steroids, the Crohn's still gave her pain, diarrhea and gas. None of the top doctors were able to help. She received acupuncture treatments twice weekly and after 2 months she got her period back. After the third month she was pregnant. Acupuncture works to improve balance, strengthen the immune system, and regulate digestion and as a result, of course, the patient feels better. I conducted medical research in China where we proved that when patients got acupuncture right after getting a Bell’s palsy attack, they did much better than when given the standard treatment of steroids for one week. Obviously, the best choice is integrative medicine, where technology and alternative medicine works together to benefit the patient. My job is also to educate the public as to what alternative medicine can do. In cases of menopause I have found that HRT (hormone replacement therapy) has many side effects and potential dangers. The body is supposed to have lower levels of hormones. Adding extra hormones with HRT can cause breast, ovarian and uterine cancer. Acupuncture offers a way to balance the body during peri-menopause to enable a gradual drop in hormones to avoid the unpleasant side effects of depression, insomnia, hot flashes and irritability.
Acupuncture Today Acupuncture has its origins in the medical styles and methodologies taught by a several different an-
cient Chinese cultures, beliefs and religious traditions. Traditional Chinese Medicine (TCM) represents a broad consensus of those traditions, but is no longer directly tied to any specific ancient Chinese belief system. It is generally compatible with both modern Western medicine and traditional Jewish beliefs and practices.
Overlaps between Oriental Medicine and Judaism An article written by Steven Schram and published in the Journal of Chinese Medicine. It describes how donning the tefilin stimulates acu-points that trigger mental clarity (needed to inspire concentration). The correlation between the specific way tefilin is worn and the psycho-spiritual points they stimulate is a compelling ‘proof’ of the benefits of living as a Torah Jew, ‘validated’ by oriental medical teachings. There is also a correlation between the views of the Rambam and TCM on diet and its role in health preservation. The Chinese tout a food called ‘congee’ which is a white rice-based food that is cooked with 8-10 times the amount of water usually needed to cook rice. One may add any array of protein and bland vegetables. Congee is similar to chulent or chamim in that it is a complete meal, cooked in one pot. The Rambam prescribed this ‘super food’ for prevention of disease because, he taught, separate food groups consumed at the same time are not easily digested by the body. However, if they are cooked together over a period of hours, the body can digest them easily. Harmonious digestion is a key to good health. Both Chinese Medicine and the Rambam recommend eating warm, cooked, easily digestible foods and advise avoiding phlegm-forming foods such as dairy, cold, greasy, fried and raw foods. Judaism acknowledges the connection between the body and spiritual-emotional mechanisms. In the times of ancient Israel, when one was sick, he or she sought the counsel of the local prophet, in the belief that he would be given the wisdom from Hashem to determine the deficit in the soul that was causing the deficiency in the body. An acupuncturist cannot identify spiritual lack, but can use the physical-mental axis to heal holistically. When a patient visits an acupuncturist to treat a physical ailment, the patient often feels a positive change in his or her emotional well-being, in addition to the alleviation of the physical symptom. These are just some parallels between Judaism and Chinese Medicine. It is important to know the origins of alternative therapies that we use. Many therapies are permitted by Jewish law and quite effective. During my experience practicing TCM, I have been privileged to treat many holy people. The relief and healing that TCM can bring enables many to better their quality of life, and in turn, better their avodas Hashem. Esther Hornstein is a NYS licensed acupuncturist and nationally board certified by the NCCAOM. She has participated in hospital acupuncture projects and research in NYU Hospital for Joint Diseases and Lutheran Medical Center. She is a mother of two, currently has a private practice in Brooklyn, NY. To learn more about TCM visit www.2ndNatureAcu.com. For questions or requests for future Alternative Way articles, please e-mail firstname.lastname@example.org.
Cholesterol: The Good, the Bad and the Ugly By Jason Esses M.D.
everal weeks ago, one of my good friends, a smart pediatric neurologist who has a knack for staying up-to-date, challenged a point that I had made regarding high density lipoprotein (HDL) cholesterol at a health symposium on cardiac issues. “Your information is out dated”, he pointed out. “Just last week we found out that HDL is not important”. He was referring to recent reports in the medical literature, picked up by The New York Times (May 15th edition, “Doubt Cast on the ‘Good’ in ‘Good Cholesterol’”) and other media outlets, that raising HDL has not been proven to lower heart disease. I told him he was right. I also told him that he missed the point. Let me explain. Many patients know that cholesterol is somehow related to health, and that they should have it checked. In fact, many patients know that high cholesterol is bad for them, and that low cholesterol is good for them. For example, “What’s my total cholesterol?” a patient might ask. “Is it greater than two hundred?” That is where the general knowledge usually ends. Unfortunately, most patients aren’t aware of the importance of the other molecules that comprise the Lipid Panel. In addition to total cholesterol, the lipid panel includes: low density lipoprotein (LDL), HDL, and triglycerides (TG). If in fact they have heard about HDL and LDL, it is usually that one is “good” and the other is “bad”, however, what the cut off is, that knowledge is lacking. (HDL should be high, and LDL should be low) There is a strong, clear inverse relationship in the medical literature between HDL cholesterol and coronary heart disease. In other words, if the HDL is low, or less than 40 mg/dl, the risk for heart disease rises, as well as the reverse. In fact, a general rule in cardiology is that every increase of HDL cholesterol by 1mg/dl is associated with a 2 to 3 percent decrease in the risk of total cardiovascular disease. Over half a century ago, little was known about the causes of heart attacks and stroke. The evidence began to emerge in the 1960’s from studies that observe a group of individuals over time, including the classic Framingham Heart Study (FHS),
which followed approximately five thousand participants from the small town of Framingham, Massachusetts for over twenty years. (In fact, the FHS continues to this day, following the third generation of the original participants!) We know from this study, and similar ones, that hypertension, smoking, family history and abnormal cholesterol, specifically low HDL, is linked to heart disease. The evidence is clear and consistent throughout the decades - low HDL can lead to coronary heart disease. How does it work? On a very simple level, HDL is thought to participate in “reverse cholesterol transport”, transporting “bad” cholesterol from the arterial wall, augmenting the breakdown of cholesterol. That is why it is considered the “good” cholesterol. If this is true, why are there new reports that raising HDL doesn’t protect the heart, or in other words, reduce the risk for cardiovascular disease? Logically, if we know that low HDL is one of the causes of coronary heart disease then we should do what we can to raise it, including medications. For years, I have been telling patients that exercise, moderate consumption of alcohol, and taking the drug niacin are the ways to increase HDL levels. Indeed, several drug companies are currently looking at other medications that increase the HDL level (in fact, well above 100 mg/dl!) Are the studies, or the current theory of “reverse cholesterol transport” incorrect? Low HDL is a risk factor, for coronary heart disease. It is present early in life, and is associated with an increased risk of developing future coronary heart disease. That is undeniable. What is unclear, however, is if low HDL is a marker, or sign of disease, or is it a culprit, a cause of the disease? Herein lies the difference. If it is a culprit, then raising the HDL should reduce the risk. If it is merely a marker, not necessarily a cause but rather a byproduct of the disease process, then raising HDL will not help. The recent reports picked up by the media seem to suggest the latter. For example, everyone knows that high blood pressure will lead to heart disease, and that we should intervene by lowering it. That is to say, we have a modifiable risk factor, i.e. hyperten-
sion, and we should treat it as a culprit to reduce risk. Apparently, we can’t say that for HDL for one of two reasons. Either our theory about HDL is incorrect, or our treatment modalities to raise HDL are ineffective. The optimists suggest that the new data is showing that when we raise the HDL quantitatively, we might not be creating a quality, effective HDL molecule, but rather a bloated HDL cholesterol molecule which cannot fulfill its positive function. On the other hand, the pessimists suggest that our previous understanding of HDL cholesterol and “reverse cholesterol transport” was wrong, and that it is only a marker, which plays no role in the development of coronary heart disease. If that is the case, HDL becomes a non-modifiable risk factor for heart disease, akin to family history of heart disease over which we have no control – “you can’t choose your parents” (although many would like to.) What is a patient with low HDL to do about it? The jury is not out yet,
and in general, physicians are continuing to recommend the traditional methods to raise HDL cholesterol, such as exercise and moderate alcohol consumption, although, it might turn out that high HDL may just be a marker for good behavior. We also continue to recommend taking niacin, albeit, less enthusiastically. To my good friend the pediatric neurologist, I would say, yes, it is true that raising HDL might not help, however, a low HDL clearly demonstrates elevated risk for coronary heart disease. In such cases, we, the physicians will be more aggressive at lowering risk, and so should the patient, with exercise, diet, or medications such as statins. Where does that leave LDL, the “bad” cholesterol? That is a whole other discussion. Don’t even mention the “ugly”! Jason Esses M.D. is a board certified cardiologist, affiliated with Maimonides Medical Center, and practices in Brooklyn.
Tanya’s Top Ten Dieting Tips By Tanya Rosen
veryone’s always asking me what my “best advice” is in order to achieve diet success. While I don’t have a magic answer, here are my top ten tips that I have accumulated in my years of working with different clients.
At a party, keep your hands (and mouth) busy.
For many people, dieting is much easier when at home or in a familiar setting/routine. Once at a party, or any type of social function, diets tend to get pushed aside, in favor of something more tantalizing. If avoiding the party is not an option, then once there, KEEP BUSY. For example, be the overly gracious hostess or the amazingly helpful guest busy serving, clearing, etc. If there are kids around, you can be busy with them, playing on the floor (away from the table). If it’s a buffet reception, hold a glass in one hand (filled with a no calorie beverage) and chew gum so that your hand and your mouth are kept busy. This won’t prevent you from reaching for food, but it will add an extra layer of difficulty to it, and force you to think about what you are about to do (See tip #9).
Eat on small, dark colored dishes in a bright room
Research shows that light colored plates bring about hunger, and a better appetite. Ever notice the color of plates in restaurants? Choose a dark plate of a smaller size, so less food will make the plate look full. Eating in intimate and dark settings causes people to eat more (Again think of restaurants, weddings, etc). Eat your food in the most brightly lit place available.
3. Write it all down… for better or worse! This is probably my personal favorite. Keep a complete log of everything you eat. I have been doing this for myself for almost ten years now! Ideally, you should have someone read your journal, but even if no one does, it’s a sense of accountability. When
I read my clients’ food logs, I am very impressed when I see a specific cheat list that entails every extra jelly bean, cookie, and chips. Yes, it’s cheating, but the fact that it’s there in writing shows that there is still control and accountability.
4. Drink 2 full cups of water before any occasion This one is hard to get used to, but is so helpful. I recommend that my clients do this before going out to eat, before a wedding, or any event, and even before any meal. This helps tremendously to feel full, curb your appetite, and hopefully avoid overeating.
Make mealtime sacred
When was the last time you really enjoyed your food? When was the last time you went through a meal slowly with no rush, enjoying every bite? If you’re like most people, you don’t get that opportunity very often. If you could try and make at least one meal a day “sacred”, you will feel such a difference in how much you enjoy it and feel afterwards. Some ways to achieve that are eating out of a real plate with real cutlery (versus plastic), sitting down for the entire duration of the meal, and having as little interruptions or outside stimuli as possible while you are eating.
6. The scale is your friend, but only once a week When you spend too much time with the scale, your potential friend becomes your enemy. The ideal amount of times to weigh your self per week is… ONE! Make a date with the scale (same time, same place) and say goodbye to it until the following week. I have heard from so many women how that number can ruin that they did not like completely affected their day! Seeing a “bad” number after putting in work dieting and exercising is extremely discouraging and frustrating. Some people will even get on the scale a few times a day, hoping for better results. In fact, our weight normally fluctuates for any number of rea-
sons, (sodium retention, hormonal changes, constipation, etc), but these factors tend to average out over time. Seeing a “bad” number after putting in work is extremely discouraging and frustrating. You are much more likely to get a more accurate and encouraging reading of your progress If you only go on the scale once a week.
7. Reward yourself… with food, or without When you reach a goal, or a milestone, you can and should give yourself a reward! Non food rewards can be a small (or large) gift to you, a day off, or even a day (or an hour) at the spa. Yes, it’s ok to reward yourself with food, IF this is planned and controlled. There is a big difference between excitedly devouring a bag of chips to “celebrate” a weight loss milestone and going out to a nice planned dinner, or sitting down to a well-earned (and planned) dessert!
8. Smile (Or drop the fork!)… You’re on “camera”! Many of us behave very differently in public than we do in private. This also applies to how we eat! It is so much easier to “be good” in public than it is in private. I like to tell my clients to pretend that they are being videotaped at every meal for all to see and analyze. It’s amazing how this really works on some people, try it and see!
9. Make your (food) life more difficult Another term for this is “obstacle creation”. Think of your diet as an obstacle course, the fewer obstacles the better. Now think of cheating on your diet; the MORE obstacles, the better. So what I try to teach my clients is to actually go and create obstacles for themselves so that it’s hard to cheat. Here are some examples: 1. Put tempting foods on a very high shelf. This way you will need a chair to climb and get it, creating an obstacle. 2. If dairy foods tempt you, become fleishigs! This way, no matter how
much you want it, you can’t have it for the next 6 hours! 3. When going to the pizza store with the kids, take EXACTLY enough money for THEIR pizza. This way, at worst, you’ll munch a little on theirs, but you simply won’t have the money for your own. 4. When buying challah or goodies for Shabbos, buy EXACTLY enough for everyone else. This way, if you cheat, you’re taking away someone else’s portion. 5. Do NOT have tempting foods in the house. Tempting means whatever it is that tempts YOU. Do not buy it. If you really need it (or rather THINK you really need it) you will have to get into your car, turn on the ignition, put on a seatbelt, drive to the store, park… (You get the point).
10. Fall in love with (ANY) exercise Don’t worry. It’s still OK to hate exercise in general. Try and find just one activity that you can really enjoy. Aside from the obvious benefits of burning calories, people who exercise on a regular basis tend to keep their weight off longer. The reason is not clear, but I suspect that people who do exercise get into the health mode and become naturally reluctant to ruin it by eating too much. Some non-typical types workouts that may appeal to you include: jump rope, hula hoop, dancing, house cleaning, mall walking, or even gardening, which can be just as effective as more conventional workouts like the treadmill, a step class, or Zumba. Whichever one you prefer, make ANY workout routine a part of YOUR routine for the best results. 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. Tanya can be reached at 917-913-1523
Sweet and Tart Holiday Menu! By Nina Safer Kick off the High Holidays with a sweet and tart menu. Take Rosh Hashanah menu staples such as apples and pomegranate seeds and create new dishes that are bursting with flavor.
Apple Cider Chicken with Pears & Apples Apples and pears cook together to make this wholesome and nurturing dish that is full of flavor.
• • • • • • •
Ingredients: 2 tablespoons olive oil 1 small onion, cut into small slices 4 pieces boneless, skinless chicken breasts 1 large apple, peeled and cut into thin slices 1 large pear, peeled and cut into thin slices 1 cup of apple cider 1 tablespoon of apple cider vinegar
an additional 5 minutes then serve with apple and pear slices.
pepper and juice of 1 lime. Add dressing to quinoa salad and mix well.
Quinoa Salad with Avocado and Pomegranate Seeds
Apple Pie Egg Rolls
Quinoa is the perfect base for a salad since it's hearty and filling and can be paired with any dressing. This once is sweet with a slight tart kick. The pomegranate seeds (which many have gotten used to spitting out rather than eating) give it a nice crunch.
Apple pie is the ultimate classic dessert. This recipe literally wraps it up and serves it with a modern twist. The outside is crunchy and the inside is deliciously sweet.
Ingredients: • 1 cup of quinoa • 2 cups of chicken stock • 1 small red onion, diced
Directions: Saute onions in 1 tablespoon olive oil until • • • • •
• • • • • • • • • translucent. Add chicken pieces and cook until no longer pink. Remove from heat and set aside, wrapping in foil to keep warm. Add remaining olive oil to pan, and cook the pear and apple slices until tender. Combine the apple cider with the apple cider vinegar and add to the pan and bring to a boil. Lower heat and add the chicken back to the pan. Cook for
1 avocado, cubed 1/2 cup of pomegranate seeds 1/3 cup of olive oil 1 tablespoon balsamic vinegar 1/2 tablespoon brown sugar 1/4 teaspoon garlic 1/4 tsp. salt 1/4 tsp. black pepper juice of 1 lime
Directions: Cook quinoa as directed on packaging, using chicken stock in place of water. Once cooked, combine in a large bowl with avocado, red onion and pomegranate seeds. Prepare dressing by mixing together the oil, vinegar, brown sugar, garlic, salt,
Ingredients: 5 granny smith apples, peeled and diced 1 tablespoon cinnamon 1 tablespoon sugar 1/2 cup of apple cider 1 package of eggroll wrappers
Directions: Combine diced apples with cinnamon and sugar. Place in pan with apple cider and cook until tender. Place 1 tablespoon apple mixture in center of eggroll wrappers and roll as directed on packaging. Bake in oven on 350° for 15-20 minutes until crispy on outside. Serve with powdered sugar and ice cream. next favorite dish. When Nina Safar is not updating recipes on Kosher in the Kitch, she enjoys playing hostess. Never having too much time in the kitchen, she likes recipes that taste great and are easy to make. You don’t have to be a chef to cook a good meal! For more great menu ideas and tasty recipes, check out www.kosherinthekitch.com for your next favorite dish.
HEALTHY HOLIDAY COOKING TIPS: • Colorful veggie and fruit kabobs make wonderful appetizers. • For a quick and easy soup, cook winter vegetables such as butternut squash, carrots or sweet potatoes until they are soft enough to puree and season. • Use ready- made salsa and whole wheat crackers or tortilla chips to create a crunchy and flavorful salad. • Marinate chicken in a low sodium broth, fruit juice or wine and cover with foil when cooking to prevent drying out. • Remove skin from poultry before cooking and eating. • Poached pears make a great dessert! Poach in a dessert wine or apple cider with some cinnamon. • Chummus and roasted red pepper dip are great as a spread and dip for cut up veggies and crackers • ALWAYS bake over frying!
Gaming Consoles for Seniors By Shimon Lewin
he video game phenomenon has evolved greatly over the last few decades. Video games, which were once regarded as entertainment suitable only for children and teenagers, have now become a big hit for people of all ages. The senior population especially can benefit from today’s ‘video games.’ The first gaming systems were introduced in the 1980’s by game makers, such as “Atari” and “Nintendo”, among others. Compared to the game systems of today, they were quite primitive. They had very low quality graphics and their limited data storage and processing power made the games very basic and relatively simplistic. As the years went on, and the computer technology upon which they were based continued to be improved, so did the quality of the games and the capabilities of the consoles that run them. In the nineties, both parents and doctors were complaining that too much time playing video games was taking away from the vi-
tal exercise that growing children and adolescents needed. Two of the most common signs and symptoms in this age group attributed to video games were fatigue and obesity. Today, the entire gaming experience has been revolutionized with the classic sedentary model of the video game becoming obsolete due to the popularity of the Nintendo’s Wii, which introduced the motioncontrolled active play gaming experience. No longer did playing video games mean sitting stationary in one spot, staring at a screen. The Wii introduced interactive games that provide a great physical work-out, not to mention loads of fun. The Wii’s popularity prompted Microsoft to introduce the Kinect device as a motion sensing input device for its popular Xbox game controller. The Wii requires the player to use a hand-held game controller wand, but the Kinect allows the Xbox user to play using only gestures and spoken commands. When the Kinect became available in North America in November 2010, it established a world record by selling 8 million units in
60 days. These two innovations have changed the entire concept of video gaming. Traditional gaming required hardly any physical movement. Now the Wii and Kinect have turned the modern gaming console into affordable
As everyone knows, walking is great cardiovascular exercise. But during inclement weather, when you feel that you have to stay indoors, the Nintendo Wii or the Microsft Xbox with Kinect can help you keep in shape and get your blood circulating, all within
and fun-to-use exercise machines which even the elderly can use safely to work out in their own homes. If you are a senior reading this, you are probably thinking, “This is ridiculous. I am an elderly person. Why would I play video games like a child?” Well, before you dismiss this idea, take a step back and consider the various options and benefits that these games have to offer you. For starters, these games can give you a complete workout that will be truly beneficial to your health. Many seniors (and some adults) are cautious exiting their homes in the winter when there is snow on the ground. Because of this, many stay indoors and start to fall behind on the basic general exercise that is needed to maintain a healthy regimen. It is no surprise that many retirement homes are now advertising Wii gaming in their brochures. Wii has become a favorite in the recreation rooms of many retirement housing developments and in assisted living homes. In fact, TAbby Mandel, the Director of Recreation at the Lakewood Courtyard in Lakewood, NJ says that, “residents love using the Wii. It makes them feel so youthful and they get their exercise in at the same time.”
the safety and comfort of your own home. In addition, these games can be challenging and fun at the same time. The gaming systems can simulate running, tennis, baseball, golf, and a whole host of other fun and healthy sports and activities. They are also good for exercising during the summer when it’s too hot to venture outside. These games are also great for enabling the elderly to play sports such as bowling and tennis, which they enjoyed when they were younger but now may be too strenuous or even medically forbidden for them to play. These games keeps elderly adults fit and young at heart, and help them to relive their past fun times. If you know an elderly person who needs to get more exercise but who is reluctant to go to a gym or spend much time outdoors, suggest a Wii or an Xbox Kinect. And if you need to get more exercise, but always thought that video games were not for you, think again! Shimon Lewin is IT director for The Jewish Press and the author of numerous articles on technology and software. He can be reached via email: email@example.com
Stairlift Sets Shabbos Prisoners Free By Raquel Wildes
abbi Yisrael Rozen, from the Zomet Institute for Halacha and Technology, has dedicated his life to finding ways to combine the latest technological advances with a deep, intricate understanding of Halacha to enable technology to enhance religious life in full compliance with the laws of Shabbos and the other Mitzvos. As was described in the previous issue of Health & Living, twenty years ago, at the request of one of the Gedolei Hador, he helped create a halachically-friendly electric wheelchair to enable those who could not walk to shul on Shabbat to become more mobile. Now, in the same spirit, Zomet has created the Shabbos StairLift, which allows those who are unable to navigate stairs on Shabbos or Yom Tov a chance to re-gain their mobility and the ability to celebrate these occasions with their families. The Shabbos StairLift was inspired
by a phone call to Gabriel Gozland, the Riverdale-based U.S. agent for Zomet. One of his clients sought out Gozland’s help after her elderly mother, who was alone for Shabbos, was
tance. This elderly woman planned on eating her Shabbos dinner before sunset, and then use her conventional stairlift to go downstairs before Shabbat started. However, she fell asleep
forced to remain in bed for 25 hours without food because she could not walk down the stairs without assis-
and did not wake up until after dark and found herself trapped upstairs until Shabbat was over. After learning
of the woman’s Shabbat ordeal, her distraught daughter called Gozland, who then conveyed the problem of designing and building a Shabbatcompliant stair lift to the experts at Zomet. Now the Shabbos Stairlift is available for installation in any US home. “The Shabbos StairLift gives people the peace of mind to know they or their loved one can stay in their own home, or with their children and grandchildren, in comfort and safety. It enables individuals with limited mobility to reclaim their dignity, and it helps families to come together for meaningful occasions,” said Gozland. It enables the elderly or others with limited mobility to more conveniently observe and sanctify the Shabbos in full compliance with Halacha in the comfort of their own home. It is another example of how Halacha can complement technology and how the two can continue to work together to make our religious experiences increasingly meaningful, practical and enjoyable.
Kosher Power Bars and Where to Find Them Most basic foods fall into two categories: they’re either kosher or not. However, there are also food items in which the kashruth picture is mixed -- some brands and flavors are kosher while others are not. Power bars are one of the most popular food items in that category, with kosher consumers often searching high and low for “good” kosher brands. Here are some of the most recommended and commercially available kosher power bars. Clif Bars: A favorite of hikers and bikers everywhere, this company makes both Clif Power Bars and Luna Bars for Women. They are organic and come in a wide variety of OU-certified parve and dairy flavors. They are widely available in supermarkets, the food sections of discount stores, and specialty food stores like Whole Foods. A pack of six bars typically sells for approximately $5.50.
Compiled by Karen Greenberg
Nature Valley: These granola bars were the original standard for energy, nutrients, and great taste. The classic flavors are all OU-certified parve,
but there are a few newer options, such as Chewy Trail Mix Bars, that are dairy. They can be found at your local kosher or general supermarket for about $4.00 a box. Grab1: Not only are these power bars great for energy, but they are specially designed to help you lose weight as well. The company’s bars are chaf-K certified and come in 2 parve and 5 dairy flavors. The
dairy flavors are chalav yisroel. The bars are not as widely commercially available, but can be purchased on the Grab1 website for $19.95 for a pack of 20 bars. Balance Bars: Everything about these bars is in the name – Balance. Specifically developed to
provide the optimal balance of nutrients, these quick snacks keep your power going and come in six flavors that are OU certified and dairy. They are available in most supermarkets and can sell for anywhere between 5 to 8 dollars a pack. EAS Advantage Edge: These power bars are geared towards more fitness-minded individuals, as opposed to those who just want a quick snack to get them through their day. For anyone who is more serious about training, these bars come in four OU- certified dairy flavors. They can be found at Waldbaums, CVS, Rite Aid, and online at the EAS website for about $20 for twelve bars. There are a few popular brands of powers bars that are sold all over the country and are NOT kosher. The following are to be avoided: Powerbar: This brand is sold in countries all over the world, but absolutely no Powerbar products are certified Kosher. Detour Bars: Although they are not made with any specifically unkosher ingredients, these bars are not certified kosher. Also note that not every product made by the listed “kosher brands” is kosher. Check each package for certification before purchasing.
Food Allergy Alert Bracelet Allerbling Food Allergy Alert Bracelet is an accessory that has the potential to save a child’s life. The Allerbling wristband is a clearly marked medical bracelet to help indicate to children’s caregivers which foods a child must stay away from. The bracelet displays iconic symbols of the food products that an individual
child is allergic too. The bracelet also serves as a visual educational tool for children, constantly reminding them which food groups are risky to their personal health, while being cute and approachable—something they will never want to take off. It is recommended for children ages three and up.
Showcase Israeli Tea Manufacturer Has Medicinal Benefits Galilee Tisanes, an Israeli tea company that combines modern agricultural techniques with traditional herbal medicine remedies, is providing hope for those who suffer from diabetes, hypertension, asthma, and other disorders. The company, which benefits from the Galilee’s fertile soil and cool climate, grows the finest possible herbs that are both tasty and medicinal. For example, the Glucole tea for balancing blood sugar levels, is proving extremely helpful for diabetics. It works by activating the pancreas, causing it to produce insulin, which absorbs glucose. Thus, sugar levels in the blood are reduced. In a clinical trial, patients who drank between 2 and 3 cups a day saw significant results. The natural line of teas is certified kosher by Badatz and all are tested in research and development before being manufactured. The remedial formu-
las are developed by a team of phytotherapy doctors, herbalists, and pharmacists, who ensure that the teas are specifically targeted to improving each respective condition. There are absolutely no preservatives or chemicals added, ensuring a completely natural herbal treatment. As a family business, Galilee Tisanes has been run for 3 decades by the Solodochs, who have passed this valuable trade between generations and remain committed to a healthy and effective experience with their tea.
Take Shape for Life Take Shape for Life is a Free Health Coach division of Medifast, and a John Hopkins clinically approved program. The goal of Take Shape For Life is to help people optimize their health — leading to richer and more fulfilling lives. Being able to get off diabetes, high blood pressure, cholestoral, and sleep apnea medications are just a few of the benefits involved. Many Jewish women or men have accumulated unwanted pounds due to poor eating habits, lifestyle, etc. Take Shape for Life health coaches offer longterm solutions to weight management challenges while providing the informed, caring support their clients require. Statistics show that working with a health coach produces a much higher success rate of losing weight and keeping it off, especially with
someone who’s experienced the program themselves. There is a group of Orthodox health coaches available in all major cities across the U.S. All of these coaches are knowledgeable of the Take Shape for Life program with relation to Shabbos and holidays, and have experienced healthy, permanent weight loss themselves. Over 50 of the 70 various meal replacements are kosher! The company launched off 11 new products a few weeks ago, all of which are kosher as well. For more information, please contact Certified Health Coach, Shari Marks firstname.lastname@example.org (619)972-2986 www.thintogether.com
App Reviews Fooducate has been voted the best app for eating healthy by Time Magazine, Heathland. By simply scanning the barcode on packaged food items, you can learn all the key nutritional facts of a product without reading a single label. Fooducate rates every food product based on health criteria with letters A through D, taking into account the nutritional density of each food, preservatives, additives, high fructose corn syrup, food colorings, added sugar, serving sizes, and other ingredients that get lost in a marketed label. Shoppers are then able to compare
multiple products in order to choose healthier options.
DO YOU HAVE A PRODUCT OR SERVICE THAT YOU WOULD LIKE US TO FEATURE? EMAIL US AT - SALES@JEWISHPRESS.COM
Community Profile By Sandy Eller
t was a bout with leukemia that turned then 22-year-old Jay Feinberg, a foreign exchange analyst at the Federal Reserve in New York, into the founder and director of the Gift of Life Bone Marrow Foundation, a non-profit public bone marrow, blood stem cell and umbilical cord blood registry that facilitates transplants for individuals suffering from life-threatening diseases including leukemia and lymphoma. It was Feinberg’s four year odyssey to find a suitable donor that brought about the now massive Gift of Life registry, which, as of 2010, was the eleventh largest in the world. Diagnosed with chronic myelogenous leukemia in 1991, Feinberg and his parents were told that only a bone marrow transplant would save his life, but none of his relatives, including his two older brothers proved to be a match. Doctors told Feinberg that his odds of finding a match were poor because a donor would need to be someone from a similar ethnic background and, at the time, there were very few Jews in the national bone marrow registry. “While doctors may have understood tissue types and transplants, the one thing my doctor didn’t understand was the Jewish mother effect,” recalled Feinberg. “There was no way my mother was going to take her son home and prepare a bucket list.” Sitting around the Feinberg family’s dining room table in West Orange, New Jersey, a grassroots campaign called “Friends of Jay” was created to find a suitable donor. The Jewish community rallied behind the Feinberg family, with hundreds of bone marrow drives taking place throughout the world, including the United States, Canada, Israel, Belarus, Australia and South Africa. Feinberg describes the massive blood drives as “a campaign not to save one life, but a mission to save many.” By 1995, approximately 60,000 Jews had been added to the bone marrow registry and one hundred matches were found for others in need of transplants, but Feinberg’s condition was deteriorating rapidly and a suitable donor for him had yet to be found. In a last ditch effort to find a donor, a Chicago resident whose friend had found a match through Friends of Jay decided to return the favor by running one final drive in the area. Approximately one hundred and fifty people were tested and as the
event was concluding, Becky Faibisoff, a teenage volunteer who had been handing out flyers, decided to be tested, despite having a fear of needles. It was her bone marrow donation that saved Feinberg’s life. Once Feinberg’s recovery well underway, Friends of Jay evolved into the Gift of Life Foundation, which is now headquartered in Boca Raton, Florida. Gift of Life still runs drives all over the United States. Feinberg’s odyssey “to save many” is continuing full steam ahead. “We do seven to eight hundred donor drives annually,” said Feinberg. “We work on college campuses through Hillel, in synagogues and we partner with organizations like Birthright and do cheek swabs with them. In my time, in order to be tested, it was blood or nothing, but today not only is getting tested simple but even donating bone marrow has become much simpler. While twenty years ago, donation involved using a syringe to extract bone marrow from the hip bone, today eighty percent of donations are done using blood stem cells taken from the arm. It is a short procedure that involves nothing more than minor discomfort. Just four hours and you can save someone’s life.” Gift of Life, a registered tax exempt organization, relies on fundraising to cover its costs. Currently, the cost of testing each potential donor is $54. While the drives continue, there are 10,462 cheek swabs that have already been taken but have yet to be processed because more funding is needed. Gift of Life has numerous creative fundraising options, which include mitzvah projects for Bar and Bat Mitzvahs and a Gift of Life Visa card that makes a donation to the organization with every purchase. Donor circles, which create a social networking system that allows for tracking of activity, including financial donations, matches made and transplants facilitated, are another unique idea created by the Gift of Life. A donor circle created this past winter by the a cappella singing group, The Maccabeats, used their YouTube video “Miracle” to raise $80,000 over Chanukah for the Gift of Life, in the hopes that one of the swabs waiting to be analyzed might provide a match for Ezra Fineman, a two-year-old from Fair Lawn, New Jersey who is in need of a bone marrow transplant. While Ashkenazic Jews are now well-represented in the registry, Feinberg estimates that only forty percent of Sephardic Jews would be able to find a match in the registry, a number that he hopes will grow as Gift of Life targets the Sephardic community to increase its representation among those tested. “We have a cord blood program with Maimonides Hospital in Brooklyn and it has been very
promising for patients with rare tissue types,” explained Feinberg. “Cord blood cells are very immature and consequently they can co-exist with the immune system of someone who isn’t a perfect match, so we don’t have the problem of rejection. ” Feinberg has been the recipient of the Jewish Federations of North America Jewish Community Hero Award in 2010, an Honorary Doctor of Humane Letters from Yeshiva University in 2003, the inaugural Charles Bronfman Prize in 2004, Citizen of the World Award from Hadassah International in 1999 and the 1994 Allison Atlas Award from the National Marrow Donor Program. Twenty one years after his diagnosis, Feinberg continues to give his all at the Gift of Life, remembering all too clearly how it felt to be on what seemed like a fruitless search for a donor. “The one thing I think about every day is the families we work with all the time. I can relate to how they are feeling and it is such a blessing to be able to help them find a donor,” he said. 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 email@example.com.
FAST FACTS: • • • • •
Number of registered donors: 205,008 Number of matches made to date: 9,052 Number of transplants facilitated: 2,479 Number of donor recruitment drives held: 4,051 Gift of Life was the first registry worldwide to use cheek swabs to test donors at recruitment drives, to recruit donors online and to recruit donors within the Jewish community. Gift of Life is the only registry in the world founded and directed by a transplant recipient. On average, 1 out of every 1,000 Gift of Life donors match with a patient each year. Only 30 percent of leukemia patients find a bone marrow match within their own families. By law, bone marrow donors cannot be compensated for their donation. Gift of Life is one of only three registries in the United States that list unrelated bone marrow donors.
Community Provider Bulletin Behavioral Intervention for Weight Loss at New York Methodist Hospital NYM now offers short-term cognitive behavioral therapy (CBT) for patients who want to lose weight. While other medical and surgical services of the Weight Management Program are available to treat overweight or obese individuals, CBT is a supplementary, drug-free tool that can help those who want to address the mental hurdles that stop them from keeping the pounds off. “About seventy percent of dieters who are initially successful at losing weight will regain it all—and then some—within a few years,” said Yen Ling Chong, M.D., psychiatrist in the Department of Neurosciences at NYM. “Mental blocks, such as stress and disappointment, are the most common barriers to successful weight loss, and CBT can help patients address those issues and achieve the
long-term results they need.” The CBT weight loss program at NYM is an in-
dividualized, one-on-one collaboration between doctor and patient. Over the course of ten to twelve 30-45 minute sessions, the doctor works to help overweight individuals identify the causes of unhealthy eating and weight gain. The goal is to help patients alter the way they think about food and their eating habits, while they remain in control of their individual nutrition and exercise regimens, and to eliminate trigger thoughts; it is to give dieters the awareness and discipline to identify triggers, change the behaviors that result from and break the weight-gaining cycle. For more information or to schedule an appointment, please contact NYM’s Comprehensive Weight Management Program at 718.780.3771.
A Guide to the New Terminology of Home Care
People and families seeking or receiving home care may find the new terms which have recently replaced the old labels used to describe agencies and services to be very confusing. Here is an explanation of what these new terms mean: Certified Agencies provide skilled care to patients requiring nursing skills, including physical therapies, as well, if medically indicated. Patients will receive a certain amount of personal care, for a designated amount of time, depending on their coverage. These skilled services are paid for by
Medicare Part A, Medicaid or Private Insurance. When the need for skilled care is over, these services will be terminated. A patient who has Medicaid will then be transferred to a Managed Long Term Care agency, referred to as an MLTC. The MLTC will coordinate services such as personal care, dentistry, podiatry, medical equipment, audiology, optometry, non-emergency transportation and many other services. The MLTC patient will be serviced under a custodial home based individual.
Though terminology is changing, the Home Care industry remains intent on continuing to do its utmost in providing care to those needing their
services. Provided as a service to the community by Isaac Soskin, CEO of Revival Health Care.
High-Tech Plus Soft-Touch Equals Superior Rehabilitation Results at Heimeshe Mercy Medical Center Near the 5 Towns The latest in high-tech therapy combines with soft human touches to produce superior results for rehabilitation patients at Mercy Medical Center in Rockville Centre near the 5 Towns and West Hempstead communities. Mercy Medical presents their patients with a heimeshe environment. Patients’ religious comforts and requirements are addressed to the fullest possible extent with complimentary bikur cholim, Shabbos rooms for family members to stay over with their older parents / loved ones, a well stocked strictly kosher pantry, and a shul on-site with mincha minyanim in winter, you have the perfect setting for superior rehab results. Mercy’s highly professional yet humanistic approach to rehabilitation maximizes independence without compromising religious observances, and is dedicated to superior outcomes, with rapid recovery to higher levels of function. Mercy is home to one of the largest dedicated inpatient acute rehabilitation programs in Nassau County. Its highly-skilled staff uses the latest innovative techniques to speed the recovery of patients from catastrophic illnesses
and injuries such as stroke, spinal cord injury, amputation, major orthopedic surgery, severe disabling arthritis, and brain injury. Mercy’s expert multidisciplinary Rehabilitation Team is led by Dr. Perry Stein who is Board Certified in Physical Medicine and Rehabilitation, as well as Neuromuscular and Electrodiagnostic Medicine. Featured in New York magazine and U.S. News and World Report as one of the region’s top physiatrists; he is supported by some of the region’s best physical, occupational, recreational and speech therapists, and rehabilitation nurses with excellent Patient Satisfaction scores. The multi-disciplinary team helps each patient to reach their highest possible level of function and independence, and utilizes the latest technology, such as LiteGait® partialweight-bearing therapy for lower-extremity impairments, VitalStim® therapy and the only FDA-approved electrical stimulation therapy for the treatment of swallowing difficulties. Novel approaches such as Nintendo® Wii™ basketball, bowling and tennis games improve strength, range of motion, balance, and coordination, and a Pet Therapy program whereby specially-trained dogs visit patients provides encouragement and emotional lift. For a tour of Mercy’s rehabilitation facilities, or a physician referral, call: 516-62MERCY or visit on line at: www.MercyMedicalCenter.info
JCCRP STREET FAIR
Where: Reads Lane between Cedarhill and Oak Drive. Far Rockaway, NY 11691 Hours: 2-6 P.M Free Children's Rides by Traveling Tykes. - Glatt Kosher Food from Traditions Eatery will be available for cash purchase. Raffle Tickets for a variety of prizes that were donated by local vendors will be available for cash purchase. Contact: (718) 327-7755.
Weight Management Support Group
Where: Lakeside Health System, 156 West Ave. Care Center Conference Room, Brockport NY 14420 Hours: 6:30-7:30 P.M Lakeside Health System If you are need of help to control your weight, join us for nutrition information and moral support. Cost $ 5/meeting. Contact: (585)395-6095 x 4265
Jewish cuisines have been nourishing each other for more than 2,000 years. This lively afternoon will feature recipes and stories from Italian-Jewish kitchens throughout the ages. A reception will follow featuring kosher Italian wine provided by Sentieri Ebraici Wines and cheese provided by Brent Delman, The Cheese Guy. $15, $12 Members. Contact: 646-437-4202.
Where: Riverdale YM-YWHA 5625 Arlington Ave. Bronx, NY 10471 Hours: 10-3 The Riverdale Y Senior Center will host a rededication. Adults of any age are welcome to experience the Y’s programs at no charge. During the morning, participants will be able to sample many of the classes offered at the Center. Classes will be followed by a gourmet hot kosher lunch (the Y is under the supervision of the Vaad of Riverdale). Contact: Sharon Asherman at 718.548.8200 x 230.
Where: 29 Mariner way (back entrance) Monsey, NY Hours: 8:00 PM – 9:00 PM Get inspired and reach Kedusha in 10 steps. Suggested donation $10. Audience: Women Only. Contact: (845)216-07144.
Back to School Issues for Adults with ADD/ADHD
Where: International Seafarers House, NY. 123 East 15st. NY, NY 10003 Hours: 6:45p to - 8:45p.m Want to go back to college, or get your GED? Sounds good, but maybe things didn't go so well the first time around. What issues -- study skills, time management -- are likely to come up? And what resources, or accommodations, might be available? For more on this, hear education counselor Okie Hrycak, who serves as the learning-disabilities coordinator at Barnard College. Price $5. Contact: (212) 677-4800
Day of Service Blood Drive
Where: JCC of Manhattan The Samuel Priest Rose Building 334 Amsterdam Avenue at West 76th Street New York, NY 10023 Hours: 10 - 2:30 P.M The NY Blood Center needs close to 2,000 people a day to roll up their sleeves and give the gift of life. Please donate blood at the JCC during the 9/11 Day of Service. For more information about donating blood, please visit The New York Blood Center website. Contact: 646-505-5708.
Re-Opening Riverdale SeniorCenter
Where: Upper Park Heights area. Hours: 7-9 p.m. The Kosher Kwilters meet the third Wednesday of every month. We are a Jewish group of women who are interested in quilting. Come join us and show us what you are working on, get advice, schmooze, and join in our projects! Beginners welcome!
N’Shei C.A.R.E.S Maimonides Birth Center Tour
Where: Maimonides Hospital. 4802 10th Ave. Brooklyn, NY Contact: (718) 283-6000
Raoul Wallenberg and His Legacy
Where: Museum of Jewish History. 36 Battery Place. New York, NY 10280. Hours: 7pm Kati Marton, author of Wallenberg: The Incredible True Story of the Man Who Saved the Jews of Budapest, and Wallenberg historian Bengt Jangfeldt, Royal Swedish Academy of Sciences, in discussion with Museum Director Dr. David G. Marwell On the 100th anniversary of Wallenberg’s birth, Jangfeldt and Marton discuss the life, legacy, and still-unanswered questions surrounding the Swedish diplomat who helped rescue tens of thousands of Hungarian Jews during the Holocaust. . Free with suggestion donation. Contact: (646) 437-4202
Where: Museum of Jewish History 36 Battery Place New York, NY 10280. Hours: 2:30 P.M Meet food historian Cara De Silva; chef and food writer Silvia Nacamulli; Walter Potenza, Potenza Ristorante; food writer Alessandra Rovati; moderated by cookbook author Jayne Cohen . From Roman artichokes to Venetian fried fish, Italian and
Zichron Shlome Refuah Fund Annual Aseres Yemei Teshuvah Breakfast Where: Ateres Golda 1362 50th St Brooklyn, NY
N’Shei C.A.R.E.S Maimonides Mothers of Multiples Support Group
Where: Maimonides Medical Center. 4802 10th Ave. Brooklyn, NY. Contact: (718) 283-6000
Connect to Jobs
Hours: 12-3 P.M. Meet recruitment professionals from a broad range of companies and staffing firms, including: financial institutions, health care, retail and others. Speak with employers and improve your networking skills. Connect to Care staff can give advice on services available, employment, legal and financial issues. Contact: To register or for more information call 718-331-6800
Where: American Cancer Society 1120 So. Goodman St. Rochester, NY 14620. Hours: 4-6 P. M. Man to Man is a FREE educational and supportive program for those touched by prostate cancer. Open to men and their spouses and partners. Topic: Side Effects of Prostate Surgery and Treatment Speaker: Dr. Jean Joseph and Gina Fries,PA . Contact: 1-800-227-2345.
Avinu Malkeinu: Night of Inspiration
Where: Brooklyn College 2900 Bedford Ave. Brooklyn, NY 11210. Hours: 7 P.M. Shiurim for women only. Contact: www.ohrnaava.com
Man to Man Exploring Italian-Jewish Cuisine
Eating Your Way To Good Cholesterol (National Cholesterol Education Month)
Where: Maimonides Cancer Center, 6300 Eight Ave, Bklyn Conference Rm., 1st Fl Hours: 2-3 PM. Led by Chief of Nutrition, Heidi Becker, MS, RD, this workshop will include recipes, food tasting, and cooking demonstrations, as well as information and tips. This workshop is taught in English. For cancer patients only. Contact: firstname.lastname@example.org, (718) 765-2526.
20's & 30's Volunteer Corps: Rosh Hashanah Package Delivery
Where: Brandeis High Shool - 85th Street Bet. Columbus and Amsterdam across from DOROT Hours: 11:00am - 2:00pm Join 20's & 30's Volunteer Corps and DOROT to brighten the day of a senior. Volunteers meet at Brandeis High School to collect packages of Rosh Hashanah treats and then deliver the treats to seniors in the neighborhood!. Staff, Volunteers, and signs will help you find your way. Contact: 646-505-5708.
Jewish Quilt Group
Chai Lifeline Annual Chinese Auction
Where: Chai Lifeline at 151 West 30th Street. New York, NY Contact: call 212.465.1300, or e-mail email@example.com
TO SUBMIT AN EVENT FOE THIS LISTING OR FOR THE WEEKLY JEWISH PRESS: EMAIL CALENDAR@JEWISHPRESS.COM
Health and Living Service Marketplace Addiction Recovery Recovery Road 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 1720 Pacific Ave., Suite 235, Venice, CA 90291 310-505-0439 - RecoveryThroughTorah.com A Torah path to 12-step recovery from addiction. Confidential / anonymous phone appointments.
Relief Resources 5904 13th Ave. Brooklyn, NY 11219 718-431-9501 - www.reliefhelp.org A non-profit organization which provides multiple services to people suffering from mental disorders. These services include medical referrals, community education support networks, and more.
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.
Assisted Living Ateret Avot 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.
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.
Reva Judas, Director: 201-692-9302 An organization dedicated to helping all family members who experience infant and/or pregnancy loss at any time in their lives. We provide Immediate help, community awareness programs, and referrals to Rabbis and medical personel.
Yad Ephraim 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.
Yad v'Ezer 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.
Elder Law Korsinsky & Klein LLP
Community Support Chai Lifeline 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.
Kids of Courage
To advertise in this section, contact Shaindy Urman at firstname.lastname@example.org or 718-330-1100 ext. 373
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.
2926 Avenue L, Brooklyn, NY 11210 718-312-3222 Specializing in Elder Law, Estate Planning, Medicaid Law, Probate, Wills & Trusts, and Guardianships
Family Health A Time 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 and infertility.
Bonei Olam 1755 46th Street, Brooklyn, NY, 11204 719-252-1212 - www.boneiolam.org Helping couples that are experiencing infertility to realize their dreams of having a child of their own. Its mis-
Health and Living Service Marketplace sion is to provide funding for all aspects of fertility treatments, thus relieving couples of the financial, emotional, and physical stress resulting from infertility.
www.NannysforGrannys.com Companion care to keep your loved ones safe at home. Live-ins, hourly, overnight available.
Reliable Community Care, Inc.
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. Participants can use the system to learn their genetic compatibility with potential marital partners.
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.
Refuah Resources 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. Refuah’s mission is to alleviate some of the burden of dealing with serious illness by providing guidance and direction accompanying patients and their families through difficult medical crisises, and serving as a source of advice, support and assistance.
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. Its mission is to alleviate some of the burden of dealing with serious illness by providing guidance and direction.
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, equip ment, and social service.
Medical Supplies American Discount Medical 800-877-9100 - www.AmericanDiscountMed.com Never pay retail for medical equipment. We specialize in pediatric and adult home care equipment.
CPAP 800-356-5221 - cpap.com Great prices on the Sleep Apnea products you know. Text your e-mail address to 516-240-9162.
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. See our ad on page 3.
4918 Ft. Hamilton Parkway, Brooklyn, NY 11219 718-972-2500 Specializing in Alzheimer/Dementia Care. Registered Nurses, Certified Home Health Aides.
646-543-8811 Your home becomes accessible again. Everyday. Shabbos and Yomim Tovim included.
Nutrition / Weight Loss
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.
HamaspikCare 855-HAMASPIK Home health aide, personal care aide, nursing, PT/OT, speech therapy, social work, nutrition.
Nannys for Grannys 718-997-1800 - 212-288-1200 - 516-481-4182
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!
Medifast 619-972-2986 - www.thintogether.com Health Coach Shari Marks for Take Shape for Life® a Medifast® support program. Learn healthy habits and say goodbye to extra weight!
Mindy Rosenthal, C.D.N., R.D. 534 A Willow Avenue, Cedarhurst, NY 11516 516-336-9431 Nutrition Consultant. Weight Control Therapeutic Diets
To advertise in this section, contact Shaindy Urman at email@example.com or 718-330-1100 ext. 373
Health and Living Service Marketplace SHAKLEE
Ohel Bais Ezra
Proven Nutrition, Skin Care, Non-toxic Cleaners CINCH INCH LOSS PLAN powered by Leucine, designed to help break diet cycle. Performance Hydration drink - Fasting Solution. VIVIX anti-aging tonic, slows aging at cellular level Vivix ingredients also support heart, brain & joint health & cardiovascular function. 718-252-7323
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 community through programs of excellence. It seeks to identify community social challenges by pioneering new programs that elevate the lives of individuals and families.
Needed for busy home care agency in downtown Brooklyn. Please email resume to firstname.lastname@example.org
Shape Fitness 718-338-8700 - www.shapefitnessgym.com The fitness DVD you've been waiting for. Order now!
Nutritional Supplements Bluebonnet Nutrition
United Jewish Organizations “UJO”
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.
32 Penn Street, Brooklyn, NY 11211 718-643-9700 - www.unitedjewish.org A social service agency servicing Williamsburg, BedStuy and Ft. Greene residents with entitlement help, including food stamps, HEAP, Medicaid, Medicare, SSI, Child Health Plus, Board of Education therapy services, Holocaust Reparations and meals for seniors.
Kosher Vitamins 56
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.
800-645-1899 - koshervitamins.com Better health is only a click away. Largest selection brand name kosher vitamins at discounted prices.
Rehabilitation Centers Meadow Park 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.
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.
Sephardic Nursing & Rehabilitation
Administrative Assistant Immediate Hire
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.
HASC, a non-profit organization, is looking for an Administrative Assistant to the Executive Director. Responsibilities incl: coordinating fundraising campaigns, creating & maintaining database & spreadsheet files, acting as liaison & other general office duties. The ideal candidate must be able to multi-task, be able to set priorities, & have excellent computer skills including MS Office. A minimum of 3 yrs experience as an administrative assistant is preferable. Exper in fundraising, marketing or PR is A+. Interested candidates please send cover letter and resume to: email@example.com
Social Services COJO of Flatbush 1523 Avenue M, 3rd Floor, Brooklyn, New York 11230 718-377-2900 - http://www.cojoflatbush.org An umbrella agency for over 220 affiliated member organizations serving the Greater Flatbush community and its environs, its mission has been to identify and address the needs of the disadvantaged, alleviate the plight of the poor, and serve as the oasis of support and assistance for the community.
Nachas Health 1310 48th Street, Suite 402, Brooklyn, NY, 11219 718-436-7373 - www.nachashealth.org
DIRECT CARE COUNSELORS needed to work w/developmentally delayed individuals. F/T and P/T positions available. Good pay and great benefits! Call Eynav at 718-854-2747, ext. 143
volunteers for Homebound Seniors Have spare time during the week So do our homebound seniors. Friendly Visiting needs volunteers to visit 1 hour a wk. 718-449-5000 x2205
Human Resources Human Resource Generalist needed for fast paced Brooklyn based business. Experience in the following required but not limited to: • Benefits programs (Health Insurance, Cobra Admin, 401K, workers compensation, disability, etc.) • Payroll Admin & Processing • Employee Hand Book • New Hire & Employee file management & compliance • Employee review & job description • Manager Coaching • Maintain Departmental Flowchart • Produce ad hoc reports from Excel & Payroll Program • Review the resumes • Knowledge of basic principles of compensation Please forward resume in confidence to HRCenter12@gmail.com
AFTER SCHOOL HOURS Positions available for Comm-Hab trainers w/exp w/Special Needs children/adults. Immediate openings for male workers in Flatbush, female workers in Boro Pk/Bensonhurst. P/T, late afternoon/eve. Also Sat/ Sun. Email firstname.lastname@example.org
HUMAN RESOURCES/RECRUITER Needed for Healthcare Staffing Agency in Bklyn. Prior experience preferred. Drivers license required. Pls fax resume to 718-504-4995 or email to Brooklynjobs5@gmail. com
Clinical Supervisor Clinical Supervisor needed to work in Community Hab. Master’s in Social Work or Psychology a must. For more info contact Sarah 718- 854-2747 ext 242; email resume to email@example.com
Community & Res. Hab Com. Hab. P/T afterschool, Evening & Sunday Res. Hab. jobs for M/F avail. Working 1-on-1 with children and adults with developmental disabilities. Car a +. Please contact Penina 718-535-1987, firstname.lastname@example.org
Counselors and Senior Counselors Machon Lev Day Hab offering positions for Counselors and Senior Counselors. Looking for responsible counselors to work with developmentally delayed high functioning individuals. Drivers license is a plus. Great pay and wonderful benefits! Contact Sarah 718-854-2747, x 242
Dental Asst/Dental Receptionist Dental Asst/Dental Receptionist wanted in Boro Park/ possibly NYC. Must have flexible working hours & be a team player. Knowledge of Dental X-rays & Dental Assisting is a PLUS. Familiar w/dental insurances & billing using Eagelsoft software. Call 718-435-0045 or email resume: email@example.com
Health and Living Service Marketplace MEDICAID Service Coordinator
MEDICAID Service Coordinator for Bklyn area. Must have exper in MSC. Hebrew/Yiddish a must. Send resume to HR@skhov.org
Receptionist P/T Sundays & weekday afternoons/evenings-for Multi- Specialty, State-of-the-Art Medical Center. Candidate must be highly organized & possess excellent communication skills. Experience preferred. Please forward resume to: HR@EzraMedical.org or fax to 718686-2098
Responsible for providing front line supervision in the daily operation of fixed-route bus service, incl. maintenance of safe/efficient service F/T. CDL License required. Excellent salary + benefits. Call 718-535-1989 or Email: firstname.lastname@example.org
NURSE Ezra Medical Center seeks F/T experienced Nurse to assist physicians in triaging patients, reviewing patient histories & performing intake. Must have prior exper in phlebotomy, be computer literate & a team player. Please forward resume by fax to 718-686-2098 or by e-mail to: hr@ ezramedical.org
OT/PT/SLP/LCSW & LMHCâ€™s Needed! Full time & part time caseload available. Clinic or schools. Competitive rate & flexible scheduling. E-mail resume to: email@example.com with subject JP0614CMO
Psychologists, Social Workers and Other Positions Psychologists, Social Workers, Mental Health Counselors, Speech Therapists, Spec-Ed Tchrs, ABA Therapists, O/T, P/T for evaluations & therapy.F/T-P/T Fax res/lic:718263-2340, email firstname.lastname@example.org
Social Worker, Psychologist or Guidance Counselor Social Worker, Psychologist or Guidance Counselor P/T to do school counseling in Bklyn elem schools. Male or mature female. Fax CV to 718-787-4418
SECRETARY for Medical Office Midwood medical office seeks exper SECRETARY to manage front desk. Excel phone & interpersonal skills, flexibility & computer knowl req. Email res: email@example.com
Therapists Therapists F/T, P/T: OT, PT, SLP & CO. Health insurance options. Email: firstname.lastname@example.org. Contact Leah: 347-663-9027
A New Era in Surgery
r. Richard L. Friedman, an attending surgeon at the Beth Israel Medical Center and at St. Luke’s Roosevelt Hospital in New York City, was among the first surgeons to be trained in today’s minimally invasive surgical techniques, at the Cedars Sinai Medical Center of Los Angeles, in 1995. After completing that fellowship, Richard went back to Beth Israel, where he had done his residency training, to become the hospital’s head of laparoscopic surgery from 1996-2004. Richard represents the fourth generation of Shomer Shabbos doctors in the Friedman family. In the 1890’s Richard’s great grandfather became the first Shomer Shabbos student to graduate the Bellevue Medical College, and was popularly known as Dr. “Shabbos” Friedman. Richard is a graduate of the University of Health Sciences Chicago Medical School. During his residency training at Beth Israel, his father, Dr. Ira H. Friedman, was an attending surgeon. Richard is a board certified surgeon, and serves as an Assistant Clinical Professor of Surgery at the Albert Einstein College of Medicine. Friedman uses laparoscopic procedures in about two-thirds of the operations he performs, including bariatric procedures, gall bladder operations, appendectomies, and some hernias. In a gall bladder operation, for example, traditional open surgery requires a large incision in the abdomen, which typically requires an extended post-operative hospital stay. By contrast, a laparoscopic gall bladder operation requires just 4 small cuts, the main one being near the belly button, and often allowing the patient to return home on the same day as the operation. Today, many open operations also use minimally invasive techniques which allow some patients to go home the same day. A common misconception is that a laparoscopic operation is “laser surgery.” Lasers are not involved. Surgeons employ very small imaging devices and miniaturized surgical tools that are inserted and manipulated through the small external cuts. The small cuts heal quickly, but internally, the procedure is just as extensive as in traditional open surgery. Laparoscopic surgery allows the organs of the gastrointestinal tract to
resume their normal functions more quickly than in open surgery. The small cuts also reduce the threat of infection and other post-operative complications. A patient who goes in for laparoscopic surgery on Tuesday, will most often be able to go home the same day, and go back to work the following Monday. However, there is still an extended recuperation period. Patients should not lift heavy objects or exercise for 4 weeks following the surgery, but they should get out of bed and start walking around as soon as possible. Patients also need to know what to expect concerning post-operative pain. In laparoscopic operations, carbon dioxide is pumped into the abdomen, which can become trapped, leading to shoulder or back pain until the gas is absorbed by the body’s tissues. More than a day or two after the surgery, patients are usually pain-free when sitting, standing or walking, and experience intense pain only during the brief moments when
patients, is open to relatively few physicians. That is because most people are unable or unwilling to pay extra for the higher level of care these practices provide. Dr. Friedman worries that as pressures increase from insurance companies and government health programs to cut health care costs, they will stop approving payment for the treatment of certain necessary but non-emergency conditions, such as hernias, which if left untreated are likely to evolve into medical emergencies. According to Dr. Friedman, insurance companies are well aware that, on average, patients change their insurance providers every two years. They therefore have an incentive to defer such non-emergency procedures in the belief that, if and when they become critical, they are likely to be another insurance company’s responsibility. As a result, many doctors are closing their practices to new patients on Medicare or Medicaid, or private insurance plans which no longer pay enough to cover the actual cost of providing care. However, Dr. Friedman remains personally committed to his family’s tradition of providing the finest medical care to all members of the Jewish community who need it. In keeping with that tradition, Dr. Friedman inaugurated and still supervises the Heritage Program at Beth Israel which is dedicated to meeting the specific religious needs and cultural sensibilities of Jewish patients, and making them feel more comfortable and welcome in what can often be a difficult hospital environment. While other hospitals have made efforts to attract religious patients, Beth Israel is the only hospital in the New York area with a staff doctor in charge of the effort. As soon as religious patients enter Beth Israel, they are greeted by one of the Heritage program’s 2 patient navigators who are experienced Hatzolah members from the Lower East Side and Williamsburg, and who take responsibility for meeting the personal religious needs of each patient. The navigators serve as guides to the many amenities and dedicated facilities that the hospital provides for kosher and Shomer Shabbos patients and their visiting family members, and inform them about additional resources available in the neighborhood. Dr. Friedman regularly consults with the hospital’s medical staff and administration to deal with new needs and situations as they may arise. His latest initiative was to encourage Beth Israel to hire frum nurses to staff each department in the hospital. They are naturally more sensitive in dealing with issues such as kashrus, Shabbos observance and tzniut and their presence will make religious patients more comfortable.
"Richard’s great grandfather was the first Shomer Shabbos graduate of Bellevue Medical College, and was known as Dr. “Shabbos” Friedman."
they are getting up from a sitting or lying position. Dr. Friedman encourages his patients to discontinue post-operative use of prescription pain killers as quickly as possible, and to manage their pain with over-the-counter drugs like Tylenol, which have fewer negative side-effects. Some surgeons have introduced a single incision laparoscopic procedure, whose primary benefit is cosmetic, but Dr. Friedman does not use it, because this type of operation is inherently more complex and the recovery process is more uncomfortable for the patient. Dr. Friedman also says that he shares the frustration that many doctors feel with the changes which have being imposed upon the practice of medicine today. Today, most doctors must work harder for less compensation, due to the burdensome new administrative requirements being imposed by insurance companies and government programs. In the past, doctors would be accorded the respect they deserve because of their medical expertise, but today, due to the deluge of medical misinformation from the Internet, many patients no longer trust their doctors’ opinion as the final authority on their care. The situation, in Dr. Friedman’s view, continues to worsen. Surgeons like him are under pressure to work more for less remuneration, while their cumulative liability risk from something going wrong during any operation increases with the number of procedures they perform. This is why so many doctors are considering giving up their private practices, or retiring early from the medical profession. Another option, transforming their offices into boutique or concierge medical practices that charge retainer fees to a reduced number of
Dr. Richard L. Friedman M.D., F.A.C.S., is a member of Park Avenue Surgical Associates, with offices at 1175 Park Avenue, Suite 1C, in Manhattan. His office phone number is (212) 369-2222.
Join Us for Our November Issue A Publication of
Genetics Based Treatment Page 9
Providing Our Kids with Healthier Snacks Page 10
War W ar Against Aga gaiin nst
Momâ€™s Dilemma emma Work or Stay at Home e
Page P Pa Pag ag ge 22 22
MIND, BODY SO& UL A Mental Health
FFebruary Feb Fe eb brrrua uarryy 2012 ua 201 012 SEEE INSIDE
A Publication of
Being Prepared for the New School Year Page 14
Making the Multi-Generational Household Work Page 20
Recipes for Yom Tov Page 45
See Page 36
Mind, Body & Soul Inside
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