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Health Care in the Jewish Community

Supplement to Jewish News May 19, 2014 jewishnewsva.org | Health Care | May 19, 2014 | Jewish News | 15


Health Care Dear Readers,

Y

ou say you know no Yiddish or German? To that we say, “Gesundheit!” The word literally means health in those languages, and invoking the popular response to sneezing is a fitting way to introduce this Jewish News special section on Health Care in the Jewish Community. Within these pages, we share with you stories and articles about world-class doctors and dentists, the latest in health care treatments, and a closer look at how rehab at Beth Sholom Village is helping members of our community get back on their feet. We are fortunate to live in an area that has such a vast, knowledgeable, concerned, and progressive health care community. May this allergy season be an easy one for you, and if not, let’s practice our Yiddish together: Gesundheit! The staff of the Jewish News

Published 22 times a year by United Jewish Federation of Tidewater. © 2014 Jewish News. All rights reserved.

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16 | Jewish News | May 19, 2014 | Health Care | jewishnewsva.org

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Health Care

With electromagnetics and metal caps, Israeli companies aim to zap brain diseases by Ben Sales

JERUSALEM (JTA)—It looks like a futuristic salon hair dryer. Connected to a computer by a bright orange strip, the half-cube with rounded corners sits comfortably atop the head, a coil of wires resting on the skull. As a doctor stands at the computer, the patient gets comfortable. A few seconds later, a brief electromagnetic pulse hits the head. Do this every weekday for six weeks, doctors tell Alzheimer’s patients, and you’ll feel your brain come back to life. The technique, known as transcranial magnetic stimulation, or TMS, uses electromagnetic waves to penetrate the brain and activate underused neural connections. Two Israeli companies are hoping it will change the way brain diseases are treated. “This is the first time in neuroscience that we have a noninvasive tool to directly penetrate and influence deep structures of the brain in a targeted way,” says Ronen Segal, the chief technology officer of Brainsway, based in Jerusaslem. “No shocks, no hospitalization. You come into the clinic, you sit

in the chair for 20 minutes, you get a series of electromagnetic zaps.” Unlike electroshock therapy, now known as electroconvulsive therapy, or ECT a risky and controversial procedure long used to counteract severe depression and other disorders—TMS targets specific regions of the brain rather than the whole organ and at a much lower intensity. Unlike ECT, Brainsway’s clinical trials show TMS carries almost no risk of seizure. Brainsway is working on using TMS to combat a range of diseases. The company received approval last year from the U.S. Food and Drug Administration to treat depression with TMS, and has European Union permission to use the technique to treat 10 diseases or disorders, including Alzheimer’s, Parkinson’s and autism, even tobacco addiction. Other drug addictions and obesity are next on the company’s list. Another Israeli company, Neuronix, focuses on Alzheimer’s, which affects 5 million Americans—a number sure to rise as the baby boomer generation ages. “Every emotion, thought or action starts with electric activity in the brain,” Segal says. “The problem is if you have too much or too

little activity, you get a brain disorder.” In a person suffering from depression, for example, the section of the brain that regulates mood isn’t as active as it should be. Electromagnetic pulses targeting that section stimulate brain cells to fire, restoring them to a normal level of activity, Segal says, and teaching them to be more active in the long term. For Alzheimer’s patients, treatment entails an additional step. Patients who receive Neuronix’s electromagnetic pulse have less than a minute of increased brain activity. During that window, a computer screen flashes a simple task meant to exercise the affected region of the brain— asking patients, in one example, whether two sentences mean the same thing. Affirming that “The salad has tomatoes” equals “There are tomatoes in the salad” helps sustain the short-term benefit of TMS therapy. “To understand [the sentences], to process them, to understand whether they have the same meaning, is a challenge,” says Orly Bar, Neuronix’s vice president for marketing. “We want to get to a point where the mechanism improves.”

While both companies emphasize that treatment should complement existing medication, not replace it, clinical trials show that TMS can be more effective in counteracting Alzheimer’s than current medications. And unlike pills that enter the bloodstream, the electromagnetic zaps have no side effects. “We know there’s medicine that works on the same mechanism,” Bar says. “There’s no contradiction. They can work together great.” Neuronix and Brainsway were both featured at Braintech Israel 2013, a conference highlighting Israel’s growing brain technology industry. Along with medical advancements, the conference showcased innovation in fields such as brain modeling and mind-control gaming. “It’s widely accepted that we’ve made a lot of progress in heart disease and cancer,” says Miri Polachek, executive director of Israel Brain Technologies, the nonprofit that organized the conference. “The one area where we need to make a big push is the field of brain research. “It’s no longer science fiction. You can see these things becoming real.”

What exactly is rehab?

Patty Stiffler, Anne Moore, Nina Turner, Mary Brewer, Mo Hardy, Ashley Nimess, Josh Adler, Jessica Keetz and Max the Therapy dog.

If you ask three people what rehab in a skilled nursing facility means you will certainly get three different responses. Some people will say it is for the person who has had a stroke and needs to re-learn the basic functions of daily living. Others believe it is for those who have had a knee or hip replacement. Then, some say it is for the resident who has become weak over time and needs to build up strength. All of those descriptions are correct. It is the experience and care one receives that is different. Rehab at Beth Sholom Village, for example, is far different than you might expect.

Ellie Lipkin spent six weeks at BSV for a broken femur. She says the physical therapist (PT) and occupation therapist (OT) were great and she worked very hard to get better. In fact, she wanted to be the first in the gym every morning so she could get on the exercise bike right away. Lipkin was so pleased that every CNA, RN and the dietary team knew her name and made sure she was comfortable and got what she needed. Warren Aleck entered rehab after having a lot of pain after a knee replacement. He rolled in in a wheelchair and walked out with a cane.

jewishnewsva.org | Health Care | May 19, 2014 | Jewish News | 17


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18 | Jewish News | May 19, 2014 | Health Care | jewishnewsva.org


Case Study

Patience with the patient Abbey Horwitz, DDS

T

here are traditional moments of dentistry where you help someone—although everybody, no matter what you do, has those. I would say one of the most striking moments I’ve had took place when the Soviet Union fell, and Russian Jews resettled all over the world, including Tidewater. Everyone chipped in to help them set up their new lives here—doctors, dentists, businessmen, real estate agents; we were seeing all these people who had nothing, and it was very rewarding helping them. There was a translator, a Russian émigré (who I am still friends with to this day), who brought this one gentleman to me to get dental work done, and this fellow was just absolutely obnoxious. I don’t even remember what he was so obnoxious about, but I remember I was incensed by his behavior. I’m thinking, “I’m here to help you, we’re not charging, I’m here to take care of you. I’m not even asking you to be grateful, but don’t be mean and don’t be an idiot.” And he just persisted in behaving that way and when finally I finished the day with him I said to the translator, “It’s just not worth it. I don’t think I’ve dealt with a patient like this except maybe once every five years, but please don’t bring him back. It’s enough. I can’t believe he’s such a butthead.” The patient went away. After a while the translator stopped by and asked to speak to me—he was a very nice gentleman and he said he had spoken to the fellow I’d asked him not to bring back, and the fellow wanted to come one more time. Against my better judgment, I acquiesced. I said, “Alright fine, lets hope he behaves himself.” So the patient did show up, and before we even started, he handed me two pieces of paper. One was in Russian and the other was the English translation of the Russian. It was a summary of the transcript of his court hearing in Russia. At a much earlier age, he had been drafted into the Russian army and he had refused to serve, which at the time in Russia was treason. According to the transcript, when they asked him if he would serve, he told them he would not serve anybody but the Israeli army. They said, “You understand this is treason?” and he said, “Yes.” And they said, “You understand that the punishment for treason in communist Russia is death?” He said, “Kill me.” And they sentenced him to death, and he accepted it. They commuted the death sentence to life in prison in a gulag in Siberia, which is where he stayed for a long time—until the Soviet Union fell and he got out. And I’m reading this document with a real sense of shock and awe, and I decided if he could tell the Russian government to go screw themselves, to go to hell, then I guess I could take a little abuse, and I did end up taking care of him. I took a copy of that transcript and translation home to show my children. It is something that affected me deeply, and is a rare moment in dentistry.

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Abbey Horwitz, DDS Dental Education Medical College of Virginia School of Dentistry in Richmond Former president of the Hebrew Academy of Tidewater, former president of the United Jewish Federation of Tidewater, Dr. Horwitz provides community care dentistry for our neighbors who are in need as an ongoing project. He has also been involved in volunteer dental services and projects in Israel, Romania and the former Soviet Union. Recently, Dr. Horwitz traveled to Nicaragua through Physicians for Peace, as a mission leader, to train dental professionals on good oral hygiene.

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Health Care

Israelis treating Syria’s wounded confront complex injuries, cultural gaps by Ben Sales

SAFED, Israel (JTA)—When an Israeli army ambulance brought an injured Syrian man to Ziv Medical Center in this northern Israeli city a few months ago, the doctors didn’t know where exactly he was from. They saw that his leg had been amputated, and based on his own fragmented account and the physical evidence, the doctors surmised he had been hit by a shell. But they didn’t know exactly how he had gotten there. And when he leaves the hospital later this month, they don’t know where he’s going. “I’m not scared,” says the Syrian, whose name was withheld by the hospital because Israel and Syria are in a state of war.

“Nothing worse will happen to me, so who cares if I’m in Israel?” Despite decades of hostility between Israel and Syria, hundreds of victims of Syria’s 3-year-old civil war have received life-saving treatments in Israeli hospitals. Israeli medical personnel say that while they’re happy to treat Syrians, the wounded pose a unique set of challenges. For one, their injuries are often complex, owing to the heavy artillery used in the conflict. They sometimes arrive at the hospital as much as days after suffering the injury, complicating treatment. And the wounded often are wary of Israelis they have been taught to despise, making it hard for Israel to address their emotional traumas in addition to their physical ones.

20 | Jewish News | May 19, 2014 | Health Care | jewishnewsva.org

“As nurses, it’s unique to deal with viding emotional support say Syrians are wounded like this,” says Refaat Sharf, a reticent to open up about their experiencnurse at Ziv, which has treated 162 Syrian es. Besides the trauma of war, there is the patients. “We hadn’t been used to these additional fear of being in an enemy state. injuries, neither in terms of their character Israeli Arabs who share a language and certain cultural norms with the wounded are nor their frequency.” Since last year, more than 700 wound- employed at all levels at Ziv and Rambam ed Syrians have come to Israeli hospitals and say they help Syrian patients navigate via the Syria-Israel border crossing on the cultural gaps they encounter. “If you want to the Golan Heights. talk about respect for The Israel Defense men and women, [a Forces has set up Medical personnel say male Syrian patient] a field hospital can’t see a woman, there, and transfers say hi to a woman,” patients it cannot that when they do says Johnny Khbeis, care for to nearby an Israeli Arab who hospitals. In some works as a medical cases it brings a leave the hospital, clown at Ziv. “There family member as are women who well. change their sheets, Northern Israel’s Syrians are grateful for and that’s hard for hospitals have them because that extensive experidoesn’t happen ence dealing with the care they received. there.” patients woundAdi Pachter-Alt, ed in battle—most Rambam’s deputy recently during Israel’s 2006 war with the Lebanese terror- director of social work, says the patients’ ist group Hezbollah. But in that conflict, reluctance to speak openly about their feelthe wounded typically received medical ings comes more from the trauma of being injured and less from ill will toward Israel. attention rather quickly. “It’s hard for us to give overall emoJoseph Guilbard, the director of pediatric neurosurgery at the Rambam Medical tional support because they mistrust us,” Center in Haifa, recalls an especially severe Pachter-Alt says. “It’s not due to the state case in which a 12-year-old Syrian boy of war. It’s because you’re in a different arrived in a deep coma with a severe state after trauma. You’re very alone, very brain injury. Guilbard performed multiple suspicious.” Medical personnel say that when they surgeries, reducing excessive pressure on the brain, removing parts of his skull and do leave the hospital, Syrians are gratereplacing them with acrylic. When he was ful for the care they received. The Syrian patient in Ziv says his opinion of Israel has discharged, the boy was walking. “If you see yourself as a doctor, a sur- flipped during his stay there. “Before the revolt, the authorities told geon and a trauma specialist, you give the same treatment to everyone,” says Hany us Israel was the enemy and we must fight Bathoth, the director of the trauma unit at them,” he says. “But after the recent events Rambam. “In every trauma, that’s how it is. there, I saw that in Israel they take care of You feel like you helped the injured. That the patients. All of the Israelis I met, Arabs and Jews, seemed unified.” gives you strength.” Hospital personnel tasked with pro-


Health Care

Simon Family JCC group exercise program offers fitness for every level by Leslie Shroyer

“At the Simon Family JCC, we are constantly changing and updating classes, working to offer the newest and best we can for our members,” says Sharon Giannelli, group exercise director. “We pride ourselves on the diversity of the classes. There is truly something for everyone.” More than 60 classes are offered each week. For active older participants, for example, the JCC offers the award winning Zumba Gold. This class also serves as an introduction for those just starting Zumba. Ai Chi is a new restorative class, taught in the warm water therapy pool. Regular water fitness classes continue to be popular with active seniors on Monday, Wednesday and Friday mornings. The JCC is the only official facility in Virginia Beach to offer Piloxing. The program blends the power, speed, and agility of boxing with the targeted sculpting and flexibility of Pilates. These techniques are supplemented by the use of weighted gloves. The class is very popular among members.

As the only official Spinning facility in Virginia Beach, the JCC provides top-level cycle classes, and has the ability to host training and certifications. A new Boxing Fit class uses boxing equipment such as gloves and wraps, instructing students on boxing techniques such as foot work, agility and speed. A New H.I.T. (high intensity training) class has become a power lunch hour class, with circuit training designed to strengthen and simultaneously provide an intense cardio vascular workout. The long-standing popular classes at the fitness center continue, such as Life Fit, a strength and cardio workout designed as a moderately intensive group exercise class. A range of yoga and Pilates classes for the experienced and the beginner continue, as does the Barre Body class, a lengthening and strengthening class, which is ballet-based and includes upper body, as well as floor work. The outdoor pool opens Memorial Day weekend, and some water fitness classes will move outside for the summer. For more information about the JCC’s group exercise classes, contact Sharon Giannelli at 321-2310.

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Your Table is Waiting! 22 | Jewish News | May 19, 2014 | Health Care | jewishnewsva.org

Biologic healing is something that I think people need to know about. It is absolutely the future of medicine. It’s the next frontier in healthcare and it’s already here—it’s [adult]stem cells and it’s PRP [platelet rich plasma injections]. The concept of biologic healing is that contained in your blood (assuming you have normal cell counts in your blood, which many people do), we have all kinds of very important cells: different kinds of white cells, platelets, and a variety of growth factors. These growth factors are unique and are immunologically linked to you. When they are extracted in a particular way, concentrated, and then injected into certain areas of your body, they act like a pseudo stem cell and can promote the regeneration of normal, healthy tissue. We’ve been able to show that PRP is one of the only things that can be injected, for example, into an arthritic knee and that can cause regeneration—over time—of cartilage of the knee. I had a PRP injection in my knee a couple of months ago—a knee that’s given me problems my whole life—and it’s phenomenal. I was the first physician in the state of Virginia to do PRP, about 10 years ago. I see myself as a kind of visionary, but just like with everything else that I do, I start kind of quietly. People tend to be a little skeptical of biologic healing; some of these procedures that we do are not considered traditional approaches and some of them are not covered by insurance—yet. The only insurance that covers PRP now is Workman’s Comp, but we’re starting to see some of the commercial carriers covering it for certain conditions; the two conditions where PRP has been most studied is in treatment for tennis elbow and osteoarthritis of the knee. Unfortunately, until it’s more accepted by the insurance companies, people who have limited financial resources won’t have access. I treat a lot of the injured firefighters and police officers in the city of Virginia Beach. I’m their main go-to person. A lot of them, all they want is PRP now. They don’t want steroid injections; they want to be treated like a pro athlete. They watch football games, they read about all these golfers who are getting this, and that’s what they want. The city of Virginia Beach has been extremely proactive with this, and we have been able to get so many people back to work full time, on full duty, and these are people who have really strenuous jobs, who otherwise would have been sidelined in their careers. The city has been so progressive in embracing all of this. I’ve also been involved in treating several of the PGA Tour players, and I’ve actually had a big time PGA tour player come see me here a couple of times. (I’m not a name dropper. Sorry!) It can be great to have patients like that—because of him, I was able to go to the 2012 U.S. Open in San Francisco. Medicine tends to get stuck in a rut, particularly where there’s an accepted standard of care, and until someone stands up and changes the standard of care, it can take a long time for things to change. For example, look at how prostate surgeries used to be done. They were barbaric. They used to cut out the prostate and destroy all of the surrounding tissue, leaving the poor guys impotent and incontinent. And now, robots are doing the procedure. The concept of biologic healing is an evolutionary process. Physicians by their nature are not really risk takers; they don’t like change. They’re going to stick to the way things are done until they’re forced to do something different. continued on page 23


Health Care

This chaplain helps end-of-life patients on their spiritual journey by Marcia Brodie

What exactly is a chaplain? Chaplain Keya Bhagirath gets this question and other similar inquires just about every day. As the chaplain for Freda H. Gordon Hospice and Palliative Care of Tidewater (HPCT), she works with patients that are at the end of life or have a life-limiting illness. Bhagirath is not an RN or a social worker, although her master’s degree is in human services and counseling. She says she “is one cog in the wheel, one member of a team that supports, assists and cares for hospice patients.” Bhagirath, known as Chaplain Keya, says she “Provides a comforting presence that promotes emotional and spiritual healing.” Patients often try to reconcile the end of their life, and “end up digging deeper into their religion and spirituality then they ever have.” Chaplain Keya helps guide them through the process, helping people connect to their spiritual self. The religious part of her job brings up additional questions. HPCT serves the

needs of patients of all religions and beliefs, therefore she needs to be prepared to assist those of all faiths. Chaplain Keya will reach out to a patient’s personal clergy if requested or look within the community to find the right person if requested. She says her job is to know and learn about most religions and speak to shared humanity. Sometimes Bhagirath sits with a patient and holds their hand as they pass into the next world. Sometimes she is there as support for the patient’s family to help them say their final good-byes. Many times, Bhagirath helps a patient and their family re-define hope and guide them toward making peace with death. There is no cookie cutter process. As a chaplain, Bhagirath listens, taking time to learn what is important to each patient. She encourages patients and families to talk about things in their life that have made them happy, challenged them or caused them pure joy. Chaplain Keya’s goal is to make the complicated process of dying a little simpler, a little calmer and most importantly, more peaceful to the patient and the family.

continued from page 22

Maybe 150 doctors across the country are doing this. Maybe. But, this is the way medicine is going, and soon, the whole thing is going to change. I can guarantee you that PRP will become the standard of care over the next five to 10 years—for osteoarthritis of the knee, for most soft tissue conditions, for small rotator cuff tears in the shoulder, for discogenic back pain, early osteoarthritis of the hip, Achilles tendon tears, ankle sprains that don’t heal, you name it. Medical Education Eastern Virginia Medical School, where she was chief resident in Physical Medicine & Rehabilitation. Affiliations Assistant professor in the Department of Pain Management & Rehabilitation at EVMS Board Certifications and memberships Physical Medicine & Rehabilitation American Academy of Physical Medicine and Rehabilitation Physiatric Spine Sports and Orthopedic Rehabilitation International Spinal Injection Society AAOM Tidewater Medical Women’s Society The Medical Society of Virginia.

jewishnewsva.org | Health Care | May 19, 2014 | Jewish News | 23


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I didn’t have to go into podiatry or become a podiatrist. When I was young, I always thought about what kind of doctor I would be—I did know I’d go into medicine—but I was never told by my parents that I had to go into podiatry, even though I knew it was always an option. Podiatrists run in our family. I’m a third generation podiatrist. My grandfather, Dr. H. (Hyman) Seltzer, moved from New Jersey down here to Newport News in 1942 where he opened his practice. His office was right above the Masonic Temple in downtown Newport News, and for many years he was pretty much the only podiatrist in that area. Then my uncle, Steven Seltzer, also decided to go into podiatry. He went to medical school in Philadelphia and then did his residency in Michigan in surgery. When he started practicing in this area with my grandfather, he was one of only a few podiatrists doing surgery at that time. Then I went to school, and as a pre-med student at the University of Virginia I got into the field of sports medicine and was intrigued. I’d considered practicing pediatrics for a while, but after learning about sports medicine, I decided I’d go into podiatry too. For about five years, my grandfather, my uncle and I all worked together. Earlier, my grandmother used to come to the office, too, and my mother, Linda Roesen, still comes to work in the office three days a week. My uncle retired early, but my grandfather kept working until he was about 85. We have a lot of patients, still, who come in and say, “I saw your grandfather, I saw your uncle, and now I’m seeing you. Your grandfather was the greatest guy, he always gave us that great foot rub at the end.” It makes us feel good to know patients are still coming back to us after all these years, even though we don’t do that foot rub anymore—times change. I have a daughter and a son who are in school at Cape Henry Collegiate, and it’s always a running joke in my family: will they be the next generation of podiatrists? I’m not so sure about my children, but I do have a nephew…. Howard Roesen, DPM Affiliated Podiatrists, LLC Medical Education Temple University College of Podiatric Medicine, Philadelphia, Pa. D.P.M. Degree: June 1990 Professional Affiliations Member, American Podiatric Medical Association Member, Virginia Podiatric Medical Association Fellow, American College of Foot and Ankle Surgeons

24 | Jewish News | May 19, 2014 | Health Care | jewishnewsva.org


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