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ed Spe ic ci al al Is su e

Summer 2013 | Av/Elul 5773 | Volume 10, Issue 3 | FREE

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Modiin Area’s English Speaking Magazine


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Pictured on the cover: Eliana Newmark and Kayla Fishman (with the purple cast) from Modiin - broken arms have not kept these girls from smiling. Find out what to do when your child needs urgent care. This issue is your source of information on navigating the medical system and finding the best medical professionals.

DEAR READERS Information is Power. If you don’t ask, you won’t get answers, but what if you don’t know what to ask? At ModiInfo, we have been asked to compile a practical guide to help navigate the medical system as well as provide access to some of the country’s top specialists. The articles in this issue are intended to address some of the most common concerns when dealing with medical issues in Israel. It is advised to turn directly to your doctor when dealing with specific medical situations. Here is some additional information based on actual questions: When to use kupa vs. private insurance? Many people have Maccabi Zahav/Magen/Sheli, Meuchedet Zahav/Adif , but on top of that they also have additional private insurance such as Harel or Dikla for health and dental needs.You should always check with your private insurance about coverage they offer even if your kupa is covering some of the medical costs. For example, you can submit a receipt from a private doctor visit to your kupa, ask for the original receipt back and then resubmit it to your private insurance to receive additional reimbursement. This is completely permissible. Kupot may cover some private surgeries but you must pay out-of-pocket and then get reimbursed. Harel Insurance, for example, has an agreement with Herzliya Medical Center. They will issue a hitchavut and you don’t have to lay out any money. When to speak to your primary doctor? Always! Mother A gives birth and the hospital sees two possible signs of Down’s Syndrome. The hospital does a blood test but the results may take up to a month.The panicked mother, upon release from the hospital, takes her baby to her pediatrician and relays what happened. The doctor responds, “Why didn’t you call me from the hospital? I could have explained that given the signs, there was no cause for alarm.” It never dawned on the mother to call her pediatrician directly from the hospital, something patients are actually encouraged to do when a medical crisis arises. Find yourself a primary care doctor that you feel comfortable asking questions and find out the best way to reach them. PS, the test in this case came back negative. To sedate or not to sedate a child for an MRI? Nine years old is the official age for not needing sedation. Mother B was told she needed to take her child for an MRI and that it was up to her whether or not she wanted to sedate the child. She decided not to sedate at first with the assumption that if the child was having a difficult time, she could be sedated. Mother B found out the hard way that it doesn’t work like that. Sedation vs. non-sedation are two different hafnayot (referrals) and hitzchavuot and there is a longer wait time for non-sedation because there

are specific times of the day allotted to non-sedation. When the mother took her child for the MRI (after waiting a month for an appointment) without sedation, realized her child would need to be sedated, she then had to wait an additional five months for the sedation appointment. Lesson learned: don’t assume your doctor is giving you all the information. Ask how referrals work and what exactly you will need to cover all possible scenarios. MRI/CT – which hospital is best? It’s your job, not your doctor’s to make the appointment so start calling around. Hadassah may have an appointment in five months (FYI Hadassah Ein Kerem has both CT and MRI, Hadassah Har Hazofim only has a CT), but Assuta may have one in a month. Put yourself on a waiting list, keep calling back if you need the appointment sooner as people do end up cancelling and there’s often a last minute opening. Ask what you can bring with you to help stay calm such as music. It is worth getting an online password for my kupa website? Yes, you can accomplish a lot just by sitting at your computer. You can make some doctors’ appointments, order regular prescriptions (even anti-biotics if a strep culture comes back positive) and email your doctor questions or requests. Do I need a hafnaya to rent equipment from Yad Sarah? You do not need a hafnaya from your physician if you need to rent crutches, wheelchairs, etc. You do need a hafnaya if you need to rent medical equipment such as an oxygen tank, TENS machine, etc. My doctor’s is not working on a day that my child needs to be seen (i.e. vacation or dr.’s day off, can I see another doctor? Yes, the system is built that you can see another doctor in your kupa if your doctor does NOT have office hours at the specific time that you need an appointment. Do not delay in having your child looked at. Another option is to go to Terem. Medical care and emergencies are a fact of life. It is best to be prepared in advance so you are best able to handle them when they arise. Talk to your doctors who can offer professional advice and to your friends who have gone through similar experiences. Remember: there are no stupid questions! We hope you find this issue practical and informative. Send your questions and comments to info@modiinfo.com.

Daniella Hellerstein & Caryn Meltz Co-publishers and editors 0526-404-414 | 0523-868-768 Ofira Krakauer | Design & Layout 052-3449446 Website created by Litesites www.litesites.co.il Social Media, Shari Wright Pilo Hands-On Digital Marketing Consultant, www.shar-i.com

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Best wishes for a healthy and safe summer, Caryn & Daniella

ModiInfo is an independently owned, advertiser supported publication distributed monthly to Modiin and the surrounding neighborhoods. ModiInfo welcomes all articles and ads but reserves the right to edit or reject submissions. The views expressed by writers and contributors are not necessarily those of ModiInfo. ModiInfo is not responsible for facts or claims made by ads or authors, nor for any typographical errors. Work produced by ModiInfo is the property of ModiInfo and may not be reproduced without consent.

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TABLE OF CONTENTS 6 9 12 15 16 20 24 28 32 36 38 40 44 46 50 52 54 56 58 60

My Child is Sick! Should I Go to the ER? I’m Having Chest Pain!! What Should I Do? Technology with Heart for Disabling Pain Urgent Care at Terem Saving Lives One Ambulance at a Time Navigating the Healthcare System Being a Patient: A Guide for the Perplexed Your Prescription for a Better Visit Save a Life Asthma Emergency Care in Modiin 101 When Your Child Goes to the Hospital From Moshe to Mendel Glossary Hospital Info In and Around the City The Dog’on Days of Summer Is it Time to Take a Leap or Stay on the Fence Kids page Recipe 5


My Child is Sick! Should I Go to the ER? By: Dr. Freddy Schwartz As a pediatric emergency medicine physician, I routinely care for children who are critically ill or injured. Oftentimes, however, children are brought to emergency departments (ER) for relatively minor complaints that could have been managed by the general pediatrician or even handled at home. I can certainly sympathize with any parent’s anxiety when their little bundle of joy is unwell. And while I understand their strong desire to have Junior cared for immediately, the truth is that urgent treatment is rarely necessary. In fact, needless ER visits can be time-consuming, stressful and costly. Moreover, inappropriate utilization of ambulances and other ER resources (e.g. doctors) can impede the care for those patients who truly require emergency management. In this article, I would like to give broad suggestions for some pediatric emergency conditions and also recommend which types of complaints can safely wait to be seen. The first topic is fever, which is the most common reason parents bring children to the ER. What many parents don’t realize

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is that outside of the newborn period, fever in and of itself is not an emergency, or even dangerous. It is simply the body’s natural response to an infection. Another common misconception is that higher temperatures are more concerning than lower ones. I have treated patients with life-threatening illnesses such as meningitis who only had low-grade fevers. Conversely, I often see children with minor infections who are quite well despite their high fever. The point is that how your child appears is much more important than the

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number on the thermometer. I am more concerned about a child with a temperature of 38C (100.4F) who is lethargic, than one who has 40C (104F) and is playful. When should one seek immediate care for their febrile child? If the child is under 3 months of age; if-despite Acamol- she is inconsolable; is she is excessively sleepy or lethargic; or if the fever is accompanied by either a stiff neck or a “petechial” rash (see below). Most rashes are not emergencies. One major exception is called petechiae (pronounced puh-TEE-key-eye). These are pinpoint dark red/purple spots that are flat to the touch and do not turn white when you press on them. This kind of rash can signify a serious illness and requires rapid medical care. Another common complaint often seen in the pediatric ER is head trauma. What often is most concerning to parents is the size of the bump they feel. But remember, this represents just external soft tissue swelling, when the only real area of concern should be the brain inside. There is no correlation between the goose egg one sees and the degree of underlying brain injury. Unfortunately, one can even have an intracranial bleed with no external signs of trauma. And, once again, how the child is acting is what counts. If the head injury is associated with loss of consciousness, vomitContinues on page 8

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ing, lethargy, or any change in appearance, then the child should receive immediate medical attention. Vomiting and diarrhea are unpleasant but common symptoms in children. Mostly, the treatment is rest, fluids, and TLC. When the child becomes dehydrated, however, further treatment is warranted. Features of dehydration include dry mouth, no tears, no urine or wet diapers for eight hours, and lethargy. Every ER doctor recognizes certain patients as “frequent flyers”- people who use (abuse) the system way too frequently. If you know the ER doctor at your hospital well, you could have a problem! See the accompanying list for some legitimate reasons to seek immediate care, and some reasons not to. When deciding whether to bring your child to the ER, one general principle to use is: if he looks sick, take him in; if he looks well, it can probably wait. Of course, if you’re not sure and are genuinely concerned that there’s a true medical emergency, go to the ER. That’s why we’re there. Dr. Freddy Schwartz specializes in Pediatric Emergency Medicine. He works in New Jersey and Israel. He lives in Modiin with his wife and six children, and often discourages them from seeking ER care.

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EMERGENCIE

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EMERGENCIES: ● Difficulty breathing ● Change in mental st atus ● Fever, with headache or stiff neck or change in behavior ● Fever under 3 mon ths of age ● Scrotal pain ● Dehydration ● Uncontrolled bleedi ng NOT EMERGENC IES: ● Earache ● Sore throat ● Rash - not petechia e ● Cough and cold ● Pink eye ● Controlled bleeding

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I’m Having Chest Pain!! What Should I Do? By: Rabbi Dr. Judah Goldberg Chest pain is a very common symptom. Knowing some basic information can help you respond best and might even save your life. Definitions: • A “heart attack” (“‫ )”התקף לב‬is when the heart muscle is not getting enough oxygen, usually because of a blockage in one of the arteries that delivers blood to the heart muscle. Heart muscle (technically the “myocardium”) that is still alive but not getting enough oxygen is said to be “ischemic.” If a part of the heart muscle has actually died from lack of oxygen, then it has “infarcted.” • “Cardiac arrest” (“‫ )”דום לב‬is when the heart is no longer pumping blood. There can be many different causes for a cardiac arrest, but the most common cause for a sudden cardiac arrest is an “arrhythmia” (change in electrical activity) that can happen when the heart muscle is ischemic. When a person has suffered a cardiac

arrest, CPR can try to circulate the blood until the heart is reactivated. However, if the heart does not start pumping quickly, the patient will not survive. • “Heart failure” is something entirely different – when the heart is not pumping the blood as effectively as it should. This can be because the heart muscle has been weakened by ischemia or previous infarcts, but there are a lot of other causes as well, such as leaky heart valves. Remember these 5 quick pointers regarding chest pain: 1. Don’t ignore chest pain! Signs and symptoms of a heart attack can be subtle – ranging from crushing, severe chest pain to just heartburn or shortness of breath. The only way to know whether you’re having a heart attack or just ate too much chulent is to get evaluated by an EKG and other tests. Heart attacks are rare in young people, but still possible, and there is no absolute minimal Continues on page 10

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Continued from page 9

age. At the very least, anyone who is over 40 and is having new, unexplained chest pain needs to be evaluated. 2. Know your risk factors and change them if you can. If your parent had a heart attack at a young age (men <45 and women <55), then you are at increased risk and need to take your symptoms seriously. And if you have diabetes, high blood pressure, or high cholesterol, managing these entities with your family doctor can help lower your risk, as can quitting smoking. 3. If you are having concerning chest pain, do not go by car to Terem or the emergency room. Pick up the phone and dial “101” – even on Shabbat. While nobody wants to have an ambulance with flashing lights pull up to the house, the paramedics can make a diagnosis of a heart attack, thereby expediting your care and maybe saving a bit more of your heart muscle. Moreover, someone who is having a heart attack is at risk of sudden cardiac arrest (as above), which can be devastating if the paramedics are

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not on scene to reverse it. 4. Time is muscle. During a serious heart attack, every extra minute puts additional heart muscle at risk. If you feel like you might be having a heart attack, don’t “wait and see” if you get better on your own. Rapid intervention could make the difference between an aborted disaster and long-term heart dysfunction. 5. Not all chest pain is from the heart. There are other serious conditions that can present with chest pain, including a blood clot in the lungs (“pulmonary embolism”), a collapsed lung (“pneumothorax”), and a tear in the aorta (“aortic dissection”), the big artery that carries all the blood away from your heart. If your doctor seems to be thinking only about your heart, ask how you can be sure that you are not having one of these other problems either. Judah Goldberg, MD, MBE teaches at the Beit Midrash for Women - Migdal Oz and practices emergency medicine part-time in Pembroke Pines, FL. He lives with his wife and five children in Alon Shevut.

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Technology with Heart for Disabling Pain By: Dr. Haim-Moshe Adahan “The surgery was a success and the patient is dead”... This satirical saying sometimes reflects the sensation of patients and their surgical + rehabilitation teams when, despite completing a difficult trajectory, a patient is left with unbearable pain. The patient mustered up super-human will power to rehabilitate himself. The surgical + rehabilitation team offered the most expert accompaniment, and yet, the unrelieved severe pains that refuse to subside make what remains of their lives difficult to face. The role of Sheba’s new Pain Rehabilitation unit is to bring quality to such lives again and make such lives worth living. “When all you have is a hammer, everything looks like a nail” is a saying that points to the weakness of many a clinician›s approach to managing pain. Too many a pain patient is overtreated with pills or surgery because these are the only tools his MD has in his toolbox. In May 2013, The Journal of the American Medical

Association, contained an article clearly stating that epidural injections, the most common injection dispensed by pain clinics, should not be done to treat chronic back pain as benefits outweigh the risks. The Center for Disease Control has sounded the alarm on the fact that there is a death every 15 minutes caused by the complications of commonly prescribed pain medicine. In view of this, a pain rehabilitation specialist must assure his toolbox contains as many tools as possible to help patients manage their pain and its psychological and social sequelae as well. According to a recent world health organization, about a fifth of Israelis suffer daily disabling chronic pain. Most are successfully managed by medical + paramedical staff with various degrees of success. However, for the most problematic of pain cases, an expert team of pain rehabilitation specialists has the difficult task of travelling

deep into the pit of human misery, extending a strong hand and a warm smile to the suffering to which they strive to help. My Zionist mission is to bring such relief and hope to those Israelis suffering from severe disabling pain not responding to conventional treatment approaches. When I saw that the field of coordinated interdisciplinary pain rehabilitation had not been developed in Israel, I sold my private Academic Pain Unit in Montreal and took an NBN flight to Nof Ayalon, thus earning the honorable nickname of the “Crazy Canadian” from my Sheba Hospital colleagues. Since that fateful July 2005 NBN flight, my family has grown from six to nine souls and my Zionist dream, which started as "Isra-bluff" has now grown to include 500 sq. meters of concrete to house the new pain rehabilitation unit in Israel's largest hospital as well as its new private counterpart in the Azrieli mall of Modiin. My wife has replaced her urban dental practice with a dental chair in our home which she calls, “her little corner in Gan Eden”. I find myself treating patients that include severely wounded Israeli soldiers and civilians having suffered severe physical and psychological trauma – painful diseases of the nervous system such as Parkinson's disease, MS, stroke or brain, or spinal cord injury. Patients are also treated for severely painful orthopedic conditions and sports injuries. Professor Melzack, my mentor, was the previous director at McGill University and author of the first textbook of pain medicine, started as a psychologist counseling patients in pain. I learned from him to always appreciate a holistic approach to pain medicine that is best dispensed not just with cutting edge technologies, but also with warmth, caring and a concerted effort to understand every patient's personal story of suffering. I am also involved in research and development of new technological tools to treat pain. Since making aliyah to “the start-up nation”, I have already helped one new Israeli pain treatment device achieve FDA approval and am now working on my second invention with a team of Israeli laser specialists. These devices have brought pain relief to some of the most terrible and treatment resistant pains and have attracted attention from international media and been presented at prestigious international pain meetings. In the Advanced Pain Treatment Center of Modiin, Dr.Adahan has joined forces with Omedic, an Israeli group specializing in using laser technologies to treat difficult pain problems.Together, they hope to bring relief to Israelis in pain and continue to seek innovative effective solutions to difficult pain problems. For more information – see www.paindoctor.co.il.

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Urgent Care at Terem By: Daniel Lipczer What is Terem? Terem is a network of urgent care clinics located all over Israel, including one in Modiin. Other Terem clinics operate at three locations in Jerusalem, as well as Beit Shemesh, Bnei Brak, Ma’ale Adumim and Carmiel. We also run a clinic for refugees in South Tel Aviv, and are soon opening new branches in Ashdod and Kiryat Gat. When should I go to Terem, and when should I go to the ER? Terem staff is trained to deal with a full range of urgent care as well as minor medical emergencies, such as fever, lacerations, suspected fractures, abdominal pain, headaches, rashes, and much more. While all our clinics are equipped to deal with the most serious clinical emergencies, such as heart attacks and resuscitations, patients who believe they have suffered a serious clinical emergency should present to the ER as quickly as possible. What happens if I need treatment outside of regular working hours? The Modiin branch of Terem is open 24 hours a day, including Yom Ha’atzmaut and Yom Kippur. Why wouldn’t I go to my kupa doctor if my child has fever or I have abdominal pain? You can. Any member of a kupat holim can choose to go to their kupa doctor and in most case be treated for free. However, many patients choose to come to a Terem clinic for a number of reasons. First, Terem is open 24 hours a day, you can be treated immediately without the need to make an appointment, or wait till the next day. Second, in Terem, if the doctor decides that you need to undergo various lab tests, or an x-ray, you can have this done all at the same time without leaving the clinic, and the results will also be ready before you complete your visit. If you can just walk in without making an appointment, are there long waiting times at Terem? We know that short waiting times are important to our patients and therefore we do our utmost to ensure that treatment times are as swift as possible. We make every effort to staff the clinics appropriate the number of patients presenting. Unlike many places, all our test results come back within a matter of minutes. Every patient is checked by a nurse within their first few minutes after registering. As much as possible, and according to clinical protocols, if the nurse believes that a certain test or x-ray will be Continues on page 23

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Saving Lives One Ambulance at a Time An Interview with Donna Fried Calcettera By: Daniella Hellerstein I had heard of Donna Fried Calcaterra for many years before we actually met. She and my mother are in the same painting class in New Jersey and in addition to their mutual love of painting, they share a love of Israel. In a mostly non-Jewish class, the State of Israel became a topic of discussion for Donna and my mother. Donna, an ardent Zionist, is a huge supporter of Magen David Adom and it doesn’t take much to prompt her to donate an ambulance. Through her 613 Foundation, she has donated a total of nine ambulances, the most recent one to Modiin and two blood mobiles. When Donna's emotions are stirred she donates to MDA. Compassion, a moving story and even anger prompt her to open her wallet. After last year’s flare up in Gaza, Donna donated an ambulance saying, “When I get angry, I fight Continues on page 18

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From left to right, Donna Calcettera, Daniella Hellerstein, Shoshana Freidin, Basheva Goldberg at the Modiin ambulance dedication

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Continued from page 16

back by donating another ambulance.” Donna is passionate about MDA’s lifesaving work and cannot say enough about the MDA volunteers who make it possible. I finally had the privilege of meeting Donna when she invited me and my mother to the official ambulance dedication at the Bloomberg Center in Jerusalem this past May. The ceremony was moving and great honor was given to Donna in recognition of her support. With sincere humility, she in turn lavished praise on the MDA volunteers who she said are far more deserving of honor and recognition. Donna is also a supporter of the IDF and started a program that offers college scholarships to soldiers who have completed their army service. Yet, Donna will not allow herself to be thanked. She insists that she has done nothing compared to the volunteers and the soldiers who put their lives on the line in defense of Israel. Her contribution, she says, is only a small part of tikun olam. Where does your love of Israel come from? After I graduated college in 1970 I took a trip to Europe to see the great works of art. I had been in Italy for a number of weeks when my father called and said that I should visit Israel and he would fund the trip. I took him up on his offer and headed to Tel Aviv. When I got off the plane I was looking for a taxi (after all I had my father’s money so I could afford a taxi). I asked a young

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man where to find a taxi and he asked me if I was Jewish, because he said, taxis are for non-Jews. He helped me find the right bus to the home of some cousins whose address I had written on a piece of paper. He carried my bags and luggage and escorted me in to make sure that this family was actually related to me and expecting me. When I wanted to compensate him he said didn’t want anything – he simply said, “welcome home”. I spent a week in Israel and left an ardent Zionist. I remember seeing an ambulance on that trip with a dedication written on the side and thinking what a special thing that was. What is the 613 Foundation? I am an artist at heart. I studied art with some of the greats. My plan was to teach and be a great painter. After college I landed a job teaching painting for one year but after that the school went bankrupt and I was jobless. I went back to NY where a friend’s father offered me a job trading commodities. I thought I would do that temporarily and then go back to painting. I ended up meeting my husband, Sal, who was a broker. Every broker has a badge number and his was 613. When we first met he said to me, “You’re Jewish – what’s the significance of the number 613?” I had no idea so he told me that it means taryag – the number of mitzvoth in the Torah. Although he was not Jewish he knew this because all the Jewish brokers wanted to swap numbers with him and even offered to buy the number from him. He wouldn’t do it because Sal 613 had become the way he identified himself and the number

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had great importance to him. It’s even written on his tombstone. When he died, I created the 613 Foundation in his memory. How did you get involved in American Friends for Magen David Adom? I had seats on the Nymex commodities exchange which went public allowing me to sell my shares and realize a tremendous profit. A friend who also owned the seats on the exchange called me to share the news of our good fortune. He told me his lifelong dream was to own a Rolls Royce and now he would be able to buy one. He suggested I do the same. I had no interest in owning a Rolls Royce, I was happy with my leased car that I didn’t have to worry too much about. He suggested I indulge in jewelry or a shopping spree. But I buy my clothes at Costco and had no desire for jewelry. I remembered back to my trip to Israel in 1970 and how I thought how great it would be to donate an ambulance. The first ambulance I donated was in memory of my parents and uncle and it is in the Negev. That was in 2006 and since then I have donated eight more ambulances and two blood mobiles. What are some of your other ambulance dedications? I dedicated an ambulance in memory of the cousin, Moshe Freidin, I stayed with on that first visit to Israel. I do not request a specific area to donate the ambulance. I prefer Continues on page 49

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Navigating the Healthcare System

or help line referral and are not admitted may be liable to pay for the ER visit.

By: Dr.Tanya Cardash

Additional healthcare cover

In Israel the healthcare system is relatively easy to navigate and provides comprehensive cover. Healthcare is provided by one of four health funds- Maccabi, Clalit, Leumit and Meuhedet. Every Israeli citizen has the right to choose which health fund he belongs to and has the right to switch health funds up to twice a year. A monthly contribution to healthcare is taken from your National Insurance contributions. Health coverage in Israel is non-exclusive of pre-existing medical conditions.  

Services provided by your health fund: Membership to the health fund covers doctor’s appointments (primary and secondary care), blood tests, imaging (US, X-ray, CT, MRI), hospital admissions, paramedical treatments (physiotherapy, speech therapy, occupational therapy, etc.) and substantial subsidization of medication costs. Your primary care doctor as your Case Coordinator: Many specialties do not require a referral from your primary care doctor (family doctor or pediatrician) but I highly recom-

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mend consulting with them before turning to other specialists as they can help direct you to the appropriate healthcare provider for your particular medical condition.

Emergency Care Primary care doctors can refer a patient directly to the emergency room. If medical care is needed at a time when the clinic is closed members of all health funds are recommended to call the Help Lines which are staffed by medical professionals who will advise patients how to receive appropriate care. Maccabi runs a 24-hour help line staffed by nurses and doctors who will give immediate advice on the management of any medical emergency. The number is 1-700-50-53-53 or *3555. The help line may recommend and arrange: • Appropriate management of the situation at home • Schedule an urgent appointment with a local doctor • Refer to an emergency clinic such as Terem in Modiin which is open 24/7 • Refer to the ER with or without ambulance transportation • A home doctor’s visit Patients who refer themselves to an ER without a doctor’s referral

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Maccabi has highly attractive supplementary coverage packages. The packages are open to all to join without exclusion for preexisting conditions and the monthly premium is based purely on age. Maccabi Zahav- Services covered include the options of operations being performed in one of Maccabi’s associated private hospitals, the option to choose from a list of approved surgeons (with Maccabi contributing 85% of the cost), consultations with specialists of your choice (from a list of Maccabi recognized specialists or departmental heads), subsidized treatment at the Maccabi Tivi - complementary medical  clinics (including homeopathy, reflexology, chiropractor, acupuncture, etc.), subsidized dental treatment  and optical discounts.  Maccabi Sheli – The newest supplementary package which offers benefits including dental treatments (fillings, root canals, extractions) at a 20 NIS copayment and 50% discounts on restorative periodontal and orthodontic dental treatments; 1000 NIS for purchasing optical glasses or contact lenses, free glasses (up Continues on page 30

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Terem Continued from page 15

required, they can order this test right from the start, in order to save the patient waiting a second time later. Furthermore, we set ourselves our own internal waiting times to ensure that patients are seen and treated as quickly as possible. Do I have to pay to be treated at Terem? Terem is a private medical facility, but with arrangements with all the kupot. In most cases there is a co-payment, with the price changing depending on the different kupa (Maccabi 76 NIS, Meuhedet 39 NIS, Leumit 45 NIS, Clalit 79 NIS). With the exception of Meuhedet, if you come with a referral from your kupa doctor, there is no charge. There is also no charge for Meuhedet and Clalit patients on weekends (times vary slightly between kupa). My mother is visiting from abroad and doesnâ&#x20AC;&#x2122;t feel well. Can she be treated at Terem? Yes. We treat any patient not covered by a kupa. The cost for treatment is 420 NIS, with additional charges if further tests are required. I just want to have an x-ray. Can I have this done in Terem?

Yes. We operate a special x-ray service between 7am-7pm. No need to book an appointment in advance. Just show up with a referral from your kupa and hitchayvut. We operate a similar system with ultrasounds, but since times are more limited these appointments must be booked in advance. Please contact the Terem switchboard on 1-599-520-520. Iâ&#x20AC;&#x2122;ve heard that there is a new tourist clinic opening at Terem. What is that all about? Tourism from Israel to less developed countries, i.e. Africa, South America, India, etc, has increased in recent years. In most cases such travel involves undergoing a range of vaccinations appropriate to the particular country being visited. Terem has a new service which operates each Thursday between 6pm-10pm, and Friday morning between 8am-12pm, and involves a personal consultation with an expert doctor in the field of public health medicine as well as the ability to purchase and receive appropriate vaccinations. No appointment is necessary. For any more information about Terem, please visit their website at terem.com. Daniel Lipczer worked as a hospital general manager for seven years in the UK. Since making aliyah in 2005 he has worked for Terem, and is now Director of Personnel. He lives in Modiin with his wife and four children.

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Being a Patient: A Guide for the Perplexed By: Dr. Deena Zimmerman It isn’t easy being sick, particularly when one is dealing with a different health system than the one you grew up with. While most physicians have good intentions to provide quality care, they are working under challenging conditions. For starters, it is important to realize that health care in Israel is firmly divided at present into hospital based and community based care. Each system has its own physicians and the communication between the two is via the patient. Here are some things that patients and families can do to help out and help make the situation smoother. 1. Be organized - The average amount of time allotted to each patient visit in the community is 7-10 minutes (depending on specialty). You want to have this time used for addressing your concerns, not looking for pieces of papers. If you came to get a form completed, make sure you have filled out your portion in advance. If you are dealing with a chronic condition, take the time to organize a folder that has your records in a way that you can easily find them.

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Do not assume that your physician has copies of everything. While there is much work going on to improve the two-way transfer of information from hospital to community and primary care physician to specialist and back, there is still much work to be done. Even if the physician may have a copy within the electronic medical record, often takes more time to find it than it takes to find the paper. 2. Be responsible for yourself – There is little time provided for physicians to call back patients or to speak between themselves. Therefore, the responsibility for follow up of tests you were sent for is yours – if you were sent for blood tests or x-rays – make sure to check the results. Checking results is generally quite easy to do once sign up for this service with your kupah and get the needed passwords. Do not assume that someone will call you if there is a problem. If you don’t understand the results, get back to the MD to ask. 3. Come with a written list of questions: It is very frustrating to

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leave a physician’s office and realize that you forgot to ask something. This is especially true as it is very difficult to speak on the phone with most physicians. Having a written list of issues can help prevent this frustration. 4. Leave time for paperwork: For many services, one needs to get

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pre-approval of the kupah to pay for the service. The form that is needed for this is a tofes 17 or hitchayvut. For some procedures, getting this form needs the approval of a “higher authority”, so save anxiety by getting the approval well in advance of the scheduled procedure. If you are dealing with a prolonged illness, here are some additional tips: 5. Ask what to expect: This includes what symptoms are you expected to feel, how much time might you need to miss work and who is going to be responsible for your care at each stage of the process. Don’t assume that this information will be shared if you don’t ask. 6. Don’t hesitate to use patient support groups: They have a wealth of information that physician’s often don’t know about how to get through the experience. 7. Don’t hesitate to use the social worker of the kupah: There are often health benefits available for illness and disability that you won’t know about if you don’t ask. This is not charity – this is your tax dollars at work. Dr. Deena Zimmerman is a pediatrician who works for Maccabi, Meuchedet and Leumit in her clinic in Nof Ayalon. She can be reached at 08-979-0420 dz@terem.com.

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Your Prescription for a Better Visit More tips from our local physicians

• Before going to the doctor, take a minute to make a list of what it is you want to ask/know. Parents are often distracted during the office visit with taking care of the child - who does not always want to be there - and it’s hard to focus on what it is you want to know. Write it down when you have a minute alone, beforehand. • Be sure you understand the instructions the doctor gives you and repeat it back to him/her to be sure you got it right. Write it down as well; patients often forget half of what the doctor tells them, once they leave the room. • Be assured that whatever you want to ask, has been asked before. In fact, doctors probably asked that same question to their teachers when in medical school. So, ask anything you want and don’t be embarrassed to ask something. There are no “stupid questions”. • Bring with you to the appointment anything relevant, including paperwork from a specialist, the ER or hospital, Terem or another doctor’s visit (outside the kupa). Also, bring any medication the child is taking. If my patient has asthma, doctors often

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want to see how the medication is being used; and so, please bring it with you. • Doctors generally prefer having enough time to see all of their patients. If you would like more than one child seen, please make more than one appointment. Scheduling a 10-minute appointment for two kids means each now only has five minutes - and that includes bringing the kids into the room, taking out the cards, etc. That doesn’t leave much time for a proper exam and interview. • When patients have a non-emergency request, such as a prescription, referral or any other non-urgent request, use the website with your online password, and you can submit your request. The doctor will usually get back to you within 24 hours. This lends to less disruptions for doctors while they’re seeing patients which also translates into your visit having less disruptions too.

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• If you make an appointment and then don’t need it, don’t forget to cancel – otherwise you’re taking up a spot that someone sick needs. • Any person with significant medical history should keep a small paper in his/her wallet with basic medical history, names of doctors, and list of medications. Keep it right next to your insurance card.  Patients often do not plan on coming to the emergency room, when this information is most relevant – so you should have it on you at all times. • Ask if there is any take home message you can know for next time  - “when do I need to take a feverish two-year-old to the doctor?”, or “what can I put on a rash like this before coming to see the doctor?” Whereas doctors can’t teach you everything you know in a 10-minute appointment, in many cases there is something you can learn to help you feel more in control of your children’s illnesses. • Ask what can be done to prevent this in the future. However, don’t be surprised if most of the time there is nothing to do, except of course, be sure the kids get a good night slight, eat a nutritious diet, drink enough water and practice proper hygiene.

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to 600 NIS) for children until aged 18, 50% discount on corrective laser eye surgery, a maternity package with an allowance of 2000 NIS per pregnancy, up to 50% discount on aesthetic surgeries and treatments, supplementary child development diagnoses and treatments, etc. Dr. Tanya Cardash was born and raised in London. Tanya qualified as a doctor and graduated with honors from University College London. She made Aliya in 1999 and has been working for Maccabi Healthcare Services from the year 2000. She currently holds the positions of the Deputy Medical Director for the JerusalemShfela region, a family doctor and an olim liaison officer. Tanya lives in Modiin with her husband and four children. She can be emailed at cardash_t@mac.org.il

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Save a Life By: Chani Turk And whoever saves a life, it is considered as if he saved an entire world. Mishnah Sanhedrin 4:5; Babylonian Talmud Tractate Sanhedrin 37a These words are words we are quite familiar with, however, many of us feel the chance to do such a mitzvah will never come our way. This is not true. Every three months a person has a chance, not only to save one life but to save three. Yes, three. For that is how many people can be saved by donating just one unit of blood. Imagine, the relatively simple act of donating a unit of blood once or twice or even four times a year gives every person the ability to perform this tremendous mitzvah mentioned in the Talmud.  A member of the community here in Moriah recently used the social hall of KSYM to organize a blood drive to give back to MADA, whose blood banks had helped to supply blood to a close family member of hers for the many years he had suffered with

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cancer. Without those units of blood that man would not have been able to fight his cancer for as long as he did. A man in NY lost both his legs after being hit by a taxi. Without the 70 units of blood he received after his accident he would have

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Ruthie Hellerstein, 17, donates blood for the first time

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died. This man is alive and recovering and is thankful for the gift of every moment he has with his wife and three kids. His story inspired thousands of people to donate in his name. Premature babies, surgical patients, cancer patients, patients with any number of chronic or acute illnesses use countless units of blood. My mom needed two units of blood after her “routine” knee surgery.  One does not know if they themselves will ever, G-d Forbid, be on the receiving end of a unit of blood. But what one does know is that he can help fill the desperate need for blood we have in this country.  There are mobile blood ambulances stationed all around the country. Here in Modiin they come once a month for anyone who wants to donate. Additionally about three times a year we organize a blood drive that is held in the social hall of KSYM. This is a particularly easy way to donate - reminders are sent out and if you stick to our schedule you know that you are good for at least those three units a year. Imagine that, 3 drives = 9 lives saved! No medical degree necessary! Now that is impressive.  And remember, to quote a girl who was born at 24 weeks gestation and spent the first 116 days of her life in the neonatal intensive care unit, “Donating blood is not scary, fighting for your life is.” Donate blood and save a life today! Chani Turk lives in Modiin with her husband and five children. She is a registered nurse who worked in Terem in Modiin. She, along with Doni Stern, organizes a triannual blood drive that takes place in the social hall of KSYM in Modiin.

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Asthma:

Emergency Room Visits and Hospitalizations are Nearly Avoidable! By: Robert M. Cohen, M.D. Asthma is by far one of the most common conditions treated in both pediatric and adult emergency rooms and is a very common cause of hospitalization. Particularly during the fall and winter, emergency rooms are filled with wheezing children. But, the good news is that with early and aggressive intervention this scenario is almost completely avoidable. Asthma is a very common disease. In the United States, about 20 million people have been diagnosed with asthma and nearly 9 million of them are children. Studies have found the overall asthma prevalence in children in Israel to be 7.8% for Jewish children, 4.9% for Arab children, and 3.7% for the total population. Asthma generally presents in the first few years of life, but it can have its onset at any age, even as an adult.

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The word asthma is derived from Greek and is literally translated as “panting” or “short drawn breath”. If you or your child has ever experienced an asthma attack, this translation may seem quite appropriate. Yet asthma specialists are quick to point out that most asthma patients commonly have more subtle symptoms and only rarely do they experience “asthma attacks”. It is now recognized that the one characteristic that all asthmatics have in common is airway inflammation. This inflammation in the bronchial tubes leads to hyper-responsiveness or hyper-excitability of the bronchial tubes to both allergic and non-allergic stimuli, resulting in coughing and intermittent wheezing. As the inflammation worsens, obstruction to breathing becomes evident due to the swelling of the inner lining of the bronchial tubes, increasing mucous production, and the constriction of the muscles around the bronchial tubes, leading to the classic symptoms of

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intermittent or persistent wheezing, tightness in the lungs, and shortness of breath. Allergies are one of the primary causes of asthma symptoms, especially in children. Any number of environmental triggers can play a role, including both indoor and outdoor allergens. The most common indoor allergic triggers of asthma include dust mites, mold spores, cat and dog dander, and cockroach allergen. Seasonal pollens including weed, tree, and grass pollens, are the most common causes of seasonal asthma, but outdoor mold spores can contribute to year-round symptoms. On rare occasions, food allergies can precipitate asthma symptoms. Allergies should certainly be suspected if symptoms appear only in the spring and fall, or when exposed to pets or dusty and moldy environments. Not all asthma, however, is triggered by allergies. Approximately one half of all asthmatics have non-allergic asthma. Symptoms of the non-allergic asthmatic are not brought on by allergens, but by exposure to irritants and other non-allergic triggers. The most common causes include upper respiratory viral infections, the common cold, sinus infections, and gastro-esophageal reflux. Symptoms can be brought on during or after exercise or laughter, and upon exposure to cold air, cigarette smoke and other strong smells such as perfumes, aerosols, and cleaning products, poor air quality, and changes in the weather. Exercising in the cold can be

very problematic. The best way to determine if you or your child has asthma is to speak with a physician experienced in the diagnosis and management of asthma. An allergy or asthma specialist will take a careful history looking for signs and symptoms of airway inflammation. A careful exam of the entire respiratory and cardiac systems will also be performed. The asthma specialist will often have Continues on page 43

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Emergency Care in Modiin 101 By: Dr. Avi Alpert Here is an article that hopefully no one will ever need. Fortunately Modiin is blessed with many excellent doctors in the Kupot Holim for preventive care as well as to address more acute medical issues. For urgent care issues or out of hours one can go to the Terem Urgent Care Center on 8 Tiltan Street located in the Maccabi building. (Disclosure- I am employed on a part time basis by Terem). They are open 24/7 and are able to take care of a wide range of urgent care medical problems such as sprains, stitches, antibiotic prescriptions, and intravenous infusions. They have xrays on the premises. They are also able to stabilize someone who comes in with any emergency issue so that the person can be taken by ambulance to the hospital. There are several major hospitals in the Modiin area including Asaf Harofeh, Tel Hashomer, Hadassah Ein Kerem and Shaarei Zedek. Ichilov and Hadassah Har Hazofim are slightly farther away. There is a preference to take major trauma vic-

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tims to Tel Hashomer and sometimes Hadassah Ein Kerem as these are Level One Trauma Centers. As Dr. Judah Goldberg writes in his article on chest pain, if one thinks one is having a heart attack one should call 101, the number for Magen David Adom (MDA). This call goes to a central station which identifies the closest ambulance which is sent to the scene. There are two types of ambulances â&#x20AC;&#x201C; the regular ambulance which is staffed by medics also known as emergency medical technicians and the more advanced ambulance staffed by paramedics to give more intensive care. At the sa me time that the ambulance is notified, a text message or call is sent out to volunteer on-call responders who have life support equipment in their car. There are three groups of on-call volunteers in the Modiin area, all of whom work well together. There are the volunteers through MDA who are notified via MIRS which uses GPS to locate the eight closest responders. Most of the volunteers are at the level of an emergency medical technician although there are some paramedic and physician volunteers. In addition, there is Hatzoloh of

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Yehudah and Shomron as well as United Hatzoloh. Many of the volunteers are members of more than one organization. All should have a yellow vest that identifies them on the scene. Often the on-call volunteer arrives first and then continues to work with the staff from the ambulance. Besides these volunteers, lives have been saved of victims of a cardiac arrest by ordinary citizens who have taken a basic CPR course and learned how to use an automatic external defibrillator (AED). These are now located in many public places including the airport, malls, and synagogues. There is always a need for more volunteers. For more information on MDA one can refer to their website www.mdais.org. To volunteer for Hatzoloh Yehudah and Shomron contact Moshe Sadia at moshesadia@gmail.com. To volunteer for United Hatzoloh contact: 02-5002020 Dr. Avi Alpert volunteers for MDA and Hatzoloh and in his spare time works in the Emergency Department at the Shaarei Zedek Hospital. He lives in Modiin with his family.

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When Your Child Goes to the Hospital By: Daniella Hellerstein Most kids go through life without ever spending time in a hospital. But for countless others, a hospital stay is required at some point in their childhood. Sometimes it is for a scheduled routine surgery but it may also be for an unforeseen emergency room visit. Children with a chronic illness spend lots of time in the hospital and become experts themselves on what to expect. Knowing in advance what to expect, or at least knowing what to ask will likely be useful at some point since so many parents find themselves in a situation with a child that needs hospital care. If you know your child is scheduled for a procedure, such as surgery, there are steps you can take to prepare yourself and your child to help things go as smoothly as possible. As the parent, it is your job to find out as much information as possible about the procedure. Questions you may want to ask include: what will happen; how long it will take; how long a stay is required; what you need to do to prepare beforehand; and what to expect afterwards. Once you have the information, you need to decide exactly what and how to relay it to your child. This will depend mostly on your child’s age. For example, a toddler does not need to know more

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than a few hours in advance of going to the hospital whereas an older child might be told several days beforehand. Choose what information is relevant to the child without overloading him with details. When Tamar and Shlomo Weiss’s (then three and a half-year old son), Elisha, went in for a scheduled procedure at Boston Childrens’ Hospital, they felt very prepared. The hospital had given them a pamphlet in advance so they could acquaint themselves with what was to be expected. They were also given the opportunity to ask questions and tour the facility. Tamar says that this allowed her to confront the situation feeling calm and prepared. In addition, a parent was allowed to accompany Elisha into the operating room. This policy, adopted now by many Israeli hospitals including Schneider’s Childrens Hospital in Petach Tikvah, benefits all parties involved including the child, parent and surgical team. Children take their cues from their parents. Therefore, when parents feel calm and in control children tend to relax too. Once at the hospital, a nurse or Child Life Specialist (a trained therapist who helps children understand and cope with hospital-

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ization) can spend time with you and your child to help explain what will happen. Using props is very beneficial. A mask, bandages and other equipment may be available to touch and explore. Using dolls to role-play with helps give the child a feeling of empowerment and allows them to become familiar with what may happen. Post-procedural play is important as well. Toy doctor kits may be very useful with this when at home after the procedure. It is important to encourage your child to ask questions and to be honest with the answers. Fear of the unknown is often worse than knowing the truth. When children feel information is being kept from them it creates more anxiety and creates an environment of secrecy that is very frightening. Realize that children can sense when there is more going on than what is being told to them. Maintaining a relationship of trust with your child is critical. Psychiatrists have written extensively about the emotional impact of illness on a child. Often the psychological trauma may be longer lasting than the physical. Even in emergency situations, children benefit from on the spot explanations and preparation. When Ruth Rose’s “eight-year-old son”, Shimon, was hospitalized for a knee injury, a painful procedure involving a needle was required. The doctor told him that the procedure would not hurt but was, in fact, extremely painful, even by adult standards. As a result, his mother says that Shimon has a huge fear of needles and

is untrusting of doctors. His father, who was with him at the time, also suffers from the trauma of feeling misled and unprepared. Rachel Berger says the most important thing she learned from her son Noam’s (then two and a half) hospitalization is to trust your maternal instincts. She believes in being an advocate for your child and not being afraid to speak up when you suspect something may not be right. Parents should also insist on being with their child as much as possible, both before a procedure and in the recovery room. Separation is a key fear, even with older children. In one study, children who had to undergo frequent painful procedures said that what helped them most was having their parents with them – even though they knew their parents could not relieve the pain. One way of helping your child through the hospital experience is to take pictures and make a book that tells the story of what happened. Then your child has a memento he can share with friends and refer back to in order to internalize the event. Other ideas include drawing pictures after the procedure that could be made into a book based on his memories and perspective or if old enough, writing the story. Of course the best way to help your child through any difficult experience is with lots of love and support. Hugs and kisses don’t hurt either. Daniella Hellerstein is a Certified Child Life Specialist who worked at New York University Hospital and for Chai Lifeline before moving to Modiin and co-founding ModiInfo.

Asthma Continued from page 37

you or your child perform a lung function test by blowing into a spirometer in order to detect any evidence of airway obstruction. Since allergies play such a common role in asthma, allergy testing will be indicated in many cases. Your doctor may also need to rule out other causes of breathing difficulties by determining the health of your lungs and heart with X-rays or an EKG. Sometimes other conditions may induce asthma-like symptoms, such as pneumonia, bronchitis, sinus infections, gastro-esophageal reflux (GERD), or heart disease, just to name a few. The diagnosis of asthma in infants and young children can be especially challenging, due to the fact that lung function testing in young children is difficult. Therefore, the diagnosis of asthma may become evident only with the passage of time. Commonly, infants and young children are diagnosed with Reactive Airways Disease, or RAD, which may eventually be confirmed as asthma. Recurrent wheezing and a strong family history of allergies or asthma may lead doctors to diagnosis asthma at an earlier age. If treated early and aggressively, asthma can, in most cases, be easily controlled. Emergency room visits and hospitalizations can be dramatically reduced with the proper intervention. The best outcomes can be seen with the following: • Early diagnosis • Education of children and parents to recognize asthma symptoms and severity • Identification and avoidance of allergic triggers • Early intervention by a physician for symptoms that do not respond to bronchodilator treatment • Aggressive use of controller of preventative medication • Proper technique in the use of inhalation devices such as inhalers (This is critical!) • Early introduction of anti-inflammatory medication for prevention and during an asthma flare-up A close relationship with an asthma specialist and an individualized asthma treatment plan can not only reduce emergency visits and hospitalizations, but it can reduce asthma symptoms, leading to more symptom free days and a better quality of life for both children and adults with asthma. Dr. Robert Cohen is an American Board Certified Allergist and has his Allergy Specialty Recognition from Misrad Habriut. He has a private practice in RBS where he treats children and adults with allergies and asthma. He can be reached at 02991-3547, IsraelAllergy@gmail.com, www.TheOnlineAllergist.com

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From Mendel to Moshe Genetics in the Talmud and in the Modern Laboratory By: Rav Gideon Weitzman The Augustinian Friar, Gregor Mendel, is widely regarding as being the Father of Modern Genetics due to his extensive work on inheritance in pea plants in his Czech monastery. Interestingly the Talmud contains a number of references to human inheritance of genetic traits. For example if a child dies as a result of bleeding to death after circumcision, due to what appears to be hemophilia, a disease that affects blood clotting, the next child will be circumcised. If he also dies then the next child will not be circumcised due to the fear that he is also affected by the disease and therefore in danger. The novelty of this Talmudic decision is that circumcision is a serious Torah obligation that carries one of the most severe punishments if not performed, and, in this case, we do not know that the child is affected, only that his siblings were affected and so we can assume that he may be in danger. The Talmud then takes this idea to another stage and states that if the mother's sister has

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a child he will also be exempt from being circumcised due to the possibility that he is affected with hemophilia. This suggests that our Sages understood something about human genetic inheritance and how it can affect families. Today our knowledge of genetic diseases is greatly advanced and we can map an individualâ&#x20AC;&#x2122;s genome giving us a wealth of information about the possibility of that person or members of his family contracting certain diseases. Each ethnic group has their own genetic diseases and the number of diseases with the Ashkenazi Jewish population, such as Tay-Sachs disease, is well known. One of the ways to combat this is prenuptial genetic testing, and unique programs within the Jewish Orthodox world have been successful in almost eradicating such genetic disorders. However this testing is not applicable to all genetic disorders, either because they are not known and the genetic marker is not

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MEDIC AL GLOSSARY Allergic (to medicine) ‫רגיש‬ Allergy ‫אלרגיה‬ Ambulance ‫אמבולנס‬ Anesthesia: General anesthesia ‫הרדמה מלאה‬ Local anesthesia ‫הרדמה מקומית‬ Asthma ‫אסטמה‬ Bleeding ‫דימום‬ Burn ‫כוויה‬ Cast ‫גבס‬ Chest pain ‫כאבים בחזה‬ Cough ‫שיעול‬ Crutches ‫קביים‬ Disease ‫מחלה‬ Emergency Room ‫חדר מיון‬ Fever ‫חום‬ First aid ‫עזרה ראשונה‬ Genetics ‫גנטיקה‬ Heart attack ‫התקף לב‬ Hospital ‫בית חולים‬ Indigestion ‫קלקול קיבה‬ Infection ‫דלקת‬ Insurance ‫ביטוח‬ Lethargic ‫רדום‬ Medicine ‫תרופה‬ Pain ‫כאב‬ Pregnant ‫הריון‬ Prescription ‫מרשם‬ Referral ‫הפניה‬ Runny nose ‫נזלת‬ Sedation ‫הרדמה‬ Seizure ‫התקף‬ Surgery ‫ניתוח‬ Side effects ‫תופעת לוואי‬ Specialist ‫רופא מומחה‬ Stitches ‫תפרים‬ Strep throat culture ‫משטח גרון‬ Stroke ‫שבץ‬ Swelling ‫נפיחות‬ Treatment ‫טיפול‬ Urgent ‫דחוף‬ Vomiting ‫מקיא‬ Wheelchair ‫כסא גלגלים‬ Wound/injury ‫פציעה‬ X-ray ‫רנטגן‬ 46

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From Mendel to Moshe

Saving Lives

Continued from page 44

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available before marriage, or in the case of dominant genetic disorders that express themselves even if one of the couple has the defective gene. In these cases today we can perform a procedure called Pre-implantation Genetic Diagnosis (PGD) where a couple undergo in-vitro fertilization and the embryos are examined in the laboratory to determine whether they carry genetic diseases or a specific unwanted genetic trait. Israel is one of the world leaders in PGD and hundreds of healthy children have been born as a result of this cutting-edge technology. However PGD raises a large number of halachic and ethical dilemmas; mostly around the use and abuse of the technology. We can use PGD to eradicate disease and spare parents the anguish and heart-ache of having children with serious genetic abnormalities, but the same technology can also create children with specific desired genetic traits. Are we attempting to create the "perfect child" and in so doing are we in fact removing genetic characteristics that may be undesirable but essential? Should we be using PGD to select the desired gender? In cases of X or Y linked genetic disorders, i.e. those that affect one gender only, it should be permitted, but the answer may be very different when dealing with the elective desire of a couple with one male child who would now like to have a girl to complete their family. What about cases where there is a societal reason? The most famous was a case of a cohen who wanted to have a girl to cover up the fact that he and his wife used a non-Jewish sperm donor. Is this enough of a reason to undergo PGD? Other questions involve doing PGD to eradicate carriers or for diseases that may express themselves later in life. To undergo a procedure to achieve a healthy pregnancy is one thing, but only in order to have a child free from all genetic abnormalities even if they have no immediate ramifications is another issue. These questions are currently under debate both in the medical community and between the halachic authorities. Our knowledge of genetics has saved countless lives and impacts our future but we need to learn how to use this information well and to realize that not everything that can be done should be done.

that MDA put them where they are needed most. One day the granddaughter of that cousin stepped out of her house in Modiin and saw an ambulance go by with her grandfather’s name on it. It turns out, ironically, that the ambulance I dedicated in memory of my cousin, was placed in Modiin where his grandchildren live. I recently dedicated another ambulance in memory of a young girl named Amber Biton. I never knew Amber but I read about her in the AFMDA newsletter I receive and was struck by her story. Amber was a youth volunteer with MDA. Soon after she completed the training she was diagnosed with leukemia. Amber continued to volunteer even during chemo treatments but unfortunately she succumbed to her disease. Amber was a hero and I felt there was no better way to honor her than to continue the work she was doing. Another situation that prompted me to donate an ambulance was the recent Olympics. I was enraged that there was no minute of silence to honor the 11 Israeli athletes murdered in Munich. I decided that I would honor them by dedicating an ambulance to the Munich 11. Did you ever think you would be such a significant contribu-

tor to the State of Israel? I always assumed I would be a starving artist. I never imagined I would be in a position to be as philanthropic as I have. I feel that all the years of torture working on the trading floor has paid for these ambulances. In terms of Israel, growing up I didn’t even want to be Jewish let alone a Zionist. It was the Eichman trial and my trip to Israel that turned me into an identifying Jew. I am now trying to help raise funds for a new blood center in Tel Aviv. It is all a small part of what I can do for tikun olam.

Rabbi Gideon Weitzman is the Rabbi of the Merkaz Modiin Synagogue (sometimes called the Bunker) and is the Director of the English Speaking Section of the Puah Institute for Fertility and Medicine in Accordance with Halacha. He is also a Visiting Associate Principal at the Albert Einstein College of Medicine and writes a popular weekly column in the Torah Tidbits.

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Hospitals Listed by Area Code Jerusalem Bikur Cholim, 02-646-4111 Hadassah Ein Kerem, 02-677-7111 Hadassah Mt. Scopus, 02-584-2111 Misgav Ladach, 02-567-8444 Sha’arei Tzedek, 02-655-5111 Terem Emergency Room, 02-652-1748 Tel Aviv Assuta Tel Aviv, Ramat HaChayal, 03-764-4000 Assuta HaShalom, 03-764-3000 Ichilov, 03-697-4444 (except pediatrics) Dana Pediatrics Hospital, 03-925-3666 Be’er Yaakov (outside of Rishon Lezion) Asaf HaRofeh, 03-977-9999 Bnei Brak Maayanai Hayeshua, 03-577-1111 Holon Wolfson, 03-502-8211

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Petach Tikva Rabin Medical Center (Beilinson), 03-937-7377 Schneider Children’s Hospital, 03-925-3252 Ramat Gan Tel Hashomer, 03-530-3030 Rishon Lezion Assuta, 03-764-3333 Hadera Hillel Yaffe, 04-630-4304 Haifa Assuta, 04-881-0600 Rambam, 1-700-50-51-50 Bnei Tzion (Rothschild) Medical Center, 04-835-9359 Tzfat Ziv, 04-682-8811 Ashdod Assuta, 08-854-6333

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Ashkelon Barzilai Medical Center, 08-674-5555 Eilat Yoseftal, 08-635-8011 Be’er Sheva Assuta, 08-626-7000 Soroka, 08-640-0111 Rechovot Kaplan Medical Center, 08-944-1211 Kfar Sava Meir (Sapir Medical Center), 09-747-2555 Herzlia Herzlia Medical Center, 09-959-2555 Raanana Assuta, 09-764-4444 Netanya Laniado, 09-860-4666

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In and Around the City This year the city has continued to blossom and increase the recreational services available to residents. It is thrilling to see families enjoying the various parks and facilities that enhance the daily lives of children and adults. As part of Modiin’s effort to

Sderot Hashmonaim

provide the maximum quality of life to residents, there are currently four more exciting projects in progress throughout the city Sderot Menachem Begin

First project: Grassy strips and bike paths along Sderot Hashmonaim Extensive landscaping is currently underway on Sderot Hashmonaim which will complete the upgrade of Sderot Hashmonaim leading to Tzomet Shilat and the city center. In recent years much effort had been focused on beautifying the boulevard with flowers, olive trees, lighting, paving and sculptures. The grassy strips on both sides of the road will have bike paths, walking paths, greenery, lighting, places to play sports and places to sit along the entire boulevard. In the future the completion of the “Amat Hamayim” area will include commercial space and offices as well. It is expected to be finished in September.

Second project: Cafe in Park Anabe At the end of Emek Zevulun a new cafe is being built that will overlook Park Anabe. “Cafit”, a known Jerusalem based restaurant with four branches in Jerusalem and a fifth one opening soon, will run the cafe. They offer a wide range of Italian food and various Israeli foods. The Board of Directors of the development company has agreed to manage the development and construction of the building shell, the interior work, the finishing, furnishing the cafe and managing it for the next seven years with an option of another seven years. The cafe’s location takes advantage of the views of Park Anabe and allows easy access to the train station and the city center, and is within walking distance to the nearby parking lots.

So as to take in the maximum park views, the cafe is planned as an “L” shape, with one side parallel to the north park path and the other side parallel to the parking lot. In the open area created by the two sides, there will be a multilevel outdoor garden for the cafe guests to enjoy during the summer, fall and spring. The open terraces will allow seating outdoors, while the glass enclosed indoor seating is located above the park and overlooks the lake. The building has an upstairs and downstairs which will allow room for modest events of up to 200 guests not including the outdoor area. The cafe will have two separate kitchens to accommodate the needs of all residents. One kitchen will run seven days a week and the second kitchen will run five and a half days a week and follow the kosher guidelines of Rabbanut Modiin. The architectureof the building was planned by Tzvika Tamari from the Tim Adrichalim Studio, a Modiin resident and an accomplished architect, who presented a few different ideas until this one was chosen. The cafe is expected to open this September.

Third project: Community Center Beit Sachlavim, the Modiin Community Center, is in the process of being built and is looking to open at the end of next month. The new center is located on Emek HaEla in the Cramim neighborhood and will house a Beit Akim for children with special needs. The building will be 1400 meters large divided into two levels with a number of areas: acoustic music rooms, classrooms for art and computers, offices

Cafe in Park Anabe

for Amutat Sachlavim (who are moving from caravans in the entrance to the city) and a multipurpose hall for up to 150 people. The building was designed by architect Dalia Lapidot and outdoor architect Nitai Bluka. The seven million shekel project is accessible to the handicapped and includes 48 parking spaces and an activity yard. In the future there are plans for an additional building with classrooms and a center for youth activities and retirees.

Fourth project: Park Sderot Menachem Begin Over the next year, all the parks and open spaces along Sderot Menachem Begin in the Moriah neighborhood will be completed. The “Extreme Park” recently opened at the

beginning of Sderot Menachem Begin and is one of the biggest in the country. The five million shekel park has been a great success and is used daily by hundreds of teenagers.The park consists of sports facilities, paths, grass, flowers, nearby parking and a small kiosk. At the other end of the boulevard, near the Reut side the first city sportec will be built. This is an open complex of various courts for different sports. On the other side of the boulevard, next to the Ariel school, there are plans to build a youth club and a shopping center as well as the main park of the Moriah neighborhood which includes special playground facilities, shade, places to sit, greenery, flowers and more. The road system, sidewalks, stratification roads, traffic lights and street signs will soon be finished thus completing construction of the neighborhood.


The Dog’on Days of Summer By: Dr. Ilan Schvekher The sunny weather in this country can be a great sense of joy but it may also be very dangerous. In the hot afternoon hours, it is preferable for dogs to be in the shade with a bowl of fresh water nearby. It is very important to make sure that their water bowl is full throughout the day with nice cool water. You may even add ice cubes to their water. Even at the beach, under an umbrella, the heat is too much and so it is important that your dog has a bowl of drinking water available. Of course exposure to the heat in the afternoon hours is dangerous for all dogs, but it is especially dangerous for certain breeds, for example: Pekingese, Chinese pug, bulldogs and others. These particular breeds have problems with body heat regulation. You may notice that after a short time in the sun, they will lie down on their bellies and relax. The reason for this is because of the shape of their skulls and their heat regulation system. This system is not able to retain body heat and lower it, like other breeds can. Therefore, their body heat rises and they get very tired very quickly. These dogs return to normal when their body heat starts to go down. The clinical symptoms of a sun or heat stroke are increased breathing (breathing with tong out), seizures, collapsing and even dying. In the case that your dog has one or more of these symptoms, you must quickly bring your dog to the vet. It is important to remember that the hours from 11:00-3:00 are the hottest hours of the day and walks must be kept short. The recommended hours for walks are in the early morning and evening. Dogs with long heavy fur can get especially hot in the Israeli summer. You can help them by getting them a short haircut once every few months. In the summer months the amount of food your dog eats decreases as opposed to in the cold winter months when their body needs more energy to warm up. Most dogs prefer to eat in the cool hours of the day such as the early morning or late night. Therefore, it is not recommended to leave the food bowl out during the day since food that is exposed to heat spoils. Food poisoning can be avoided if the dog gets his food on time, in the cooler hours of the day. In the summer month’s people like to travel all over Israel and often, the family dog comes along. Like humans, dogs also need breaks. During car rides you must make sure to stop at a safe place with your dog so that he can go to the bathroom and drink. There are 54

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dogs that tend to get car sick and even throw up during car rides. If this is your dog, your vet can give you pills to prevent car sickness. When you arrive at the place you’re staying it’s important to show your dog where he will sleep and where his food and water are so that he’ll feel free to drink and eat when he wants and not have to look for his food. When you are hiking it’s important not to walk in high grass and to make sure your dog doesn’t dig under rocks where poisonous snakes often hide. A bite from a poisonous snake may be critical and if your dog gets bitten you must bring him to a vet right away. Never take care of the wound on your own. Between the months of March and November, ticks and fleas multiply. These creatures live off of the blood of the dog. Not only will your dog get annoying stings and itches but he may also get an allergic reaction or a “hot spot” which is one spot full of painful wounds. A tick bite can be dangerous. If a tick bite gets infected, it can cause diseases like “ehrlichias canis” (tick fever). These diseases can damage the brain and stop platelet production. For these reasons it is very important to use pesticides against ticks and fleas. Now that we’re ready for summer, remember to drive, hike, have fun and protect all the members of your family - those walking on two and those walking on four. Dr. Ilan Schvekher is the director of Mahmadi Veterinarian Center in Dimri Towers.

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Is It Time to Take a Leap or Stay on the Fence? By: Moshe Cohen For most of us, the single most important financial investment we make in life is our home. While we all spend time thinking and talking about house prices, it is something we think of as an abstract idea that we will rely on as an inheritance for our children, a nest egg for our retirement, or a long term investment for the family. It is important however, in the short to medium term, that we feel safe in our ability to cover the mortgage repayments as well as maintain the property and accordingly, the value of the investment. This being said, the question everyone is asking is not whether prices of property will continue to rise at the same pace as previous five years, but whether prices will rise at all or even fall over the coming five years. To answer this question let’s look at what happened generally in 2012, what changes have happened since the election in February, and the appointment of Moshe Kahlon as the

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new head of the Israel Lands authority. Looking at the facts on the ground, new mortgages were 4% higher in 2012 than in 2011 at NIS 46.6B almost equalling the 2010 record of NIS 47B. New mortgage regulations came into effect from November 2012, restricting first time buyers to 75% LTV (percentage financing allowed) and foreigners and Investors to 50% LTV. Despite these restrictions the rate of new mortgages has continued to rise month on month (since November 2012) with a brief lull in April 2013. VAT rose by 1% to 18% in June, and one of the immediate effects was the sudden rush of first hand buyers to pay down early to avoid the 1% increase of outstanding amounts owed to contractors. Those thinking of upgrading homes in the future should also pay attention to the fact that if passed by the Knesset, will need to pay an additional NIS 50,000 in purchase tax due to Ministry of Finance removing previous exemptions for people upgrading their homes.

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The one plus, however for home owners and home buyers is that the prime lending rate has fallen substantially over the last 12 months from 4% to 2.75%. The net effect of low interest rates is lower monthly mortgage repayments in the short term which increases demand for people looking to purchase. Taking into account the current low interest rates, this would be a good time for home owners to look at one’s current mortgage and consider refinancing. So, you may ask yourself, do I take the leap and buy now, or stay on the fence and wait? On the one side we have major new mortgage restrictions, a rise in VAT and purchase tax increase but to counter, we have low interest rates (due to the problems in the world economy still looming, interest rates are likely to stay low for the foreseeable future) and continued supply pressure. While we don’t see property prices rising at the pace they have over the past few years, we do not forecast prices dropping significantly or at all due to continued supply demands which are likely to overshadow the downward pressures, as mentioned above. Moshe Cohen is the managing partner at Blue Crown Capital / Blue Crown FX, a mortgage consulting firm based in Modiin.

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Hear from the Volunteer Hila Elimelech Magen Dovid Adom Teen Volunteer

What made you want to become a MDA volunteer? I took a CPR and first aid course at my school, Ulpanat Shaalvim in 9th grade which I enjoyed a lot. They told us about a MDA course that they give over the summer and it sounded like something I would like. I thought if I could be part of saving lives it would be amazing. I completed the course last summer and started volunteering with MDA in Modiin three months ago. What was the training course like? It was really hard and there was a lot of material to learn but I found it really interesting. The course took place every day from 9-4 for two weeks over the summer. It was a total of sixty hours. There were 25 kids in the course which was offered in Modiin. I was 15 1/2 at the time and I started volunteering when I turned 16. Not everyone who took the course decided in the end to volunteer. Some just wanted to learn the material. I really enjoyed the course and found it to be an amazing experience. What is being a MDA volunteer like? I really like it. I mainly sit at the MDA station and wait for a call to come in and then we go where we are needed. Every ambulance has three volunteers and a driver who

is a medic. We go out with the ambulance and do what needs to be done. Once we got a call that a two and half year old boy was choking but by the time we arrived he was ok. We were called to the home of a 90 year old who didn’t feel well and we brought her into the hospital. Modiin is relatively quieter than other places. The best part is when the people say thank you after I help them and I see the smile on their face. I volunteer 8 hours a week. There are around 120 volunteers at the Modiin station. There are three active ambulances in Modiin. It’s all very organized and well run. Do you want to go into the medical profession? I really have no idea right now, maybe I will be a doctor but I don’t know. You are also a Bnei Akiva Madricha in Modiin, how do you find time for everything? I started volunteering a little bit before the bagruyot. Volunteering is basically a few hours and when it’s quiet I can study. Usually we get called out once or twice. It’s important to me so I make the time. What is your advice to other youth who are considering volunteering? I think this is an amazing and worthwhile experience. Even just to take the course is worthwhile. Definitely do it!

Hila, second from the right, with Modiin Mayor Bibas and MDA volunteers.

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RECIPE

Black Bean Salad By: Debra Waldoks 1 1/2 cups black beans 1 1/2 cups corn  1 red pepper, chopped 1 green pepper, chopped 1/2 cup red onion, chopped 1 cup scallion, chopped 2 cups tomatoes, chopped  1 garlic clove, minced 1 jalapeno, optional (or one dash cayenne pepper) 1 tablespoon coriander juice from 1 lime 1 teaspoon coarse sea salt 1 tablespoon extra-virgin olive oil

BILLBOARD Combine first seven ingredients (black beans through tomatoes) in a large bowl. For the dressing, combine the rest of the ingredients in small bowl, pour over salad and toss lightly. Chill two hours before serving. This black bean salad recipe is great for summer picnics and Shabbat pot luck lunches. It’s not only colorful and tasty but it is also loaded with vitamins, minerals, antioxidants, fiber, and protein. Note: For the corn, simply defrost some frozen corn. For the beans, you can use canned black beans if you rinse and drain them but since those are difficult to find in Israel, make a big batch (soak overnight, drain, cook in fresh water without salt) and keep some on hand in your freezer. You will want to make this recipe again soon!

Easy and Beautiful Summer Salad A vegetable chopper makes this easy salad even easier. Ingredients: Beets, uncooked, peeled, and chopped into small bite-sized squares. Firm sweet apples, peeled, and chopped into small bite-sized squares. Combine beets and apples in a pretty serving bowl. Squeeze fresh lemon juice from one or two lemons. Pour one or two tablespoons of pure maple syrup. Stir gently to combine. Adjust flavoring and enjoy!

Debra Waldoks, MPH, RD, CLC is a Registered Dietitian and Certified Lactation Counselor with a Master’s Degree in Public Health, and additional training in Functional Nutrition. Her nutrition specialties include: weight loss, women’s health, fertility, PCOS, pregnancy, food allergies, and pediatrics. Prior to making aliyah in August 2012, she worked in New York City in various public health capacities, maintained a private practice, and was an adjunct nutrition lecturer at Queens College-CUNY. You can find her blog at www.BeyondPrenatals.com.

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CLASSIFIEDS Professional, Effective, Practical & Caring Help Psychotherapy, Counseling & Coaching Anxiety, Depression, Stress Disorders, Family Issues

Dr. Simcha Sheldon Licensed Marriage, Family & Child Therapist Clinical & Medical Psychologist & Hypnotherapist www.drsimcha.com Feel welcome to call: 976-1056

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Reduce Your Aches and Pains Soft tissue release, sports injury treatment, therapeutic massage, dry needling, manual therapy and more Call for an appointment

Talia Tzadok Qualified physiotherapist Bsc (Physiotherapy)

Learning Circle Preschool Summer Camp For English Speakers Fun summer learning through play - Daily letter recognition/literacy activities, English song and story time, baking, sports, swimming, art … July 28-Aug 15 (or per week) 8:00-13:00/16:00 Contact Alana: 054-7550747 or tlcmodiin@gmail.com www.thelearningcircle.co.il

Ofira Krakauer - Graphic Design

Store for Rent 45 meters on a Hollandi road Prachim neighborhood, close to the mall For details, call Maya, 054-630-2253

Brand Identity for Your Business: Logo, Business Card, Flyer, Folder, Catalog, Packaging, Advertising, Newspaper, Magazine Hebrew and English

052-3449446 ofirak@gmail.com

052-504-0613

CANDLE LIGHTING June 28/20 Tamuz Parashat Pinchas Candle lighting: 19:28 Shabbat ends: 20:30

July 5/27 Tamuz Parashat Matot/Massei Shabbat Mevarchim Candle lighting: 19:28 Shabbat ends: 20:30

July 12/5 Av Parashat Devarim (Chazon) Candle lighting: 19:26 Shabbat ends: 20:27

July 15/9 BeAv Fast begins: 19:24 Fast ends: 20:15

July 19/12 Av Parashat Veetchanan (Nachamu) Candle lighting: 19:23 Shabbat ends: 20:26

August 2/26 Av Parashat Reeh Shabbat Mevarchim Candle lighting: 19:14 Shabbat ends: 20:15

August 9/3 Elul Parashat Shoftim Candle lighting: 19:08 Shabbat ends: 20:10

August 16/10 Elul Parashat Ki Tizei Candle lighting: 19:01 Shabbat ends: 20:00

August 23/17 Elul Parashat Ki Tavo Candle lighting: 18:53 Shabbat ends: 19:55

August 30/24 Elul Parashat Nitzavim/Vayelech Candle lighting: 18:45 Shabbat ends: 19:45

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July 26/19 Av Parashat Ekev Candle lighting: 19:19 Shabbat ends: 20:20


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