Health Care in the Jewish Community - 6.27.22 Special Section

Health Care

in the Jewish community

Supplement to June 27, 2022 jewishnewsva.org | June 27, 2022 | Health Care | JEWISH NEWS | 13

LIVE your LIVE your life. life.

Let US LIVE your life.

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Health Care

Dear Readers,

T

he medical profession has devoted tremendous resources to battling and preventing the COVID-19 virus since early 2020. Rightly so, vaccinations, masks,

lockdowns, new treatments, and social distancing have dominated the world’s attention.

But, there’s more to the virus than the virus.

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Since the beginning of the pandemic, a notable increase in mental illness has been

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documented across all age and socio-economic groups. Tidewater is fortunate to have psychiatrists, therapists, primary care physicians, and hospitals that are adjusting their practices, hiring clinicians, and even building new facilities to meet the mounting needs

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for more care. In this section, Jewish News speaks with Debra Mayer of Jewish Family Service, Dr. Michael Weissman, and Dr. Carl Peterson of Children’s Hospital of The

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King’s Daughters about the state of local mental health services. The articles begin on page 16.

For some, COVID isn’t over after it’s over. The interview on page 20 with Dr. Lisa Barr discusses, among other topics, a pain management approach to long-haul

Having been used to treat cancer since 1990, proton therapy is part of the standard of care for many cancer types, is FDA-approved and covered by Medicare, Medicaid and most insurance providers. No case is typical and results may vary.

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COVID. The focus on COVID, however, didn’t mean other conditions and illnesses have been ignored for two years. Always looking forward, Dr. Alan Wagner, a nationally recognized ophthalmologist who specializes in vitreoretinal surgery, is currently conducting trials for an FDA-approved study into gene therapy to halt or even reverse certain blinding eye

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conditions including macular degeneration, diabetic eye disease, and stroke inside the PROSTATE CANCER SURVIVOR

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eye. Read about this groundbreaking treatment on the next page.

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to seek medical care if you need it.

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Having been used to treat cancer since 1990, proton therapy is part of the standard of care for many cancer types, is FDA-approved and covered by Medicare, Medicaid and most insurance providers. No case is typical and results may vary.

14 | JEWISH NEWS | Health Care | June 27, 2022 | jewishnewsva.org

Terri Denison Editor

Health Care

Alan Wagner, MD Local ophthalmologist is first in region to use gene therapy to halt/reverse blindness and other conditions wall of the eye, Wagner explains, and it dispenses medicine throughout the day.

It only needs to be refilled once or twice a year.

“It’s amazing,” says Wagner. “For the last 10 years, we have been injecting things inside the eye. Now we are putting a gene inside the eye and the body makes the medicine, and we have a device that eliminates the need for injections.”

In addition to gene transfer therapies, they are the only surgeons in Eastern Virginia that were involved in the

validating research of, and are presently implanting, this new technology.

Wagner Kapoor Institute and its Research Institute is the first practice providing these therapies in a four-state region. In addition, the Institute has a full-time geneticist onsite for the testing of retinal and ocular diseases such as macular degeneration—many other potentially blinding diseases are also inherited.

Having a family history of macular degeneration is not a green light to start gene therapy until the patient’s other risk factors are studied and their specific diagnosis and symptoms are appropriate for the treatment. “We do not give the

medicine prophylactically, and there are provisos, just like for any kind of treatment,” says Wagner.

The most important thing of all is early detection and prophylaxis. When it comes to blurry vision, Wagner states, see a professional immediately.

“With state-of-the-art science, we now have a much better understanding of the processes that make people go blind,” says Wagner. “We find the little places along all those different disease pathways to stop or reverse these conditions. That’s what drives our groundbreaking research.

It’s revolutionary!”

“For the last

Alan Wagner, MD.

10 years, Debbie Burke

T

hrough the Virginia Beach-based Wagner Kapoor Research Institute, local ophthalmologists and vitreoretinal surgeons Alan L. Wagner, MD, FACS, FICS, FASRS, AME, and Kapil G. Kapoor, MD, FACS, FICS, are conducting trials of an FDA-approved study into gene therapy to halt or even reverse certain blinding eye conditions including macular degeneration, diabetic eye disease, and stroke inside the eye.

“Most blindness is preventable, and frequently, reversible. If detected early, it can be stopped from getting worse,” says Wagner. “This gene transfer study is the first of its kind, and has been in trials for about six months.”

The technology involves implanting a new and proven small device that eliminates the monthly to every-six-weeks regimen of eye injections for macular degeneration and diabetic eye disease.

With a minor outpatient operation, a tiny reservoir of medicine is placed in the

we have been injecting things inside the eye.

Now we are putting a gene inside the eye and the body makes the medicine, and we have a device that eliminates the need for injections.”

jewishnewsva.org | June 27, 2022 | Health Care | JEWISH NEWS | 15

Health Care

New Children’s Pavilion at CHKD serves the community’s pediatric mental health needs Debbie Burke

C

hildren’s Hospital of The King’s Daughters opened its new $224 million, 14-story Children’s Pavilion on April 25. The facility offers a wide array of outpatient psychiatric services that include pediatric psychiatrists, psychologists, nurse practitioners, mental health therapists, primary care pediatrics, laboratory and radiology services, sports medicine, and more. Later this year, CHKD will launch its 60-bed inpatient psychiatric care program.

Carl Petersen, DO, is the chief of psychiatry and mental health services at Children’s Hospital of The King’s Daughters. He is dual board certified by the American Board of Psychiatry and Neurology in general and child and adolescent psychiatry. A retired U.S. Navy captain, his experience includes overseeing several mental health initiatives and programs. Petersen spent the last 10 years of his military career at Naval Medical Center Portsmouth, serving the last three as its director of mental health.

Here, he shares his insights with Jewish News, including keeping up with trends

and research in mental health, serving the community, and working to help families and children that are seeking treatment.

children have suffered from social isolation and family trauma caused by the Coronavirus pandemic.

Jewish News: When did the idea arise for this new building?

Dr. Carl Petersen: CHKD began expanding its mental health program in 2018 in response to parents asking for mental health treatment for their children, both directly and through community needs assessment surveys. Pediatricians within our system were also asking for help in treating a growing number of children coming to them with mental health concerns. Also, our emergency department was treating an increasing number of children who arrived in crisis because of a mental health issue, some of whom spent days in the ED while we searched for proper inpatient care for them. We broke ground on the Children’s Pavilion in September of 2019.

JN: What services/amenities will be available through the inpatient units once they are complete, and what is the timeline?

CP: The 60 inpatient psychiatric rooms will be private and will have room for a parent or caregiver to spend the night.

The inpatient rooms and gathering places on the unit have been designed to keep children safe, but still be full of light. The building has stunning views of Hampton Roads, a rooftop area where children can play and get fresh air, and healing amenities such as art and music therapy rooms.

Evidence-based treatments, an academic training program, and clinical research to guide mental health innovation for children will put the facility among the top pediatric mental health facilities in the nation. We will be phasing in the opening of the beds starting this fall.

JN: Comparing the building from concept to today, has pediatric mental health remained as prevalent an issue or become even more urgent?

CP: It has become more urgent because

Children’s Pavilion.

16 | JEWISH NEWS | Health Care | June 27, 2022 | jewishnewsva.org

JN: What are the most successful modalities today that help prevent suicide in minors?

CP: There have been few randomized trials on effective suicide treatment approaches in the pediatric population. This is an active area of research with a goal to identify the most effective interventions to prevent suicide. Screening children for suicidal thoughts or behaviors has been shown to be very effective. For example, universal suicide screening of all children being seen in emergency departments was recently found to be a best practice to help identify those children at risk of suicide, which is why we implemented such screening 18 months ago.

In the past, treatment for suicidal youth focused on addressing the underlying psychiatric disorders such as major depression, and suicidal behavior was viewed only as a symptom of the underlying disorder. More recently, treatments have targeted the suicidal behavior directly to reduce risk of self-harm. The challenge

Dr. Carl Petersen.

is most youth with suicidal ideation or attempts do not share this information with their parents or guardians, As such, effective screening of children for suicidal ideation is critical as is educating parents, educators, and teens themselves on the signs that a child may be contemplating suicide.

In addition to addressing the underlying psychiatric disorders, psychotherapeutic interventions such as Dialectical Behavioral Therapy and Cognitive Behavioral Therapy target the suicidal thoughts and behaviors directly, and have demonstrated effectiveness in reducing suicide-related behavior.

Additionally, limiting access to firearms has demonstrated effectiveness in reducing suicide.

JN: What are you looking for in a professional as far as knowledge, experience, and relatability to the patient and their family?

CP: Later this year, we will have 18 board-certified child psychiatrists, 11 child psychologists, 10 pediatric psychiatric nurse practitioners, and 20 pediatric mental health therapists on staff. All of these professionals have demonstrated expertise in the field and a commitment

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Health Care

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Additionally, as an academic program, we have carefully selected our team to ensure our providers are committed to continuous learning, education, and participating in research to help identify future interventions that help children and families. With respect to relatability, we are aggressively recruiting a diverse team of clinicians that understands the challenges different parts of our community face each and every day.

JN: How does a program measure its success in outcomes?

CP: We use several symptoms scales that have been validated in research to track treatment severity and improvement with appropriate treatment. In addition, we use quality-of-life measures before and during treatment to ensure our patients are improving.

JN: What are some misconceptions that a family may have about seeking/receiving treatment for a child with a mental health issue?

CP: One that is often repeated is that mental health issues in children are rare.

The truth is between one in four and one in five children will have a diagnosable

psychiatric condition. Over the past 30 years, a growing body of research has demonstrated treatment is highly effective. Early identification and intervention are important because these disorders tend to be more amenable to treatment when addressed early.

JN: What are your hopes for the facility insofar as serving the needs of the community?

CP: We are hopeful families and their children will not have to wait as long for mental health care, and that there will be a wide array of services to help children with mental health concerns. We want to provide a full continuum of care ranging from preventive care to outpatient care to more intensive inpatient psychiatric care to meet children’s needs at all stages.

JN: Other comments?

CP: The talented mental health team at CHKD is excited at the opportunity to build programs to help families in Hampton Roads and we appreciate the support of the community.

Children’s Hospital of The King’s Daughters Children’s Pavilion is located at 401 Gresham Dr. in Norfolk.

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jewishnewsva.org | June 27, 2022 | Health Care | JEWISH NEWS | 17

Health Care

Insight-centered approach to mental health An interview with Dr. Michael Weissman but pervasive. “It’s a huge growth step if a person approaches it the right way: I want to fix it, I want to grow.” While medicine tends to be illness-focused as if something is “broken” and causing a patient to feel they are “defective,” Weissman’s approach is to teach ways of coping that are effective, whether in one’s marriage, work, or for one’s own inner peace. “At some point, everyone has to look at themselves and say ‘I want to change.’ That’s a huge sign of strength.”

Dr. Michael Weissman.

Debbie Burke

J

udging by the waiting list of more than 400 people for Dr. Michael S. Weissman, Ph.D.’s outpatient practice, you would think there is a heightened need for mental health services today, and you would be exactly right.

According to the Chesapeake and Norfolk-based psychologist who opened a private practice in 1981, the last three years have felt like a “different era.” A general state of angst, he says, is evident, transforming what used to be a large number of patients with depression and anxiety into patients now presenting with an “overlay” of an overarching sense of “existential questioning.”

“We still dig for what is triggering a person’s distress,” he says. “Before, you could say ‘let’s explore why you are anxious.’ Now, you say ‘of course you’re anxious.’” Weissman helps patients develop tools to find their own purpose and meaning.

There are two major myths people tend to have about therapy before they start.

The first is that it is somehow a weakness or a crutch. That’s flawed, he says,

“I’m most hopeful about the significant increase in people who are now seeking help.”

The other misconception about therapy is that it’s a passive process; that the therapist will somehow fix you. “This couldn’t be further from the truth. Usually they realize ‘hey, this is not sit back and let the doctor do it.’ It’s a shared journey in mastery helping a person to learn new skills and to develop better character traits. They have to be very active in that process.”

In 2019, Weissman and Rabbi Mordechai Wecker co-authored a book called Therapy According to G-d (Mosaica Press). The idea for the book came at a moment when Weissman was attending Rabbi Wecker’s weekly class on Torah and noticed how integral faith insights from the Torah were to his daily practice (he is

18 | JEWISH NEWS | Health Care | June 27, 2022 | jewishnewsva.org

a secular practitioner, taking patients of all backgrounds and faiths).

“The book is a reflection of my entire career, but I didn’t know it until I became Orthodox. Both daily life issues and existential questions are best answered by digging into insights from the Torah about purpose, meaning, personal growth, and mortality,” says Weissman.

Even with the present state of the world, Weissman remains optimistic about the mental health field and how people can continue to learn, grow, and heal.

“I’m most hopeful about the significant increase in people who are now seeking help,” says Weissman. “Much of the stigma [over therapy] has softened or gone away.

It’s troubling that there is so much need, but more people are trying to find healthier solutions to reducing such symptoms as depression and anxiety rather than resorting to substances or allowing their feelings to manifest in acting-out behaviors. So many people are coming in with frustration and hopelessness watching the world crumble, and they feel ‘so what am I; what’s the point?’ In the Torah, each one of us is responsible for fixing the world through the development of our character traits, how we deal with problems, and how we treat other people.”

Weissman received his undergraduate education at Princeton University in 1970 and earned his Master of Science (1972) and Doctorate (1974) degrees from the University of Massachusetts in the field of Clinical Psychology. He completed a Postdoctoral Fellowship at Upstate Medical Center in Syracuse, New York, before moving to Virginia in 1975 to take a position as the first doctoral level psychologist at Maryview Community Mental Health Center followed by five years at Portsmouth Psychiatric Center.

He started his private practice in 1981 which has grown to two locations, one on Colley Ave. in Norfolk, and the main office at Churchland Psychological Center.

Excerpt, Therapy According to G-d

by Rabbi Mordechai Wecker and Michael Weissman, Ph.D. Chapter 3 “No One in My Family Gets Along” Both Jennifer and George state that their discussions get nowhere, and they realize that they have a severe breakdown in communication. They acknowledged that they both end up saying very hurtful things to the other…. They…are willing to try one more attempt at therapy with the goal of trying to address these communication issues as well as more deeply rooted underlying issues…. “…Jennifer and George…were presenting with a myriad of interconnected issues which result in a family which is always close to a state of chaos. In complex situations such as this, it becomes important to find a place to start which will allow both persons to feel that what they have to say counts, that their feelings are important, and that the other person in the relationship wants to understand their feelings. … [T]he starting place should be in helping them learn that there are proper ways to talk with each other as well as ways that are unacceptable, ways that never work, and therefore need to be first identified and then abandoned. …

[L]et us see what the Torah has to tell us. The Torah is infinitely rich in giving us rules for living which we have learned from how our forefathers conducted their lives, as well as from the commandments themselves.”

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hink about it: the world went through a pandemic, a lockdown, reintegration, new variants, social isolation, and financial uncertainty. Why wouldn’t anxiety be at an all-time high?

“The level of stress has exploded,” says Debra Mayer, LCSW, CT director of clinical services at Jewish Family Service of Tidewater. “Since COVID started, the trend we are seeing is that everybody across the country has a demand for service greater than the providers that are available. This is especially true in working with children and the elderly.”

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piled up on people.

The elderly are experiencing lots of isolation. For kids, it’s been difficult to not be around other children for so long.”

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JFS provides counseling services for people from ages two through 100.

Outpatient counseling is available for individuals, couples, and families. Currently, three full-time LCSWs and three parttime LCSWs are employed to provide the counseling. But for the first time in 25 years, there’s a waiting list for services, so it’s time to grow and Mayer says JFS is actively looking for more staff.

“There was always a shortage of mental health providers, especially psychiatrists, but that shortage has gotten worse,” Mayer notes. Family doctors and pediatricians are now stepping up to prescribe psychiatric medication because it can take three to six months to get an appointment with a psychiatrist.

“If a child is properly diagnosed with ADD [for example], most pediatricians feel fairly confident to treat that. But if the diagnosis is anxiety or depression, they really want them to see a specialist,” says Mayer.

When the COVID-19 pandemic began, JFS began to deliver counseling services

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Mayer is also a Certified Thanatologist (grief counselor), and she and her staff specialize in grief counseling. This includes coping with life transitions, divorce, and illness, as well as the death

of a loved one. For the past 21 years, JFS has also partnered with Edmarc Hospice to provide “Peace by Piece” which are free community support groups for grieving children and their families.

“So much of it has piled up on people,” says Mayer. “The elderly are experiencing lots of isolation. For kids, it’s been difficult to not be around other children for so long. Now that they’re back with other kids, it’s been hard for them to reintegrate.”

For more information, contact JFS at www. jfshamptonroads.org or 757-459-4640.

jewishnewsva.org | June 27, 2022 | Health Care | JEWISH NEWS | 19

Health Care

A pain management approach to long-haul COVID, gut issues, and what to know about medical marijuana Debbie Burke

S

taying on top of current research in pain management is very important to Dr. Lisa Barr, who has more than 30 years of experience as a board-certified physician treating patients in Tidewater with muscle, nerve, and joint problems related to sports injuries and degenerative conditions. The author of Outsmart Your Pain: The Essential Guide to Overcoming Pain and Transforming Your Life (Synergy Health Quest, LLC, 2018), Barr discusses with Jewish News the most common issues she comes across and what new research reveals.

Jewish News: What are the different types of pain and their causes that you typically see in your practice?

Dr. Lisa Barr: At the Barr Center, we

provide non-surgical treatment for low back and neck pain, as well as sports injuries and overuse conditions using traditional modalities as well as regenerative therapies. We also have a keen interest in functional medicine which seeks to assess the root cause of many diseases and conditions. This includes looking for nutrient deficiencies, hidden gut infections and genetic weaknesses that impact cellular function. As an offshoot of our functional medicine program, we recently opened an IV therapy practice with a focus on solving challenging problems like long-haul COVID. We also advocate the use of CBD products as the studies of the endocannabinoid system are overwhelmingly positive for reducing pain, improving gut function, and helping with brain function and mood, as well as supporting immune function.

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JN: With long-haul COVID, what should people know about for pain management?

LB: The primary concerns we see are brain fog and generalized fatigue. The reason people get long-haul issues is the effect of the virus on ACE2 receptors that ultimately cause vascular issues and inflammation that can impact any organ system. It also impacts the critical energy-producing organelles called mitochondria. Brain inflammation causes brain fog and mitochondrial dysfunction severely limits our ability to produce energy, causing fatigue. COVID also effects the gut microbiome which impacts production of the crucial neurotransmitters responsible for pain threshold.

JN: Concerning medical marijuana, what do people need to know about its use, including the legality of it for pain management as prescribed by a doctor?

LB: Marijuana and CBD are both phytocannabinoids. That means that they are plant-based substances that can influence our endocannabinoid system (the role of which is to regulate one’s ability to achieve homeostasis; by regulating the nervous system, it protects the immune system). Both marijuana and CBD come from the hemp plant, but each is bred to yield plant material with different features; some plants have more THC and others have more CBD. There are nearly 60 different phytocannabinoids and these are the most popular, but there is also CBN, CBC, and CBG which have different therapeutic effects.

The legal limit of THC in any phytocannabinoid in the US is < 0.3%. Anything higher than that is considered marijuana.

THC is a powerful pain reliever, but it is also a hallucinogen and potentially addicting, while CBD is not, so when we determine someone would benefit from a phytocannabinoid, we consider these factors.

Topical CBD salves are effective in treating pain in the neck and extremities as they are easily absorbed and provide an all-natural form of pain relief and reduced

inflammation. For more diffuse pain conditions, most patients start with full spectrum CBD gummies or tinctures and only if they don’t respond do they consider getting a medical marijuana card.

Products are purchased at a dispensary.

To obtain a medical marijuana card, you have to apply online through the Virginia Board of Medicine and have a physician’s support.

JN: What role does the gut’s microbiome play in pain?

LB: The gut microbiome is responsible for about 60% of our immune system. A healthy and diverse gut microbiome is essential for good health. When there is an overgrowth of certain bacteria or a significant deficiency, we can experience symptoms such as IBS and autoimmunity.

Pathogenic bacteria, viruses, parasites, and candida can cause pain, arthritis, gastric ulcers, IBS, cancer, and many other disorders. A simple stool sample can assess the health and diversity of one’s microbiome. The gut microbiome is linked to the gut-brain connection and that is why our gut is often referred to as our second brain. Think ‘gut instincts.’

They are real!

JN: Advice to people experiencing pain about how to find the right practitioner?

LB: Seek providers that focus on the root cause of pain so that the underlying cause/causes are addressed rather than simply treating symptoms. Make sure that your provider can distinguish between compensatory patterns and pathology, and address each appropriately. In other words, we can have an injury, and through our body’s innate protective behaviors, adopt painful postural and gait patterns.

At a certain point, these compensatory patterns can take over and become the cause of persistent pain.

The Barr Center for Innovative Pain & Regenerative Therapies is located in Virginia Beach. Visit barrcenter.com or call 757-578-2260.