Israel Health & Wellness Guide

Bizness Magazine's

Is Kupat Cholim Enough?

PROTECT YOUR FAMILY

with Health Insurance Experts Egert & Cohen ALTERNATIVE MEDICINE I THERAPISTS I COACHING I FITNESS I DIET I NUTRITION DOCTORS I DENTISTS I EYE CARE I SPA I MASSAGE I INSURANCE I EDUCATION

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CONTENTS E D U C AT I O N

Machon Givolim Developmental & Educational Challenges

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Avigail Gimpel ADHD, Curiosity & Respect to Diagnosis & Intervention 10

Sasson Chacoty Insurance Must-Haves

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Maaneh Can You Keep a Secret?

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Tsipi Egert Rheumatic Diseases in Children and Young People

Zarchin Institute Conquering Severe Dyslexia

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Meshi Courage, Love and Super Heroes

Chaim V Chessed Therapy Through Your Kupat Cholim

12

Yonah Pollak How to Break Through Denial in Addiction

David Kronish Communicating Effectively with Your Teen

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Yonatan Sapir Take Control of Your Anxiety

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Rachel Gottesidener Life as Children Should Know It

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Judah Katz Embracing Who We Are

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43

Abby Weisz Communicating Healthy Intimacy to Our Children 70

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A LT E R N AT I V E M E D I C I N E

Shana Neril Insights from Jerusalem Naturopath Zalman Medwed Back Pain Prevention and Spinal Health

Aryeh Feldstein Getting to Know Your Pain 71

FITNESS & NUTRITION

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Rivka Matluk Better Living Through Exercise

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18

K'chudo Shel Machat Chinese Medicine and Optimal Health

Xperience Senior Enrichment

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20

Dr. Reuven Rosenberg Factional Lab Testing to Cure Illnesses

Aliza Eisenstein Heal Your Relationship with Food

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22

Tamar Zakon Chinese Medicine in Fertility Struggles

Jerome Wojtalik Change Your Mind About Fitness

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24

Sky Gym The Sky’s the Limit

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Dr. Nimrod Liram Hi-tech to Healing Back Pain Mordechai Katz Pathway to Optimum Health Paul Shrell-Fox Cognitive Psychology and Chinese Medicine

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THERAPY

27

Hillel Zeren Dialogue and Collaboration

28

Sharon Wolfman Pelvic Floor Dysfunction

INSURANCE, ORGANIZATIONS AND SUPPORT

Yehudit Kushelevsky Should I See a Psychologist?

Shimon Cohen Basic Life and Supplemental Health Insurance 30

Ephraim Portnoy Facilitating Real, Lasting Change

Dor Yesharim Eradicating Genetic Disease

Dr. Natalie Gar Overcoming Anxiety with CBT

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Freyda Weis Oral Motor Speech Therapy

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Shoshana Shinnar Enjoy Life in the Golden Years

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Zehava Waltzer All Work and All Play

75

Batya Jacobs Playing with Problems

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DOCTORS, DENTISTS & EYE CARE

Naomi Vision Boutique Behind the Frame, Beyond the Eyes

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Gedalya Shindler How to See Effortlessly

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M A S S AG E

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Eran Karnieli Harmony Through Supportive Touch

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Udi Rothstein The Magic Touch of Baby Massage

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P R O D U C T S & S E RV I C E S

Bunye Fridman Nursing Your Baby

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Letter from the Editor

Editor in Chief Ariel Topf

Chief Business Development Yisroel Meir Simon

Managing Editor Aviva Sapir

Assistant Managing Editor Lori Fagelston

Administrative Assistant Shira Simon

Business Development Binyamin Simon

Yitzchak Bassous Gila Block

Chaya Hyams Estie Lindner Sharon Miller

Social Media Director Devorah Benarroch Social Media Manager Elie Mendlovitz

Chief Design & Layout Matt Mildinovick

Maya Mildinovick

Graphic Design Chaya Feldman

Tova Siegel

Contributing Editors CY Frankel

Daniella Levy

Heidi Tapnack

To reach us: 02-999-3938

healthandwellnessguide.biz

Dear Reader, Over the last eight years, we have been publishing quality magazines, guides and catalogs, incorporating insightful content and practical information on local professionals and service providers for the English-speaking community in Israel.

We are therefore excited to bring you Health & Wellness, a guide that focuses on everything you might need for your health and wellbeing. Whether you’re looking for an expert in conventional or alternative medicine, therapies, fitness, or just want to get support for you or your loved ones, the Health & Wellness guide offers you tips, practical advice, and a directory to the top-quality local service providers in all areas relating to your health. You’ll find all the information you need and a little bit more—all that’s left for you to do is make a call.

Limited copies of this edition are available upon request.

To your health!

Ariel Topf The Health & Wellness Guide has a corresponding premium website and a Facebook page that will be constantly updated and expanded.

Visit us at healthandwellnessguide.biz Health providers who we could not accommodate in this edition are warmly invited to contact us now for an immediate feature on our website and Facebook page.

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Education

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In Every Sense:

The Givolim Institute’s Extraordinary Approach to Resolving Developmental & Educational Challenges Nurit Zucker and Tirza Ben Yaacov of the Givolim Institute explain how what we perceive through our senses in early childhood shapes our temperament and ability to cope with stimuli in our environment.

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e all hope our children will do well in school and in life; that they will pass the necessary milestones on time, master the required skills for their age groups, and form strong and supportive social connections. We hope they will be attentive and obedient in class, and energetic and well-loved in the playground.

This is our general image of a healthy, well-adjusted child who will grow up to become a successful adult.

But what happens when our children don’t exactly fit this image?

We first encounter this anxiety as soon as we receive positive results on a pregnancy test, and we experience it over and over, with increasing intensity, at every doctor’s visit and ultrasound scan; when waiting for the pediatrician to pronounce our newborn’s Apgar score; at every Tipat Chalav visit, and at every parent-teacher meeting. Is our child gaining enough weight? Is he meeting his developmental milestones? Is she performing the tasks expected of a child her age? Does he have enough friends? When we see a wrinkled brow or a slight frown on the faces of one of these professionals, our stomachs might clench in fear. What now?

Doctors, nurses and educators may suggest methods and solutions for dealing with any delays or problems that arise. The kupot cholim offer various subsidized therapies, depending on the nature of the issue. However, there are some problems that seem so vague and non-specific that these professionals might shrug their shoulders and chalk it up to a child’s individual temperament, claiming that that’s not something anyone can change.

Nurit Zucker and Tirza Ben Yaacov of the Givolim Institute would beg to differ.

Givolim is a therapeutic and educational center based around a method called NDFA (Neuro-Developmental & Functional Approach). Developed by psychologist Rami Katz, NDFA is a groundbreaking approach to addressing a wide variety of difficulties, from motor issues to speech development to ADD to social adaptation. Many of their clients have been able to cut back or eliminate the use of medication such as Ritalin or sleeping pills as a result of

their work. The method centers around two principles: infant development, and balance and regulation of the 15 sensory systems in the body. Through very precise physical exercises, NDFA therapists are able to counter and correct any irregularities that took place during a child’s early development, and retrain the brain and the nervous system to balance and regulate the senses.

“Where is one’s temperament born?” asks Nurit. “We might easily label a child as naturally jittery, attention-seeking, forgetful or a daydreamer. But our temperament doesn’t come out of nowhere. It develops in response to the stimuli in our environment—starting in the womb, with our sensory experiences as a fetus, and moving forward with the connection to our parents and our experiences of the world. Our senses have a central part in our perception of the world and in shaping our temperament.”

Nurit first encountered NDFA through her work at a preschool. She asked her mother, Tirza, to help her find out where to learn NDFA therapy as a profession, and they discovered Rami Katz, who invited Nurit to participate in a training course. Undaunted by the fact that her oldest son had his brit milah the day the course began, Nurit simply brought her newborn along with her to begin her studies.

Her mother Tirza tagged along as caretaker for the baby, but

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Rami invited Tirza to participate while the baby slept, and so mother and daughter trained together.

Up until that point, Tirza had been working as a music and rhythmic teacher for preschools: “I worked with a bunch of different preschools, especially on Chanukah and end-of-year parties with my accordion, and the kids who had trouble functioning during the parties were always my favorites,” says Tirza. “I was always most drawn to them.”

Born in Kibbutz Yavne, Tirza and her husband became religious when their eldest sons—twin boys—were two and a half. They went on to have four more children; Nurit is their fourth child. They lived in Mesuot Yitzchak for many years, and then, 25 years ago, moved to Efrat.

When Nurit and Tirza graduated Rami Katz’s program, they began seeing clients in their home in Efrat, with Tirza gradually transitioning from her work with the preschools to full time at their home clinic. That clinic developed into the Givolim Institute, which currently includes a therapy room, an office, and three classrooms for Gan Givolim, a private preschool run according to the principles of NDFA. According to the Neuro-Developmental & Functional Approach, the milestones that may seem rather arbitrary to us reflect a neurological process of proper development that can affect all areas of functioning. Nurit explains, for example, that a baby’s process of learning to roll front to back and back to front in both directions is critical for building and maintaining symmetry in the neurological networks within the brain. A baby who rolls in both directions is more likely to crawl well, with synchronized movements on either side, further contributing to neurological symmetry. This symmetry and synchronicity, Nurit explains, makes our brains into a sort of tight sieve that doesn’t lose information. Holes in the sieve resulting from asymmetry or irregularity can cause the child to experience difficulty with recall.

One example of a sensory system that affects a child’s development is the vestibular system. This is the system that helps us detect where we are in space—our orientation relative to the ground, general motion, and sense of balance. Many of us have experienced the effects of a disruption in our senses related to the vestibular system when we get motion sickness; motion sickness results from the conflict between the signals from the vestibular system, which is telling our bodies that we are in motion, and our visual system, which perceives that we are sitting still in a car or boat.

“The vestibular system is a huge center of information located behind the brain stem on both sides, and its central location controls five main areas of human functioning,” explains Nurit. “Sleep and wakefulness, for example, and our sense of hunger. We check the functioning of the vestibular apparatus by having the patient roll forward and side to side and spin in place, since when we move, the vestibular system moves. We might be able to treat a

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baby who has trouble sleeping or who eats but doesn’t seem satisfied by assigning exercises that help create balance in this system. Another example would be a child who always speaks too loudly—that’s hyper-arousal, also connected to the vestibular system. Activities connected to eye movement, like reading and writing, are also connected to this system. Reading requires a very precise and synchronized linear movement of the eyes, and when this is out of balance, children struggle to read.”

Another sensory system with a lot of influence is the tactile system, which involves the perception of light touch and personal space. Nurit explains that this system is connected to fetal development, since our first experiences with gentle touch take place in the womb, and our ability to connect intimately with others evolves from this primal relationship. Nurit says that many of her clients’ parents mention that they have been in couple’s therapy for a long time; a lack of balance in this system is often passed from parent to child, since it revolves around a child’s sense of connection to its mother. In this way, by working with the body, Nurit and Tirza are able to address emotional and psychological issues as well as physical ones.

“Our bodies are like trees, where the roots are our senses, and the fruit are our symptoms,” Nurit explains. “Very often, if we address the problem at the root, the fruit resolve themselves.”

In general, parents who bring their children sometimes discover that they, themselves, have imbalances, and Nurit and Tirza are happy to assign them exercises and assist them.

While all this may sound like magic, it’s important to Nurit and Tirza to emphasize that the method involves work and requires commitment.

The Institute provides evaluations and packages of 16 50-minute treatments. Though NFDA therapists have been working within the education system for a while now, the method is relatively new and has not yet been recognized as effective by kupot cholim or insurance companies, so treatments must be privately funded. Givolim offers special discounts for families who struggle to pay the full price.

“We strive to provide parents with the skills and knowledge to work with the child themselves,” Nurit says. “Parents who come with one child may discover that their other children struggle with similar issues, and we hope that the tools we provide for the one child will be helpful with the others as well.”

“Our ultimate goal is to channel light into homes that struggle with various challenges,” says Nurit. “For every mother to know how to be a ‘lighthouse’ for her home.”

Tirza adds, “We want every family to have access to this light, and for it to penetrate into all educational institutions, so every teacher will know how to assess and respond to challenges with her students so they can approach their studies and their lives with joy.”

For more information contact Machon Givolim at 054-671-3010 or through their website givolim.com

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ADHD Reintroducing Curiosity & Respect to Diagnosis & Intervention The trend for dealing with ADHD is treatment through medication such as Ritalin. Avigail Gimpel - founder of Hyper Healing, advocates a holistic approach to diagnosis and intervention, based on curiosity and respect—an approach that in her experience is safer and far more effective.

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The causes of ADHD are as yet unknown. It is suggested that ADHD is hereditary and associated with a brain chemical imbalance. “However,” Avigail, educator specializing in ADHD, points out “causality is quite murky. Despite enormous efforts by psychiatry and pharmaceutical companies, the brain chemical imbalance theory remains a theory—it has yet to be scientifically proven.”

Every week, Avigail is contacted by parents who are unsatisfied with medication or are concerned about side effects. Indeed, Ritalin does not seem to “fix” these kids. At best, stimulants act as a bandage covering up “bleeding” from ADHD symptoms, while sometimes causing extensive side effects. And although many children initially get a major boost from the medication, the progress often fades over time.

A HOLISTIC APPROACH ADHD is not a stand-alone disorder, but a list of neatly-packaged symptoms tied together by the American Psychiatric Association. It doesn’t have one simple cause. Rather, symptoms occur due to many complex factors, including environmental, physiological, social, and emotional stress.

We all deserve the respect and patience to discover the root causes of our challenges and the tools to overcome them. Avigail’s assessment of a new client begins with the assumption that she is meeting a healthy person who is struggling. The question she asks is “Why is he suffering?” and not “What is her disorder/diagnosis?”

By listening carefully to each client’s personal story, Avigail is able to peel back the layers of complexity and provide a more accurate and holistic diagnosis. She investigates by asking questions about underlying health issues, allergies and food intolerances, trauma, learning disabilities, sleep habits, amount of screen time, and many more contributing factors. She is then able to set up an intervention plan that takes all elements into account.

“I consider myself a wellness detective, looking for clues within the story,” Avigail says.

YOU CAN! The trend for quick diagnosis and then medication stunts growth and instills in the sufferer a feeling that they “can’t”—that there is something inherently wrong with them and that there’s no point in trying. “We have to stop telling our kids who have been diagnosed with ADHD that they can’t!” Avigail urges. “Let’s make a commitment today to say ‘Focusing and concentrating and sticking with a process are hard for you right now. But you can do it with

help and support.’ Let’s give our kids the privilege of working hard towards a worthwhile goal instead of branding them with ‘You can’t!’”

SPECIAL ENERGY Avigail began her career as a special education teacher in an inclusion classroom, with children of all ability levels, unique gifts, and challenges. She recalls, “I loved all my students, but the most intriguing were the students with ‘special energy,’ the ones who were trying to drink from a waterfall instead of a glass. These are the kids who dream all day, but then say something that no one else thought of; the ones whose engines run on instant gratification and have not developed habits and routines to focus their explosive energy.”

The children were creative, funny, out of the box and… struggling. They had trouble with follow-through, organization, social skills, routine, and emotional regulation.

“It was time to fill their tool kit with strong skills and habits,” says Avigail. “I developed an intervention program full of novelty, discovery, structure, responsibility, routine, and faith in each child’s ability. My special energy kids began to flourish.”

Hyper Healing offers five tracks to cater best to the clients specific needs: Adult clients with ADHD symptoms, couples struggling due to ADHD behavior in one or both spouses, parents of children with ADHD symptoms, 7-part series workshop for parents of children with ADHD and a 12-part series for educators.

ABOUT AVIGAIL Avigail Gimpel, M.S., is an educator who specializes in ADHD and founder of Hyper Healing, a holistic approach to diagnosing and treating ADHD in children and adults.

She is a college lecturer, practitioner in private practice, and parent educator, with a master’s degree in Special Education and further certifications in Special Education with focus on Dyslexia, Instrumental Enrichment, and MLE. Avigail can be reached at 054-441-3295 or at hyperhealingadhd@gmail.com Visit her website www.hyperhealing.org

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Beyond Words: Conquering Severe Dyslexia

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arents who have taken their kids to the Zarchin Institute describe it as a place where miracles happen.

A child walks in with a severe learning disability diagnosis and dismal educational prospects… and a few months later, he walks out able to fully integrate into a normal learning environment. It’s not that we teach patients a new approach,” says founder Michael Zarchin. “Rather, we connect them with and lead them to discover the potential that already exists within them, as an integral part of who they are.”

“The act of reading requires the integration of three components: vision, sound, and the cognitive ability to interpret signals. The Zarchin Method works on the principle that learning disabilities result when there is a disruption in the coordination between these components, and that the solution is to correct the disruption at its root.

“The therapist is a sort of orchestral conductor,” Michael explains. “The orchestra is composed of many musicians, each of whom play different instruments. The client has many instruments—senses—but they do not always work correctly and are not always well-timed. The conductor’s job is to ensure that all the instruments function correctly and with the right timing to create pleasant music.” Treatment combines conversation with games that develop coordination, visual focus, and processing of visual signals.

For example, playing a game of catch while having a lively conversation helps combine visual focus with hearing and motor coordination, and the distraction of the conversation helps the client integrate automatic skills of signal processing.

The Zarchin Method was born from bitter personal experience. Michael Zarchin himself suffered from a learning disability so severe, he couldn’t read or write until he was 16 years old. His first-grade career was extremely shortlived; when the teacher asked him to write something on the board on his very first day, he threw the chalk at the board, fled, and never went back. He spent the next ten years drifting in and out of various institutions, trying to fit in and hide his illiteracy from his classmates. All along the way, he was supported by his mother, who was completely determined that he would one day learn to read.

Then, when he was 16, she finally made the discovery that changed everything.

Dr. Jerry Getman was a doctor in Philadelphia who had developed a theory on developmental vision; an idea that turned everything everyone knew about learning disabilities on its head. Every other method—even those that exist today—is based on the idea that learning disabilities must be managed or worked around. According to Dr. Getman, they could be treated at the root… and cured.

Michael and his mother flew to Philadelphia for an evaluation with Dr. Getman, and he found that Michael had a rare combination of high intelligence with a complex learning disability. He advised them to go to his student, Dr. Stanley Abelman, for treatment. Within six months, Michael was reading.

He returned to Israel at the age of 17 and served in the IDF, eventually joining the family textile business.

During that period, he wrote to the Lubavitcher Rebbe with a business question, and the Rebbe advised him to write his life story. This had never occurred to Michael, and he shrugged it off.

Ten years later, however, a friend of his asked Michael to help his child who suffered from a learning disability.

Michael worked with the child and discovered that he had the ability to help him. He began offering his services professionally, eventually developing his own unique method and founding the Zarchin Institute: a center for the treatment of learning disabilities of all kinds, including dyslexia, dysgraphia, dyscalculia, ADD and more. As of today, more than 1000 children, teens and adults with learning difficulties have received treatment through the institute and gained the ability to function completely normally in their learning and work environments.

Michael also eventually did as the Rebbe advised, and committed his story to paper: his book, Hashlichut Sheme’ever Lamilim (“The Mission beyond Words”), was published by Modan/Misrad Habitachon.

In addition to treatment, the Zarchin Institute offers a course that trains therapists and educators to use his method. The course is offered through the institute, and is additionally part of the special-ed B.Ed. programs at Michlala Jerusalem, Beis Yaakov and Beis Rivka Colleges.

When asked for advice for parents of children with learning disabilities, Michael emphasizes the crucial role the parents play in the success of their children. “It is important for parents to believe in the potential of their child and encourage him. This supports the process of bringing the potential to actualization.”

ABOUT THE INSTITUTE The Zarchin Institute offers solutions for a wide variety of learning disabilities, including dyslexia, dysgraphia, dyscalculia, ADD and difficulties with reading, writing, reading comprehension and written expression.

For more information contact them at 050-420-0291 or www.zarchin.org

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Courage, Love and Super Heroes Some parents just want their children to be average. Ordinary. Others want them to pursue extraordinary goals. But all agree that no other person in the world is exactly like their child and no one else in the world can fulfill their unique purpose. Each child is unequivocally irreplaceable. Precious. One of a kind. And we thank God every day for this gift.

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ome children, however, are unintentionally extraordinary. Their severe disabilities—either from congenital neurological disorders or as a result of a debilitating illness or injury—make them a unique type of extraordinary, more irreplaceable and exceptionally precious. Meshi Children’s Rehabilitation Center overcomes seemingly insurmountable challenges, and enables these children to live an ordinary childhood in the most extraordinary way.

Meshi was founded in 1998 by Hadassah Zuravin and her daughter Lifsha Feldman, who refused to accept a neurologist’s dire prognosis for their granddaughter and daughter, Ruchama. Although the infant’s disabilities seemed overwhelming, Hadassah and Lifsha set their sights on creating an unparalleled rehabilitation center for Ruchama and countless other children for whom no other framework existed.

Meshi originally worked in partnership with Jerusalem’s Alyn Hospital until Meshi’s growth compelled the establishment of its own facility, the Donald Berman Meshi Educational and Rehabilitative Center. Soon, families residing outside of Jerusalem began to enroll their children at the Center, and children from across the world joined Meshi’s intensive summer therapy ses-

sions. By 2003, Meshi’s student population had grown in number and age, prompting the opening of the Meshi School, which today serves grades one to seven. Currently enrolled in the program are 210 children ranging in age from six months to 17 years and the Center is one of the very few to serve children under age three in a daycare and nursery school environment.

“Meshi’s mission is to provide comprehensive early intervention for children with neurological, muscle, and nervous system disorders,” says Rav Asher Zuravin, Director of Meshi. “Severely disabled means they are unable to walk, speak or eat.” The unflagging, grassroots efforts of Meshi’s founders, staff and parents have made Meshi Israel’s leading early childhood development center. The personal, one-on-one attention, innovative and pioneering techniques, state-of-the-art equipment and wide range of intensive therapies—including physical, speech and communication, occupational, music, animal-assisted and hydrotherapy—combine to create an unprecedented therapy and educational framework.

Atara Taragin, one of Meshi’s physical therapists, is emotional as she talks about the staff’s excellent credentials and wealth of experience, alongside abundant dedication, encouragement and love for the children

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and their colleagues. “I don’t know exactly where it came from or how it started, but there is a certain level of love in this place that you don’t see anywhere else. You can see it on the children’s faces. They’re happy, they feel accomplished and they feel good about themselves. They surpass all expectations.”

Children whose parents had been told with grim finality that their child would have zero chance of talking or learning to walk, are taught to master these elementary skills, and much more.

“Each child is unique and has his or her own individual circumstances and needs,” says Dikla Gol, Director of Occupational Therapy at the Meshi Preschool, “Which is why we design a custom-tailored program with a unique therapy mix where the number and type of therapy sessions is determined individually for each child so they can fulfill their full potential.”

I don’t know exactly how it started, but there is a certain level of love in this place that you don’t see anywhere else. You can see it on the children’s faces.

They’re happy, they feel accomplished and good about themselves.

They surpass all expectations.

Miriam Falk, mother of 9-year-old Elazar, shares her experience at Meshi: “I watch my son who is disabled and living on a respirator, participate independently in activities. Meshi taught him how to communicate using symbols and letters, and within a few months he could spell words and express himself like any other child his age.

I used to observe his individualized therapy session and watched in awe as Elazar communicated, read, engaged in educational games, and even checked and responded to email completely independently, by use of a computer that tracks his eye movements. I witness him actively and enthusiastically engage in his classroom discussions – asking questions and suggesting answers – like any other child his age.”

Having a special needs child is demanding both economically and emotionally. Even minimal tuition is a hardship for families. But Meshi will never turn a child away because of insufficient finances and receives broad support for its extensive therapeutic and educational programs both from the Israeli government and generous donors, with limited parental contributions. “The government thinks so highly of the work Meshi does, that it provides us with approximately $5 million of our $7 million budget. They just recently gave us land in Ramat Shlomo in Jerusalem and agreed to cover close to 70% of the estimated $20 million construction costs for the new campus and building,” says Zuravin. Meshi helps parents

identify psychosocial problems through home visits, assists families in applying for government entitlements, and navigate the complex and often overwhelming government bureaucracy.

Driven by their lionhearted souls and extraordinary potential, Meshi remains steadfastly dedicated to giving severely disabled children a chance, with respect and love. A chance for a childhood and a future. A chance to be ordinary. Or to be extraordinary. To be children. To be human. To be the very best that they can be. To be happy.

Frankly, that’s what all parents want. And really, it’s more than enough.

ABOUT MESHI Meshi is an unparalleled Children’s Rehabilitation Center in Jerusalem.

For more information and donations, visit their website at www.meshicenter.org

PROFILES

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RAC H E L KO E NI GSON Field

YEARS OF

Alternative Medicine

PRACTICE

Specialty

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Personal Trainer, Massage Therapist, Acupuncturist, Cosmetic acupuncture Education

Wingate Institute Rachel Koenigson understands that life can be dynamic and stressful. As a personal trainer, masseuse and acupuncturist she is well qualified to teach clients multiple ways to adapt healthy lifestyles, ease day-to-day stresses and then treat and bring bodies to equilibrium. Rachel does personal training at clients homes and the King David Hotel gym. She also runs massage technique workshops and treats clients for various ailments through acupuncture.

MOTTO

Listen, Advise, Heal

Location

Jerusalem Area

Contact info

054-787-2151 www.rachelshealthandfitness.com

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Alternative Medicine

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Tapping into Your Body’s Wisdom for Optimal Health

Insights from Jerusalem naturopath, Shana Neril

“The body knows what it needs to create vibrant health and the times we are living in demand that we access our body’s ability to heal itself.” says Shana Neril, director of Maayan Health.

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hana has been involved in holistic health for over 15 years. After completing her B.A. in psychology at New York University, she studied Ayurveda, detoxification therapy and meditation instruction at various institutions in California. Later, she studied Naturopathy, Nutritional Counseling and Chinese Medicine at Reidman College as well as Health Kinesiology in Jerusalem. After taking on a religious Jewish lifestyle and making Aliyah, Shana established the Maayan Health Center in Jerusalem.

WHY DON’T PEOPLE FULLY HEAL? According to Shana, toxins, poor digestion, nutritional deficiencies, old injuries and genetic weakness are among the most common reasons that prevent people from healing on the physical level. One can also have blocked energy on the spiritual and emotional level that can prevent a physical condition from healing.

“Many people’s attempts to eat healthily may be undermined by poor nutrient absorption due to weak digestion.

Often, old injuries create tissue weakness. This can be a root of persisting health issues. Many people also take synthetic supplements which may not be resonant with their biofield.”

A study testing herbal products using DNA barcoding found that ingredients not listed on the label occurred in 30 of the 44 products. Only two of the twelve tested companies sold products without any substitution, contamination or fillers (BMC Medicine, 2013).

Shana explains that the extent to which a clinician can offer remedies of the highest efficacy is of extreme importance.

“A correct diagnosis with incorrect or poor-quality remedies is a key factor why many people remain ill.”

For example, Esther came to Shana to address chronic colds and food intolerances. Esther ate a healthy diet and had tried taking a number of supplements. Shana muscle tested her and discovered that her lungs and large intestines were weak. She also found that a previous cesarean section had contributed to a weakening of her digestive organs.

After a month of taking the foods and supplements that tested resonant with her biofield and receiving a treatment that restored function to her digestive organs, Esther no longer had frequent illness and she began tolerating many new foods.

At Maayan Health, Shana Neril draws primarily from quantum reflex analysis which strengthens weak organs through identifying the most effective remedies and detoxification therapy which causes damaged body tissue to regenerate and heal.

Additionally, she draws on Chinese medicine, applied

kinesiology, and functional medicine for diagnosis and treatment options.

Together, the integration of these modalities has enabled Shana’s clients to heal from situations relating to metabolic issues like insulin resistance, heart disease, and obesity; digestive issues like reflux, IBS and colitis; hormonal imbalance such as PCOS, premenstrual syndrome and difficult menopause; and issues relating to chronic pain and autoimmune disorders.

GOING BEYOND THE PHYSICAL Research from Carnegie Mellon University in 2012 found that psychological stress had a direct impact on the body’s ability to regulate inflammation. This showed that stress can cause disease to develop or worsen. Through the use of techniques for spiritual and emotional healing, Shana has consistently seen physical ailments heal or significantly improve.

For example, Sarah, who suffered from joint pain, depression, and allergies, shared that soon after her divorce there was a significant worsening of her ailments. In addition to balancing the organs that muscle tested weak with the appropriate nutrition and supplements, they worked together on the internal factors that had been putting her under tremendous stress. After three months, Sarah was pain free, her allergies had subsided and she had unexpectedly lost weight. Additionally, she felt a new sense of empowerment!

“I believe in empowering people with the knowledge and tools needed to take healing into their own hands, and self-sustain vibrant health of body, mind and soul,” Shana emphasizes “Vibrant health is our birthright.”

ABOUT MAAYAN HEALTH Maayan Health, founded by Shana Neril, is a premier Jerusalem-based naturopathy and healing center. Integrating diagnostic and therapeutic tools from a wide variety of disciplines, Maayan Health tailors an individual approach to assist each client in achieving optimal health. In addition to her private clinic, workshops are held regularly on topics such as detoxification, weight loss and breaking sugar addiction for the Jerusalem community.

Shana can be reached at 054-771-9432 www.maayanhealth.com shana@maayanhealth.com

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IMPROVE YOUR POSTURE: The master key to back pain prevention and spinal health Good posture not only prevents back pain and promotes spinal health, it also helps us breathe, think and look better; and be more positive, confident, and productive.

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By Dr. Zalman Medwed with Shaina Medwed

ust as the spine is the foundation of our body’s structure, good posture is the foundation of spinal health.

Yet, poor posture and its damaging effects on the spine and overall health are epidemic. This is due primarily to a lack of awareness of how sedentary lifestyles both at home and work, combined with prolonged sitting in ways that produce spinal slumping, cause harm and increased risk of injury. In fact, back pain is the second- leading reason for visits to family doctors in the USA. This article briefly presents four simple steps to help you begin to achieve good sitting posture—even as you read this!

Step 1 Understanding Our Form Our spine is formed with three curves. From the side, these curves look like an elongated “S,” with the head aligned directly above the shoulders and hips. In a healthy spine, these curves bend forward at the neck, backward at the upper back and forward again at the lower back. They serve as shock absorbers that allow us to carry the heavy weight of our bodies effortlessly. They also protect the health and function of our spines. We achieve good posture by developing the habit of maintaining these curves in correct alignment during the course of our day, whether we are sitting, standing or performing our daily activities.

Step 2 Awareness: The Foundation of Good Posture At this moment, while sitting, bring your awareness to your posture. Is your lower back slumped, head lurching forward from your shoulders, shoulders tight? Do you feel any discomfort, tension or “creakiness?” Do you sit for hours hunched over a computer? Are you concerned about your appearance or an increased spinal curvature in years to come?

Now, let’s create an experience of good sitting posture.

Reposition yourself so that you’re sitting safely but close to the edge of your seat, feet on the floor, slightly pulled in from your knees. If your head is bent in front of your shoulders, become aware of the realignment of your spine as you raise your head and position it directly above your shoulders. If your lower back was sagging backwards, it will have realigned forwards.

Now, take a deep breath. Visualize an imaginary string attached to the back of the crown of your head, gently stretching you up towards the sky, lengthening the back of your neck and your entire spine. Allow your shoulders to relax down and slightly back. Feel the balance.

This elongated feeling gives height, form and health to your spine and always accompanies good posture. To recall this experience, imagine the string and say to yourself: “Sit tall!” Congratulations on your first encounter with good sitting posture!

Step 3 Support Good Sitting Posture If you are currently in pain, avoid any exercise that makes it worse and consult a specialist.

“Sitting tall” is the model form of good sitting posture.

You do not, however, always have to sit on the edge of your seat. To achieve good alignment, proper pillow support of the curve of your lower back will prevent spinal sagging and allow you to maintain the ease and comfort of “sitting tall”. This means that the pillow must have a shape and thickness that will produce a feeling of good support, comfort and ease. Experiment with a variety of chairs and pillows in your home to find the combination that gives the best support. Couches always need more than one pillow.

Step 4 Posture Reminders Integrating new habits requires repetition and reinforcement. Post notes and set your phone to remind you to “sit tall” once per hour.

Honor the form of your body, in position and movement. Its design is wondrous, awesome, replete with divine wisdom, and leads us to healing.

ABOUT DR. MEDWED Dr. Zalman Medwed. DC, developer of Light Touch Chiropractic Methodologies and The Posture Improvement Program, is an American trained chiropractor with 35+ years of experience. Dr. Medwed receives patients locally, nationally and internationally. His unique, non-force, exceptionally gentle protocols are particularly suited for delicate and difficult conditions and offer pain relief, healing and restorative movement to people of all ages. This article has introduced you to a “Posture Improvement Program.”

For more free information in this series and to find out about Dr. Medwed’s posture seminars, send your email to zalmanmedwed@gmail.com. Dr. Medwed can be contacted at 050-415-4317, 02-654-0246 or www.jerusalemlighttouchchiropractic.com/

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Looking for the Right Doctor?

How Chinese Medicine Helps Us Achieve and Maintain Optimal Health

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hen we or our loved ones are ill or suffering from a health problem, it is natural that we seek the assistance of a medical professional.

Maybe your child has caught a cold. Maybe your parents have high blood pressure or diabetes, or a friend is suffering from depression. These are just a few examples of situations where we need to seek help from a medical professional. But how do we know who to turn to?

Who we see may not seem to matter in the grand scheme of things, but the truth is that the person who attends to our health has a tremendous influence on the process of healing and the maintenance of our health. It is therefore extremely important to choose your practitioner wisely.

Living a good, healthy life is important to all of us. We are born with a lust for life and with a basic desire to minimize our suffering and pain. We only live once, so we want to live it right—and in order to do so, we should not wait until we have an illness that is limiting us, slowing us down, and causing suffering before we seek care.

Instead, we can prevent our health from deteriorating in the first place by investing in its ongoing maintenance.

HEALTH IS BALANCE Traditional Chinese medicine is an ancient source of wisdom that can help us understand what it means to maintain good health, and thus how to choose a practitioner who can help us achieve that goal.

The first chapter of the internal medicine book “Su Wen” recounts a conversation between The Yellow Emperor and his physician. “I heard that in ancient times, humans lived to a remarkably old age, still walking tall and with great energy, while people today become weak before they have even reached their sixties. Why? Has the world changed and begun to have a negative effect on man, or has man himself gone astray and failed in his deeds?” The wise healer responds: “In ancient times, man knew how to walk correctly, and understood the balance between yin and yang, the earth and the heavens, and they lived in harmony with nature and knew how to conduct their deeds according to its laws. They ate and drank in moderation and maintained a balanced and regular way of life.”

The physician asserts, “Living in conflict with nature brings illness and suffering, and one must take caution.”

These words summarize an important principle: Health, according to Chinese medicine, is balance. Imbalance leads to illness and suffering. Healing, then, means restoring balance: between man and nature, the universe, his social environment, and the circumstances of his life as well as his capabilities and thoughts. Healing is creating harmony between the internal organs and

balance between body and soul. A healthy person is able to achieve self-actualization.

The role of the healer, in Chinese medicine, is to understand who the patient is and how his balance has been disrupted, and to choose the correct tools to restore that balance.

Treatment with Chinese medicine is not a one-time charm; it requires a process, a series of treatments.

THE RIGHT DIAGNOSIS In our clinic, “Kichudo shel Mahat,” we provide personalized treatment by making a precise diagnosis and tailoring the treatment plan to meet specific needs of the patient. Proper diagnosis is crucial for successful treatment, so in addition to a thorough initial interview, we examine the pulse, tongue, eye (iridology), abdomen, and more.

We offer a wide variety of treatments: acupuncture, herbs, naturopathy, tui na (Chinese massage), shiatsu, moxa, cupping, and more. The number of meetings required for success is determined in the initial meeting.

We successfully treat pain: headaches, migraines, back pain, knee pain. Digestive problems: heartburn, stomach aches, irritable bowel. Women’s health issues: gynecology, fertility, pregnancy, birth preparation. Children’s health issues: middle ear fluid, bed-wetting, ADD, emotional issues, allergies. Internal health issues: dizziness, high blood pressure, diabetes. Skin problems: acne, itching, hair loss, psoriasis, and Mental health issues: insomnia, depression, stress and anxiety.

Call us and take your first step toward healing.

ABOUT THE CLINIC “Kichudo shel Mahat” is a Chinese medicine clinic in Jerusalem co-run by Roi Kazav and Ester Moshiashvili, both trained in Chinese medicine at Ridman College and licensed by the Israel Association of Traditional Chinese Medicine. Roi also has a BA in health system management from Hadassah College and received additional training in China; Ester specializes in pediatric Chinese medicine and women’s health. The clinic is located on Yaffo Street 217 in Jerusalem, opposite the central bus station, next to the post office.

Call Roi at 0545531399 or Ester at 0559403370.

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How Functional Lab Testing Helped Identify and Cure My Illness

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hen I was 21, I started an office job at a NYC law firm.

Shortly after, I began to feel sick—I was extremely fatigued and constantly thirsty. I visited three medical experts who all said after the blood and urine tests came back normal; there was nothing wrong. Well, I knew that there was something wrong, but didn’t know where to turn.

A friend suggested a doctor who specialized in functional medicine and nutrition. Out of desperation, I made an appointment. After my consultation, he suggested a functional lab test.

The doctor explained that unlike standard blood and urine testing, functional lab tests provide information that standard tests don’t. I gave four saliva samples spaced out through the day and a single morning urine sample. The test measured my cortisol, a stress hormone, as well as other neurotransmitters and hormones.

The results were shocking. My stress levels were above the normal range throughout the day. It was no wonder I wasn’t feeling well.

Now that I finally knew what was wrong, I was able to take the first steps toward getting better.

The doctor suggested some lifestyle changes and started me on a program of diet and nutrition specifically targeted to the time of day according to my lab results. After three months I finally began to feel better. This changed my life!

I decided to return to school and earn my doctorate in chiropractic and nutrition.

If you have been suffering with insomnia, stress, anxiety, depression, schizophrenia, unexplained aches and pains, fibromyalgia, headaches, digestive problems like IBS, mid-life weight gain and loss of libido, I may be able to help you by targeting the right functional lab test which will give you the answers you need to begin the road to recovery and a healthy life.

These are some of the tests offered to my patients: ORGANIC ACID TESTING (OAT) The OAT offers a comprehensive metabolic snapshot of a patient’s overall health with over 70 markers. High levels of intestinal yeast and bacteria can cause or worsen behavior and movement disorders, hyperactivity, fatigue and immune function. Many people with chronic illnesses and neurological disorders excrete abnormal organic acids in their urine.

SALIVARY CORTISOL TESTING Because the saliva is collected over a period of 24 hours, the test provides more complete information about the body’s stress response than a single test would—such as the standard serum or urine testing a conventional doctor may offer.

Abnormal results are related to chronic stress and stress-related symptoms such as insomnia, anxiety and fatigue.

MALE AND FEMALE HORMONE PANEL The Male Hormone Panel tests for seven different hormone levels to provide a comprehensive picture of male hormonal balance. This data can be helpful when assessing conditions relating to infertility, sexual dysfunction, and andropause.

The cycling Female Hormone Panel (FHP) measures 11 saliva samples that are gathered at specific time points throughout one complete menstrual cycle. It provides a dynamic mapping of the active levels of estradiol (E2) and progesterone (P) as well as the cycle average of testosterone and DHEA. The parent of a patient recently wrote: Our teenage son suffered from anxiety his whole life. We took him to a few therapists. He needed to take Prozac at two different points in his life, and he said he always felt like he had “a black cloud” hovering over his day. He would call us multiple times from school during the day to tell us that he feels very nervous and anxious, and we just didn’t know what to do for him. We went to see Dr. Rosenberg when we heard glowing recommendations about him from a relative of ours who had achieved great results with him.

Dr. Rosenberg was patient, kind, and extremely thorough.

He recommended some testing for our son, and based on the results, he set our son up with a vitamin regimen.

This was six months ago, and our son is a different child. He’s calm, happy and well-adjusted and “the cloud”’ has gone away.

All he does is take some very healthy vitamins, not dangerous medication, and BH he’s doing so well!

Thank you, Dr. Rosenberg! We are just so grateful to you for all you have done for our son.

A very grateful parent.”

If you have been suffering and have not been offered a solution, call today and I will be happy to offer you a free consultation to see if you can be helped with functional lab testing, just as I was.

ABOUT THE PRACTITIONER Dr. Reuven Rosenberg is a chiropractor and board-certified clinical nutritionist who treats a variety of conditions at his Beit Shemesh and Kiryat Ono clinics.

Phone consults by appointment.

Visit his website: www.drrosenberg.net or call: (Israel) 058-432-5849, (US) 516-321-1155, (UK) 44-203-734-8291

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REFLEXOLOGY: FROM SOLE TO SOUL "Raayah Levy has been my refexologist for over five years.

Her magical touch combined with her professional knowledge, gives her the ability to heal and relieve severe pain.

I thank her and am so grateful for her healing touch."

"For years I suffered from terrible arthritis pain. Conventional medicine found no cure. I almost brought my tour-guide career to an early end when I was recommended to Raayah. After a series of treatments, I could walk again without pain and my career was saved."

Nomi

We were about to go through with a paracentesis operation on our two years old baby girl's ears when we were introduced to Raayah.

After eight treatments most of the fluid disappeared and our daughter started babbling nonstop. Need one say more?

Ruth&Sam

REFLEXOLOGY & REIKI Raayah Levy

Rami

More than 20 years of experience Specializing in: Prenatal and postpartum treatments, helping alleviate chemotherapy side effects, and diabetics

054-7578705

raayahl@gmail.com Jerusalem

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Fertility Struggles?

Chinese Medicine Can Help

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hile conventional reproductive medicine has made incredible advancements in recent decades, many aspects of human fertility remain a complete mystery. Many couples who suffered from fertility problems have managed to bring home a healthy baby thanks to hi-tech interventions such as IVF, surgeries, hormone therapies, using donors, etc. Many others, however, have found themselves childless despite these interventions. The State of Israel is generous with such couples in funding fertility treatments, but couples in other countries struggle to meet the high costs of treatments.

Even if money isn’t a problem, the process can be extremely intrusive and disruptive, involving painful side effects and invasive procedures—not to mention the emotional rollercoaster of repeated high hopes and disappointments.

It’s an incredibly difficult journey no couple would wish to embark on if not for the longed-for potential result.

Fortunately, there is a form of complementary medicine that has been shown to enhance the effectiveness of reproductive therapies and sometimes even replace them. Tamar Zakon is the founder of Balance Center, a complementary health and wellness clinic in Jerusalem that treats a wide variety of conditions in men, women and children. Tamar’s specialty is traditional treatment of various women’s health issues, including fertility. “We take an integrative approach to health and well-being, and some of our patients are already using artificial reproductive therapies including IVF, but many are not, and are looking to get pregnant naturally with our help,” says Tamar. “Each plan is individualized and sensitive to the needs of each woman or couple.”

A traditional Chinese program for reproductive wellness includes preparing the reproductive system, dietary adjustments based on Chinese medicine, and lifestyle changes including exercise or ways to reduce stress. “We evaluate the woman’s overall health and wellbeing and treat the whole person. The idea is balance yourself, mind, body and spirit, and of course, to bring home a healthy baby.”

Chinese medicine cares for the mind and body naturally by clearing energy with acupuncture and using herbal remedies to promote health and restore balance.

Acupuncture is generally done in weekly sessions, while herbal remedies are normally taken daily over the course of the month and adjusted as necessary.

Tamar treats many common women’s issues, such as irregular cycles, premenstrual syndrome (PMS), hormonal imbalances, headaches, insomnia, polycystic ovarian syndrome (PCOS), infertility, pregnancy and postpartum support, postpartum depression (PPD), and menopause. Tamar also treats women who experience recurrent miscarriage, and provides physical and emotional support after loss.

While Tamar believes strongly in the power of complementary and holistic medicine, she believes in integrating traditional with modern treatments. Tamar has been working in complementary medicine for more than a decade. She holds a diploma in Traditional Chinese Medicine and Acupuncture from Mayanot College of Complementary Medicine (a branch of the Merav College and the Open University), and has completed advanced certification in holistic and medical massage therapy, infant massage, Tui Na (Chinese physical therapy), herbal medicine, Master Tung acupuncture, moxibustion, fire cupping, nutrition, Hopi ear candling and narrative therapy. She is a member of the Israeli Chamber of Chinese Medicine.

After practicing privately for more than 10 years, Tamar founded the Balance Center to offer patients a wide variety of treatments in a collaborative and holistic environment.

Her vision of an integrative treatment center became a reality in 2017, and her diverse group of practitioners—each with their own area of expertise—has treated countless patients, many of whom suffered from fertility issues and were able to bring home a healthy baby thanks to the Balance Center.

“I believe in the importance of patient-centered care,” says Tamar. “I develop a close relationship with each patient and work to understand what you are experiencing, what your expectations are and what your short and longterm goals are.”

In addition to running the clinic and treating patients privately, Tamar volunteers weekly with people dealing with cancer and their families, helping to ease the emotional and physical challenges they face. A firm believer in the importance of professional development and continued education, she vows to never stop learning.

ABOUT THE PRACTITIONER Tamar Zakon is the founder of the Balance Center, a complementary medicine clinic in Jerusalem offering a wide variety of treatments for men, women and children coping with physical or emotional issues.

Visit the Balance Center online at balancecenter.co.il or on Facebook: WellnessTLC, email at info@balancecenter.co.il, or call at 058-567-6758.

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Healing Cartilage Damage and Scoliosis Cartilage damage in the knee and ankle joints is a common and incredibly painful condition. When the bones near the joint are too close together, they rub against each other and wear down the cartilage, leading to inflammation, debilitating pain and limited mobility.

This happened to S.B. His doctor prescribed painkillers, but these didn’t treat the root problem: they couldn’t correct the position of the bones or reverse the loss of cartilage. S.B.’s condition worsened until he found Alexander Gorelik. “He saved my legs. He didn’t just sit there and listen, he did the exercises with me and treated me. He felt my pain and showed me how to heal myself.”

Alexander Gorelik, expert in Chinese medicine and corrective exercise, developed his unique method over more than 30 years of experience. “The key to successful treatment is the patient’s persistence and commitment to following instructions,” says Alexander. “Healing occurs when the bones of the joint start moving away from each other, the cartilage loss is halted and space opens up for the body to regrow the cartilage.”

Word got around, and patients began pouring into Alexander’s office from all over Israel. They come with X-rays that clearly indicate cartilage loss in the knees, shoulders or ankles. Y. B., for example, suffered from cartilage loss in both legs. He was treated in the USA by a well-known orthopedist, and even underwent arthroscopic surgery in one knee. The doctors loaded him up on painkillers, but he continued suffering from debilitating pain in his knees and was unable to walk. “I heard about Alexander and decided to give it a try,” he says. “And here I am, healthy and walking on two legs. I weaned myself off the drugs and continue with the exercises every day. The cartilage started to grow back, and the pain disappeared.”

Rina, 16, whose mother is a nurse, developed scoliosis by spending too many hours hunched over the computer. The family doctor gave her painkillers even though she wasn’t in pain! Her mother took her to Alexander, who taught her a number of exercises and treated her with stretches and massage—and the scoliosis disappeared. Another teenager, a student at a well-known ballet studio, was diagnosed with scoliosis and sent to Alexander by her ballet teacher.

“Within a month of treatment, my back was completely straight,” she says.

For more information and to see how Alexander Gorelik can help you call: 054-575-2678

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A Hi-Tech, but Drug-Free Approach to Healing Back Pain:

An Interview with Dr. Nimrod Liram of The Jerusalem Spine Center

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r. Nimrod Liram is an Israeli chiropractor and manager of the Jerusalem Spine Center, a clinic offering state-of-the-art chiropractic therapy to patients with various conditions relating to back pain. Trained in the UK, Dr. Liram earned his DC (Doctor of Chiropractic) from the Anglo European College of Chiropractic in 1986, and obtained a master’s degree (MSc) in clinical science from Portsmouth University in 2001 to complement his chiropractic training. In 1987, Dr. Liram returned to Jerusalem and opened the Jerusalem Spine Center. He also joined the orthopedic spine unit at Hadassah University Medical Centre as a staff member in 1987 and has worked there part-time ever since. He is a research fellow and teaching member in orthopedics. Over the years he has also been involved in training and instruction in ergonomics, back-safety in industry and working environment and the Israeli navy reserve medical corp.

What does the Jerusalem Spine Centre offer in the way of healthcare?

We offer a specialized approach to chiropractic treatment combined with a highly professional muscle and joint rehab program, under the same clinical umbrella.

Our clinic is unique in that we incorporate two important healthcare principles. The first is correct muscle balance, joint-motion and body mechanics. We use various types of chiropractic techniques to achieve this, supported by various technologies that include ultrasound, interferential, soft laser, flexion-distraction table and Kinesio-Tape.

The second principle is functional personal training. The idea of this service is to maintain the benefits the body has acquired through the chiropractic treatment. We aim to maintain the human frame by means of rehab activity.

What is chiropractic and how do patients benefit from it?

Chiropractic is a science and a system that focuses on the human muscle, bone and nerve structure. It provides health care by evaluating posture, joint and muscle mobility, function and condition as well as all other health factors. A chiropractor is a primary health-care provider by law in Israel. It is a manual (hands-on) technique and does not practice invasive or chemical treatment. However, chiropractors in general, and our clinic in particular, make extensive use of technology, both in evaluation and in treatment. Chiropractic training is imaging-intensive and graduates learn how to use, read and benefit from X-rays, CT and MRI scans, bone scans, ultrasounds, EMGs and nuclear medicine. We carry a full array of electro-physical and light therapy equipment to support our manual skills.

What conditions do you treat?

First and foremost, chiropractic treats back pain. But back pain is a very general term, and people with back pain may suffer from any of dozens of different conditions. Some of these conditions are simple and quick to treat, while others require prolonged care and collaboration with other healthcare specialties. Back pain isn’t just felt in the low-back, either; it might be felt in the neck, chest and pelvis as well.

Back pain involves the skeletal core, joints, muscles, ligaments, cartilage and nerve disorders. Chiropractic also treats disorders of shoulders, elbows, hands, hips, knees and feet.

What is rehab?

Rehab is one of the chiropractic specialties and involves therapy and retraining techniques for those disabled by trauma, disease or surgery.

Tell us about Soft Laser Therapy.

This is an important and relatively new addition to the clinic, as of January 2017. It’s a type of therapy involving a professional clinical-use bio-photo modulation device that utilizes 240 diodes and powerful infrared and red light probes to treat various conditions, including whiplash injuries, shoulder problems, tennis and golf elbow, carpal tunnel syndrome, hip bursitis and arthritis, knee pain, ankle sprains, muscle tears and sports injuries. Our clinic is the only one in Jerusalem to carry professional soft laser equipment which is highly effective in the prompt healing of these conditions as well as many others.

ABOUT THE PRACTITIONER Dr. Nimrod Liram, DC, MSc., is a licensed chiropractor and director of the Jerusalem Spine Center, which offers a specialized approach to chiropractic treatment combined with a highly professional muscle and joint rehab program.

For more details, visit him online at www.drliram.com

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Functional Medicine:

A Personalized Pathway to Optimum Health It often seems that science doesn’t have answers for chronic illnesses, but sometimes you just need to dig a little deeper. Functional medicine can help discover the roots of illness and the path toward health.

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By Mordechai Katz M.S.

unctional medicine is the science of identifying and addressing specific clinical imbalances that are the root causes of today’s most egregious chronic illnesses.

Functional medicine does not contradict conventional medical diagnoses. Rather, it investigates the patient’s underlying physiological dysfunctions and their causes. This approach is essential today when chronic illnesses are so widespread.

All chronic illnesses, such as obesity, type 2 diabetes, arthritis, dementia, auto-immunity, and inflammatory bowel syndrome, result from the break-down of complex biological processes. Chronic illnesses are different than acute illnesses like the flu, measles, or strep throat, because they have no single trigger. Rather, chronic illnesses develop over time through the interaction of genetics, environmental, and lifestyle factors.

Even though we cannot change our genes, they are not our destiny. Our genetic expression—the turning on and off of genes—is largely influenced by our choices. Therefore, decisions we make every day affect our health today, and ultimately promote health or lead us toward chronic illness. Choices regarding nutrition, sleep, exercise, stress management, relationships and faith, affect our health so profoundly that they are considered by functional medicine as the “roots of wellness.”

Restoring balance and function throughout the whole body promotes complete health and vitality. Functional medicine incorporates powerful health-promoting choices into a comprehensive, individualized health plan to correct core imbalances that cause disease.

These core imbalances include; gut dysfunction and dysbiosis, mitochondrial damage, vitamin and mineral deficiencies, hormone imbalances, chronic inflammation, silent infections, heavy metal and environmental toxicity, and insulin resistance. In contrast, the “one-ill, one-pill” conventional medical approach often focuses on symptom relief and delaying disease progression.

Chronic illness is complex and addressing core imbalances is unique to every person. I established The Jerusalem Center for Functional Medicine in order to help patients navigate a course towards achieving their personal health goals. The center employs today’s latest scientific and medical research to formulate a personalized plan for weight control, metabolic correction, biochemical rebalance and

management of chronic illness.

The Jerusalem Center for Functional Medicine’s newly acquired Machine Learning Technology uses sophisticated computer science that compares a patient’s basic blood panel from a simple blood test, to over 75,000 lab report findings. A personal graphic profile is generated for each patient that identifies the most important clinical imbalances which promote chronic disease and are obstacles to optimum health. Results are then incorporated into a customized, evidence-based nutrition plan.

The nutrition protocols developed at The Jerusalem Center for Functional Medicine are meticulously researched using only the highest quality and most current scientific evidence.

They stay current with the latest scientific conclusions by continuously researching nutrition topics and playing an active role in the nutrition industry. All prescribed therapeutic foods and supplements are thoroughly investigated for clinical efficacy and product quality using professional databases.

They do not use foods or supplements that fail to meet the highest industry standards of safety, quality and efficacy.

Regardless of your goals, The Jerusalem Center for Functional Medicine will give you peace of mind knowing you’re on a personalized pathway to optimum health.

ABOUT MORDECHAI KATZ Mordechai Katz, M.S. holds a degree in Microbiology and Environmental Systems Management and a Master’s degree in Human Nutrition and Functional Medicine. He has trained with diverse professionals who are passionate about nutritional therapy and its key role in functional medicine. His expansive knowledge in nutrition, biochemistry, and functional medicine, as well as his creativity and empathetic nature, drive his patient-centered approach to finding personalized, long-term health solutions. For more information, visit functionalmedicine.co.il.

Contact The Jerusalem Center for Functional Medicine in Bayit Vegan at 058-716-2874, nutrition@functionalmedicine.co.il or visit functionalmedicine.co.il

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West Meets East:

The Father-Daughter Team that Heals the Mind and Body Combining Cognitive Psychology and Chinese Medicine

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ur daily lives are demanding and full of professional, personal and familial obligations. At times, in the midst of our routines, we don’t find or make the time to attend to our own physical and emotional needs. Our greatest responsibility is to care for ourselves; when we are in our prime, we are better able to give the utmost attention to all of the facets of our lives. In response to the stress which pulls in so many directions, we may lose our emotional and/ or physical balance. Integrating the philosophies of Chinese medicine and cognitive psychology allows Paul and Ilana Shrell-Fox to achieve a comprehensive and unique understanding of the underlying processes in the bodies and minds of their clients, and help them return to a state of balance.

What is cognitive psychology? Cognitive psychology is the foundation for cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). We all have thoughts and feelings that arise automatically and have a direct impact on our behavioral patterns, both positive and negative. When the scales tip towards the negative, we might develop styles of behavior that can become self-destructive. Examples of this type of thinking can include: I will never succeed in school or work, I am a shy person, I am not good at interviews, people dislike me or undervalue me. As a psychologist, Paul helps to identify these automatic and other non-beneficial thinking patterns and curtail their influence. As a result, his clients replace the negative trains of thought and behavior with positive ones.

DBT combines these cognitive behavioral techniques of emotional regulation with concepts of distress tolerance, acceptance and mindfulness derived from meditative practice. It helps to accept certain anxiety states that arise, because they can be informative and even helpful sometimes. This type of therapy has been shown to be particularly effective in the treatment of borderline personality disorder, anxiety disorders and eating disorders.

What is Chinese medicine? Chinese medicine is a general term for a multi-dimensional field of practice that originates in China and the far east. Its philosophy, which has recently begun to influence western treatments as well, teaches that the mind and body are inseparable. The treatment methods that have grown out of this philosophy view our body as a map with different points that influence our internal and external wellbeing. This interconnectedness makes it possible to treat the individual as a whole. As a practitioner, Ilana employs acupuncture, shiatsu (massage) and Chinese herbal medicine. In shiatsu and acupuncture, she gently stimulates

points on the body, causing them to influence the nervous and immune systems - which in turn affect emotional and physical balance. Herbal medicine is an effective method of combining the properties of different herbs to tailor a remedy to a client’s needs. Examples of conditions that can be treated using these methods include: recurring colds; digestive issues stemming from physiological or emotional causes; headaches, including migraines; insomnia; pain management and more. The advantage of Chinese medicine is that practitioners can identify and treat underlying patterns and causes that lead to conditions that may go otherwise unexplained. For example, in instances of recurring strep throat, when even prophylactic antibiotics don’t provide a long-term solution, a combination of herbal medicine and acupuncture can help the body overcome its susceptibility.

Paul and Ilana have recently begun to work together on a few joint projects, combining the methods of cognitive/dialectical therapy with the principals and methods of Chinese medicine. By combining these two modes of treatment, they are able to treat conditions more efficiently. They are seeking clients coping with symptoms including generalized anxiety, sleeping difficulties and insomnia, general malaise and depressive moods and symptoms. By providing interpersonal feedback, CBT/DBT work on cognition(s), while Chinese medicine addresses the physical aspects that reflect the underlying emotional distress. Through regular consultations, Ilana and Paul form an integrative team with diverse perspectives, ensuring a comprehensive and adaptable treatment plan tailored to each individual’s needs.

ABOUT THE PRACTITIONERS Paul Shrell-Fox, PhD is a licensed educational psychologist with 25 years’ experience in Israel and the USA. He works with both children and adults. His daughter, Ilana Shrell-Fox, is certified in Chinese medicine (Dipl. Ac and C.H.) through Campus Broshim College of Integrative Medicine.

She is also certified in pediatric tui na and shiatsu for adults.

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Insurance, Organizations and Support

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Protect Your Family with Basic Life and Supplemental Health Insurance

By Shimon Cohen

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e always bless each other “L’chaim” and “Labriut”.

The question is, “How can we become partners with the Almighty to protect ourselves and our families?”

Today, there are a few relatively inexpensive, yet vital steps that everyone should take to achieve this.

STEP 1: BASIC LIFE INSURANCE How many appeals have we received for a young person dying suddenly and leaving a spouse and children with very limited income to carry on?

Life insurance is extremely affordable today, especially for young couples.

Suggestion: One of the most useful gifts that you could give to a young married couple would be a life insurance policy paid up for the first five years or so—after that, it’s up to them!

The real story # 1: P.J., a 35-year-old young man, came into our office to discuss his pension plan. While going over his policies, we realized that he didn’t have any life or disability insurance. We discussed the situation and he filled out the application on the spot. About six months later, he told us that unfortunately he had been diagnosed with cancer—something that was completely unknown when he signed up. Today he is receiving a monthly disability payment and he and his family know that they have a substantial life insurance policy in place.

STEP 2: BASIC SUPPLEMENTARY HEALTH INSURANCE Israel has a wonderful public health system—among the best and most advanced in the world. However, there are still a number of areas where the coverage is not sufficient; these are the cases that usually cost tens or hundreds of thousands of shekels and are a huge drain on a family’s resources. What are these areas? a) Transplants Israel has only a small amount of organs available for transplants. Having world-wide coverage that the supplementary policy offers is critical.

Coverage: • Full coverage in Israel and worldwide with contracted service providers.

• With non-contracted service providers – up to NIS 5,000,000.

• Artificial limb – up to NIS 2,500,000.

• Includes: Disability payment of NIS 7,500 per month

for up to 12 months before the transplant and up to 24 months after the transplant. Flight to transplant center. b) Medications not covered by Kupot Cholim: • Up to NIS 3,000,000 renewable every two years.

Deductible – NIS 300 per month.

• Includes chemical and biological medications.

• Includes medications which are approved by Western countries – trial medications are not covered.

• Includes “off-label” medicines (medicines labeled for a specific condition but not covered for another condition).

The real story #2: We currently have a client who is receiving 6,000 shekels a month for medication which is not in the health basket. He will most likely need this medication for the rest of his life—consider the cost. c) Surgery abroad: • Full coverage with contracted surgeons (in most cases, this means that the company contracts directly with the surgeon you choose regarding the fee).

• Coverage for flight – if the hospitalization is over eight days. In a case of a minor, the company will also cover two tickets for first-degree relatives.

The real story # 3: The C.K. family purchased supplementary health insurance a few years ago. About two years ago, their daughter was diagnosed with a rare brain disorder which required a complicated procedure. After much research, they located the top medical center for this procedure, in the U.S. Their supplementary plan covered an initial trip for preliminary testing and full coverage for the complicated brain surgery. The coverage also included airfare and accommodation for her parents. The final cost will be over $300,000.

Remember: your loved ones’ health and security is in your hands. Call us for more details.

L’chaim and Labriut!!

ABOUT THE COMPANY Shimon Cohen is the manager of Egert & Cohen Insurance. Egert & Cohen is a family business that specializes in serving the Anglo and new olim populations. They provide a friendly and professional one-stopshop for all your insurance needs.

Egert & Cohen can be reached at 02-622-7999 or through their website www.egertcohen.co.il.

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Prevention Before the Cure:

How Dor Yeshorim Is Eradicating Genetic Disease Among the Jewish Population Getting tested for genetic disease can be overwhelming and pose complex difficulties, especially within the shidduch system. Here’s how Dor Yesharim makes it easy and affordable while preventing the harmful effects of social stigma.

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hen Rabbi Yosef Eckstein’s first child was born, everything seemed fine. Over time, however, it became apparent that something was wrong.

Every day there was further deterioration in the child’s development. Rabbi Eckstein and his wife went from doctor to bewildered doctor until finally—after two whole years—they got the dreaded diagnosis: Tay-Sachs disease.

This diagnosis was catastrophic in multiple ways. Not only was it essentially a death sentence for their child, it was a death sentence for additional children as well. TaySachs is just one of many genetic diseases found to be most prevalent in the Ashkenazi Jewish community. The fact that one of their children had it meant that both parents were carriers—and that meant that all of their children had a 25% chance of having the disease. The Ecksteins lost four children to Tay-Sachs.

As if that tragedy was not enough, the disease cast a mark of Cain on their family in the shidduch world. People were very hesitant to marry into a family of known carriers of Tay-Sachs. Even though there is no danger of having the disease if one of the parents is tested and found not to be a carrier, potential matches preferred not to get involved.

Rabbi Eckstein decided something needed to be done.

The technology for genetic testing was available in those days, but there were a few main problems with it: one was the expense and lack of easy access to it within the Jewish community; the other was the stigma and the weight of the anxiety carried around by people who were found to be carriers. The carrier status only has medical significance

if two carriers of the same disease marry each other, in which case their children have a 25% chance of having the disease. But someone found to be a carrier will need to divulge this information to all potential matches, and, like what happened to Rabbi Eckstein’s family members, their shidduch prospects may be significantly harmed.

Was there, Rabbi Eckstein wondered, a way to make genetic testing accessible to the Jewish community and to get couples tested for compatibility without burdening them with the knowledge that they are carriers?

After consulting the gedolim of the time, he found an answer—and founded Dor Yeshorim.

Dor Yeshorim is a nonprofit organization that offers premarital genetic screening tests to individuals or through mass screening drives at high schools, yeshivot and colleges throughout the world. They screen a staggering 20,000 individuals every year. Their groundbreaking system utilizes cutting-edge testing technology under strict rabbinic and medical supervision, and to avoid the stigma and emotional burden of being found to be a carrier, they developed a confidential system that does not reveal the results even to the person who was tested; instead, they assign ID numbers and simply inform potential matches whether they are genetically compatible or not.

GETTING TESTED At a Dor Yeshorim screening, individuals are asked to provide their date of birth, ancestry (Ashkenazi, Sephardi, Convert or Non-Jewish origin), maternal and paternal grandparents’ country of origin and a phone number to

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be kept on file. The price of testing is highly subsidized thanks to generous donors and, at least in Israel, participation of kupot cholim.

Once the paperwork has been filled out, an individual ID number is issued. It’s very important not to lose this number, as it will be the only way to verify your identity and if you lose it, you may need to be retested.

A small blood sample is then taken and sent to a laboratory, where a panel of tests is run using cutting-edge technology. Dor Yeshorim uses blood samples rather than saliva because they provide more reliable results. Every step of the screening process is supervised by senior inspectors, and there are rigorous, multi-tiered quality controls to ensure that the results are reliable. Then the results are entered into a highly sophisticated database under equally stringent quality checks.

CHECKING COMPATIBILITY When considering a partner in marriage, both parties can exchange Dor Yeshorim ID numbers and day and month of birth, and call Dor Yeshorim’s automated hotline to request a compatibility check. They will be prompted to enter this information as well as a phone number where they can be reached. A response regarding compatibility will only be given if the number provided matches the one registered on file. If you need to be called at another number, you’ll need to verify your information.

The information is then processed by Dor Yeshorim’s staff and the test results of the two numbers are compared.

If neither or only one of them is a carrier for a recessive disease, the match is safe and the parties are informed that they can proceed. If they are both found to be carriers, they are informed that the match is not compatible, and genetic counseling is offered.

One of Dor Yeshorim’s trained representatives will call the number on file with the results within a few business hours. To ensure privacy and confidentiality, the individual must answer the phone in person to receive the results; they will never be released to a third party, including a relative or a shadchan. If you miss the call, you’ll be asked to call the hotline and reenter the information. When the Dor Yeshorim representative reaches you, you’ll be asked to verify the ID numbers and birth dates of both parties, so it’s important to keep them handy.

WHICH DISEASES SHOULD WE TEST FOR? If you receive genetic counseling at one of the regular testing centers, you may be handed a very long list of recommended tests and find yourself at a loss when selecting which of them to do. Research has shown that genetic counseling and prenatal testing in Israel tends to be more “aggressive” and pro-medical abortion than in other countries, so a religious couple may not know how seriously to take their recommendations.

Dor Yeshorim developed a testing policy under the guidance and support of leading genetics experts alongside rabbinical authorities. The Dor Yeshorim policy is to test only for common, incurable recessive diseases which present serious health issues or risk of fatality, and for which

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the testing methods to determine carrier status are reliable and conclusive. Every disease is painstakingly researched, scrutinized and evaluated to determine whether it meets Dor Yeshorim’s criteria, and approved tests are added to the Dor Yeshorim panels in conjunction with the recommendations of the ACMG (American College of Medical Genetics), the Israeli Ministry of Health, and the Dor Yeshorim Medical Advisory Board.

Dor Yeshorim’s current standard Ashkenazi panel consists of 10 diseases. They offer an optional testing panel of seven additional Ashkenazi diseases, which are less common, but have symptoms as severe as those on the standard panel. The Sephardi panel, which was recently developed in response to growing incidence of genetic disease in the Sephardi population, includes 17 diseases.

WHY NOT TEST FOR EVERYTHING? In many cases, the manifestation of a genetic disease and the symptoms associated with it are not clear-cut, so a diagnosis may—in the best-case scenario—do nothing but cause undue worry, and in the worst-case scenario, prevent a happy marriage between compatible individuals and the birth of healthy Jewish children who will contribute positively to society. While there are thousands of possible genetic diseases, global scientific experts recommend testing for only a handful of them. Over-testing has its risks, too.

Additionally, Dor Yeshorim has found that disclosing ambiguous carrier status (in a case where the test is not conclusive) is more harmful than helpful to the community at large, given that the goal is to help create matches rather than break them. Inconclusive or ambiguous results pose moral, ethical and potential medical dilemmas to which there are no easy answers. For that reason, Dor Yeshorim invests many resources in discovering reliable testing methods for as many recessive genetic diseases as possible, and collaborate with other industry experts to unravel the mysteries of the human genome and its effect on health.

ERADICATING GENETIC DISEASE The more individuals screened and the more awareness about genetic testing pervades our communities, the closer we will be to creating a community free of fatal and debilitating genetic disease. Dor Yeshorim hopes to provide the conditions that will make genetic testing easy, accessible, affordable and safe for young Jewish couples across the globe.

ABOUT THE ORGANIZATION Dor Yeshorim is a nonprofit organization that provides premarital genetic screening to Jewish communities worldwide.

For more information, visit www.doryeshorim.org

GIVING A

VOICE TO THOSE WHO ARE VOICELESS

Amudim Israel functions as a confidential resource center providing direct support and referrals to individuals and families impacted by abuse, neglect and addiction.

Catering specifically to the Anglo population in Israel, Amudim Israel fills a crucial need in our communities, providing a lifeline to families struggling with mental health issues.

Amudim USA operates under the guidance of:

Rav Elya Brudny, Shlit’a Amudim Israel operates under the guidance of:

Rav Yosef Elephant, Shlit’a Under the clinical supervision of:

Israel Line: 02-374-0175 | USA Line: 516-636-0175 8 Harav Kook Street, Suite 308, Jerusalem office@amudim.org.il | www.amudim.org.il Amudim is endorsed by Torah Umesorah

staiman.com

staiman.com

staiman.com

Dr. David Pelcovitz, Ph.D

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Can You Keep a Secret?

Children aren’t sure what do with this question. And in many communities, neither are adults. If you choose to tell, you breach the status quo of privacy and discretion in a close-knit community. If you don’t tell, you might perpetuate lifelong trauma for victims—which can be severe—and be accused by the general public and authorities of sweeping things under the carpet. It’s a lose-lose situation.

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M

aaneh, a revolutionary therapeutic center in Beit Shemesh for the prevention and treatment of sexual abuse, is bridging the gap between the unique, cultural and logistical needs and norms of ultra-Orthodox communities, and the ethical obligation of accountability in cases of child and adolescent molestation. Maaneh is the first and only center of its kind, and offers appropriate treatment with wide rabbinical approval, which existing government programs alone cannot provide.

WORKING THE SYSTEM In order to interrogate, arrest or charge abusers, existing Israeli law enforcement and welfare infrastructure require disclosure and cooperation. If no complaint is filed, or if investigation of victims and their surroundings is denied, the cycle of abuse continues. While an intrusive threat to the delicate fabric of ultra-Orthodox society is thwarted in the short term, choosing the lesser evil can lead to a lifetime of trauma. Most importantly, refusal to cooperate with the authorities prevents victims from receiving crucial and timely therapeutic care and rehabilitation services.

Awareness, cooperation and treatment are essential if we want to eradicate the phenomenon of victim silencing “Many cases are hushed because of a lack of awareness and difficulty finding the words to communicate the abuse, coupled with the absence of appropriate and professional therapy within these communities,” confides Maaneh CEO, Aryeh Levi. “If a child is brave enough to broach the subject of abuse with their parents or another authority figure, and is met with an inappropriate response due to lack of knowledge, they might just give up trying to seek help.”

Maaneh, a non-profit organization, has introduced a welcome solution. With a focus on establishing trust among the leaders of the most prestigious ultra-Orthodox communities and educational institutions in Beit Shemesh, Maaneh is working with the Ministry of Welfare and Social Services and the Israel Police to become the preferred center for treating child abuse victims. “The natural address for any situation in the ultra-Orthodox sector is the community Rav. So, through a discreet, professional platform, we’re bringing these Rabbanim to work hand-in-hand with the experts in the field—highly-trained therapists and welfare and law authorities,” adds Rav Eidensohn, Chairman of Maaneh.

NO SECRETS, FULL PRIVACY Located in Beit Shemesh, Maaneh’s center is an intimate place, where personal attention is a top priority, and confidentiality is a core value. “There is even a unique system for the scheduling of appointments to prevent cli-

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ents from uncomfortable encounters with other clients,” shares Dr. Efraim Rosenbaum, Director of Community Relations. The two-story building houses four therapy rooms, a large yard, an office and waiting area, and is outfitted with state-of-the-art equipment, offering a wide variety of expressive therapies including play, art, psychodrama and music. A designated family therapy room enables private sessions for children and their parents.

The Center operates a 24-hour hotline, offers a free intake session, and runs lectures and workshops on prevention and treatment of abuse in conjunction with the Haruv Institute of the Hebrew University. In addition to senior management, Maaneh is staffed by eight multidisciplinary therapeutic professionals, including social workers and family counselors, many of whom are native English speakers. Lecturers and therapists themselves come from ultra-Orthodox circles and understand the delicate intricacies of handling abuse cases in the sector.

KNOWLEDGE IS POWER “Education is prevention,” says Levi emphatically.

“Awareness, cooperation and treatment are essential if we want to eradicate the phenomenon of victim silencing,” explains Levi. Maaneh’s programs include courses for kindergarten staff, school principals and educational staff in a variety of Talmudei Torah, lectures for rabbanim and community leaders in Israel and abroad, and educational programs specifically for English-speaking communities. Prevention is encouraged by teaching parents about healthy communication with their children, including age-appropriate discussions on intimate subjects.

Maaneh is looking towards expanding its activities to other cities. A pilot program run by Maaneh involved over 1,000 individual cases and highlighted the many challenges involved in shifting perceptions in the ultra-Orthodox sector. The pilot, which integrated creative and professional therapeutic practices, was so successful that many international organizations approached the Center for implementation in their communities.

“We’d like to make our model work in other cities by securing the support of the local rabbanim and community leaders in each city, as well as getting each city’s law enforcement authorities and welfare department on board,” says Levi. Of course, budget plays a very crucial role. “Government-funded welfare services and therapy programs exist, but they’re not appropriate for this sector.

Our operations are enabled by the generosity of donors and a small subsidy from the government, and we’re constantly working on getting the Israeli departments of Welfare and Social Services to recognize the need for a blanket solution for this sector of the population who constitute a very large percentage of the youth in Israel and are not immune to the phenomenon of abuse.”

For more information or to get involved in the organization, please contact Aviva at am@maaneh.org or 077-228-5817, ext 5.

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Children and Young People Get Rheumatic Diseases Too! World Young Rheumatic Disease Day (WORD Day)

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By Tsipi Egert

t was the morning of the first day of Chol Hamoed Pessach and we were getting ready to celebrate our son’s 10th birthday, when cries of distress from our youngest child—then almost two—brought me to his bed. I went to check on him; I still remember that moment of confusion. Something was clearly wrong. I tried standing him up, only to see him crumple up in pain on the floor.

Always busy and on the go, running from the age of 10 months, this morning our youngest seemed quite unable to stand, never mind run or walk. What could possibly be wrong? We quickly undressed him and saw: both his knees had swelled to the size of tennis balls. Later that day in the hospital, all the tests were clear, and over the next few weeks his knees improved and went back to normal—until the next flare up. Knees, ankles, neck, fingers, jaw—any joint could suddenly become inflamed, sore and painful to use. Because his flare-ups were so sporadic, it took a while to receive a final diagnosis: our son has JIA, Juvenile Idiopathic Arthritis.

WHAT ARE PEDIATRIC RHEUMATIC ILLNESSES? JIA belongs to a group of Pediatric Rheumatic Illnesses: rare chronic inflammatory conditions of the musculoskeletal system. JIA affects approximately 1 in 1,000 children. These illnesses range from the relatively common to the extremely rare, including: Juvenile Idiopathic Arthritis (JIA), of which there are several subtypes; Juvenile Systemic Lupus Erythematosus (JSLE); autoinflammatory disorders such as Familial Mediterranean Fever (FMF); Rheumatic fever, Kawasaki disease and more. Many of these illnesses are chronic, which means that they persist for many years or indefinitely and need to be managed to minimize their effect on the children’s quality of life.

Rheumatic disorders affect children in many ways. Some systemic disorders, such as SLE and the systemic subtype of JIA, severely impair children’s overall health and wellbeing. SLE, for example, causes damage to internal organs e.g. kidneys, heart and neurologic system. Others are more localized and primarily affect the joints or skin, causing pain and restricted joint movement, hampering daily activities and physical development.

HOW ARE THEY DIAGNOSED? Because they are so rare, pediatric rheumatologic disorders are often difficult to diagnose and are sometimes unknown to health care providers.

This can cause a significant delay before a correct diagnosis is made.

Some family physicians do not expect children to suffer from illnesses mostly associated with older people and consequently make erroneous diagnoses, attributing swelling and pain to unreported injuries, growing or psychosomatic pain. I recall the sad story of a young child who came to the orthopedist with a sore swollen elbow. The doctor placed the child’s elbow in a cast, explaining that it must be fractured (though his mother insisted that her young child had not fallen). When no improvement was seen weeks later, the doctor recast the arm. Eventually the child was referred to a pediatric rheumatologist, who diagnosed JIA and began administering the correct anti-inflammatory treatment. Sadly, it took months to repair the damage done to the elbow by being placed in a cast. The most important treatment for inflamed joints is movement, to keep the joints from becoming fused, which can cause lifelong damage and disability.

Another mother told me how she went from doctor to doctor seeking help for her young daughter who cried in pain and refused to walk, only to be accused by doctors of spoiling her daughter, who, they claimed, had nothing wrong with her and must have simply been seeking attention.

WHO TREATS PEDIATRIC RHEUMATIC ILLNESSES? Children must be referred to pediatric rheumatologists to receive optimal care. When it comes to pediatric illnesses, children are not just small adults. The arthritis which affects them is different from adult rheumatism. It needs different treatment, runs a different course and has different complications. One of the most severe complications to look out for in children suffering from JIA is uveitis, an inflammation of the eye which can lead to blindness. This complication does not occur in adults. A pediatric rheumatologist recently recounted the story of a young boy who had been erroneously diagnosed, and subsequently treated with intravenous antibiotics for almost a year to

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treat his painful swollen joints. By the time he was finally referred to the pediatric rheumatologist, one of his legs was almost immobile from the continued inflammation, and his eyesight in one eye was badly damaged by uveitis.

Another illness classified as a rheumatic disease is FMF (Familial Mediterranean Fever). This condition affects mostly people from around the Mediterranean. Symptoms include (but are not limited to) recurring fevers, joint pain, abdominal pain (due to inflammation of the stomach lining) and a (less common) characteristic rash. A young man, well beyond his childhood years, remarked to a pediatric rheumatologist after years of suffering: “I suffered all these years without knowing what was wrong, and not knowing that one of the world experts in my condition lived across the road from me!” Luckily, more and more doctors are becoming aware of these illnesses, and here in Israel children are being diagnosed more quickly than before.

Early ntervention changes lives NEW MEDICAL OPPORTUNITIES FOR SICK CHILDREN The last 25 years have opened many new treatment options for rheumatological patients. Previously, medicine had little to offer children, and many spent their childhood in pain, accumulating disabilities and misshapen joints.

Just a year ago I spoke with a young woman who showed me her misshapen arm and fingers. She said to me that if she had to be sick, she wishes it would have been now, when medicine could actually help her and keep her joints in full mobility. Today, due to pediatric-focused medical research and the advent of biologic medicines, tested specifically on children, the majority of children who receive medical and other supportive treatment can reach symptomatic remission (but not cure), with little or no permanent damage.

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Since damage to joints, muscles and tendons is cumulative, early diagnosis is crucial. Early detection usually provides a better prognosis, while delay, misdiagnosis and subsequent mistreatment can aggravate damage caused by the illness.

WHAT CAN BE DONE TO HELP CHILDREN WITH RHEUMATIC DISEASE? First and foremost—awareness. If your child exhibits swollen joints, or recurring fever that peaks in the evening, or complains of sore fingers or stiff joints, especially in the morning or after rest, don’t assume that he is acting up.

Make certain that he sees his doctor, and if necessary is referred to a pediatric rheumatologist.

Secondly, if your child is already diagnosed with a rheumatological disorder, take full advantage of the excellent medical opportunities your child has to maintain his health. Here in Israel we have been blessed with first-rate pediatric rheumatologists, who work in the main hospitals throughout the country.

Make sure that your child takes his medicine on time and visit your child’s physiotherapist regularly and keep up with the prescribed exercises. Those exercises will keep your child strong, and make sure that his body has a chance to compensate and recover from the damages of the battle with the illness. Most importantly, don’t forget to take your child to see her doctors regularly—both the ophthalmologist (to rule out the possibility of newly developing uveitis), and the rheumatologist (to make sure the illness is properly managed, and no flare ups are taking place). Finally, remember that you are not alone.

Reach out to our parent organizations (Inbar www.inbar.org. il/ and Mifrakim Zeirim mifrakim.org.il/) to get the support you need for living with a chronic illness in the house. Above all, remember: you are key to your child’s wellbeing and health!

If you are a teacher with a student who has a Pediatric Rheumatic Illnesses, make sure to speak with the child and his parents, to see if he is managing with his everyday tasks.

He might have difficulty writing or carrying his bag. Many children with Pediatric Rheumatic Illnesses find that sitting still for a whole lesson leaves their joints stiff and sore, and they need to get up to stretch during class.

SPREAD THE WORD Because early diagnosis and treatment are so important, the European Society for Pediatric Rheumatologists, PReS and the European parent/ patient association ENCA (www.

ENCA.org) are jointly inaugurating WORD Day, “WOrld Young Rheumatic Disease Day”. The objectives of this day are to raise parental and professional awareness to these illnesses, by giving parents and doctors tools to recognize symptoms which require

rheumatological attention.

Raising awareness of pediatric rheumatic diseases will help to aid the process of diagnosis, especially of rarer diseases. Information about these illnesses has been updated on a special site (EU project SHARE www. printo.it/pediatric-rheumatology).

International WORD Day will be an annual event that will take place on the 18th of March from 2019 onwards. Here in Israel, the patient/

parent organizations are working together with the Israeli Pediatric Rheumatologist Association to spread the WORD that young children can also get rheumatic illnesses. It is up to us, parents, teachers and healthcare professionals to make sure that they get optimal care as early as possible to ensure that they have the best chance of leading a healthy full life, with minimum pain.

The above information is based on an article published in The Lancet Child & Adolescent Health, available online at sciencedirect.com Tsipi Egert can be reached at tsipi.egert@gmail.com

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Therapy Through Your Kupat Cholim Throughout the evaluation and placement process, parents are encouraged to contact Chaim V’Chessed’s Special Education department at 072-CHESSED (072-243-7733). Chaim V’Chessed’s Special Education case manager will assist and guide you toward the help that best suits your child’s needs.

C

hildren grow and develop at unique rates, and developmental milestones are reached at different times by different children.

However, marked delays or difficulties are cause for concern. These include speech or language delays; slow development of crawling, walking and/or motor skills; difficulty in communicating; or difficulty in play and forming attachments with people in his environment. When a red flag arises it is important that the child be evaluated in order to afford him/her the best services available.

It is crucial to provide our children with optimal intervention while they are young and malleable. The decisions and placement process may be difficult and time-consuming, yet the reward of seeing a child flourishing and acquiring new skills is immeasurable. The sooner we help children, the smaller the gap will be between their development and that of typically developing children.

If a child is born with a syndrome or receives a diagnosis later, parents are entitled to financial benefits from Bituach Leumi. The application and approval process is tedious. You can request assistance from the social worker at the hospital, kupat cholim, or from Misrad Harevacha.

For a comprehensive list of benefits, visit the Bituach Leumi website at www.btl.gov.il.

If Bituach Leumi does not approve your request for financial aid, you should apply for an appeal; the outcome may be reversed.

Receiving an Evaluation and Therapy through Kupat Cholim Sometimes children exhibit behaviors signifying ADHD, sensory issues, social and emotional or speech and language delays, fine or gross motor delays that may necessitate therapy and/or special education school placement. An evaluation ensures that your child receives the appropriate therapy or placement in the proper educational setting. Some children who receive therapy through a kupah can stay in their current school or gan.

Below are the guidelines for applying for an evaluation and therapy through Kupat Cholim’s Child Development Center (Machon L’Hitpatchut Hayeled).

1. Identifying a Developmental Delay As soon as you notice a delay in any area of your child’s development, bring it to the attention of your pediatrician to assess if the child’s development is indeed late. If the doctor or school suggests that intervention is necessary in the areas of gross motor, fine motor, or speech and language, you will need to contact your kupat cholim’s Child Development Center to start the application process.

Information Provided By

2. The Application Process You will need: • Hafnayah (referral) from your

family doctor or pediatrician • Questionnaire for your teacher or ganenet (note there are differ-

ent forms for different ages) • Questionnaire for the parent • Eye exam (can be done by any

kupat cholim eye doctor). Be

sure to tell your eye doctor

what you need the exam for.

• Hearing test (if concern centers

around language issues) Referral from your doctor: Make an appointment at your pediatrician and specify that you are coming for a referral for hitpachut hayeled. At this time you can ask the doctor for a referral for a hearing test and the secretary for a hitchayvut (payment for the medical procedure) for the hearing test.

Note that the hitchayvut may have an expiration date.

Questionnaire forms: You can obtain the necessary questionnaire forms at your local kupat cholim branch or online. Make sure to follow up with the ganenet or teacher so that the forms are completed as soon as possible and you can begin the application process.

If your child is in need of a ganenet siach, gan safah, or any other special education environment, his ganenet or teacher will need to fill out forms from the Iriyah that will be passed on

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to the Psychological Services (Sheirut Hapsychologit) in addition to the evaluations provided by the kupah. Sheirut Hapsychologit will then review your child’s abilities and needs and invite you for a placement meeting (vaadat hasamah).

These forms need to be signed by both parents. It is worthwhile to read them over to better understand your child’s abilities and limitations as well as his functioning level in his current educational setting.

Hearing test: Contact your local kupat cholim clinic for a list of places where hearing tests can be done.

Remember to bring a referral from your doctor and a hitchayvut from the kupah.

When you finish getting all the paperwork together, make copies for your records.

You will now need to send the forms to the Hitpatchut Hayeled department of your kupat cholim, either through internal mail (sent from your local branch) or by hand delivery, as soon as possible. Check with the secretary to make sure the forms were sent, then contact Hitpatchut Hayeled to confirm that they received the forms.

If you have any other documents that are pertinent to your child’s development or to the issue of concern, such as a report from a neurologist, orthopedist, psychologist, or other professional, include it in the packet with an explanatory note.

As a parent, you have to advocate for your child and make sure that the process gets done as quickly as possible in order for your child to receive the necessary services.

3. The Evaluation and Therapy Process Hitpatchut Hayeled should answer you within ten working days from when they receive the application. If they do not contact you, you should contact them.

You will then be put on a waiting list

for an appointment for the appropriate evaluation (speech and language, occupational, physical, psychological, neurological or interdisciplinary) that best suits your child’s needs, either in Hitpatchut Hayeled or in a local clinic.

You should be aware that there may be an extended waiting period. Depending upon the needs of your child, this may affect your child’s opportunities for proper educational placement. If you are on a waiting list for an evaluation or therapy for more than three months, you are entitled to go to a private therapist and be partially reimbursed from your kupah. However, you must check with your kupat cholim to be sure that the specific therapist you choose to use will be approved by your kupah.

Tips for the evaluation process On the day of the evaluation, make sure your child is well rested, comfortable and not hungry. It is important for children to be at their best so that they will cooperate with the testing procedures. Bring any medical reports or documents and be ready for questions regarding your child’s development, any medical conditions or hospitalizations, and anything else of importance to your child’s history.

Once the evaluation is complete, you will be notified as to whether your child was approved for therapy and what services he is entitled to. If you don’t receive a written report within two weeks, with specific recommendations, call Hitpatchut Hayeled or the clinic where the evaluation was done. After you are approved for services, you can choose where to receive the therapy — either at a snif (branch) of Hitpatchut Hayeled, or at a machon hesder (cooperating clinic service provider).

Contact your individual Hitpatchut Hayeled for a complete listing of locations that offer therapy.

Once your child is approved for therapy, you may contact Chaim V’Chessed to

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help you choose the place that best suits your child’s therapy needs.

4. Optimal Educational Placements During the evaluation process, or once your child begins to receive services, the professionals may suggest looking into a different educational setting for your child. Especially young children, between the ages of three and six, can benefit greatly from a modified educational setting for a few years to help them resolve issues and acquire skills to assist in future learning. There are both Hebrew- and Yiddish-speaking placements.

Vaadat Shiluv The first step in placing your child in the optimal educational setting is a vaadat shiluv (preliminary meeting).

In order to register in a gan meshulav, you only need to have a vaadat shiluv.

Vaadot shiluv take place in March and April.

Bring your child’s eye exam, hearing test and all other evaluations that have been done to the vaadat shiluv. It is not necessary to bring along your child unless your ganenet or teacher specifies that you should.

At the meeting, your child’s ganenet will describe his functioning level in the gan or classroom. You will be asked questions about your child’s development and functioning level at home. The professional staff at the meeting will make a recommendation for your child based on the information they are given. You may be told that additional evaluations are necessary, such as that of a rofeh hitpatchuti (developmental doctor) or a psychological evaluation. These evaluations will help determine which educational setting is best for your child.

Vaadat Hasamah After the vaadat shiluv, you will be notified of the meeting’s outcome. If your child has been placed in a special education setting, you will need to complete all necessary evaluations

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and submit them to the Iriyah. After the evaluations are submitted, you will receive an appointment for a vaadat hasamah (placement meeting). The process is extremely time sensitive. Contact Chaim V’Chessed to make sure your application is submitted on time.

Though the bureaucratic procedure is unfortunately complicated and time-consuming, the benefits of early intervention are well worth the effort.

Note: Parents of a child with a differential diagnosis (down syndrome, cerebral palsy, delayed mental development, autism spectrum disorder, etc.) receive guidance from the educational staff at the child’s maon or gan as to continued educational services and the vaadat hasamah (placement meeting). However, if your child has been integrated into a regular preschool program without any assistance from Revachah (Social

Services) or Misrad Hachinuch (Ministry of Education), you will need to follow the procedure listed above.

The protocol for the vaadat hasamah is similar to that for the vaadat shiluv. Before your vaadat hasamah, be sure you have all the necessary evaluations and therapy sessions. Additionally, do some research beforehand about the optimal placement setting for your child. You are entitled to request a specific placement for your child, but the vaadat shibutz will make the final decision.

Vaadat Shibutz After the vaadat hasamah, there will be an additional meeting, a vaadat shibutz (final placement meeting).

The parents and teachers of the child do not come to the meeting. At this meeting, a final decision is made regarding where the child will be placed for the upcoming school year.

At any time throughout the process of the vaadot (meetings), parents who are not satisfied with the outcome of the meeting can request a vaadat irur (appeal committee). At each meeting you will receive the forms necessary to begin the appeal process. If the proffered explanations are not clear, you can ask the psychologist at the vaadot for clarification.

Important note: Evaluating a child can be both timely and costly. It can be done privately or at your kupat cholim.

Many of the kupat cholim have an excellent staff who provide a professional, inclusive assessment of your child.

Parents often choose to do evaluations privately so that their child is evaluated by a specialist in the specific field they need. Sometimes you can receive reimbursement from your kupat cholim. Be sure to verify the reimbursement policy before the private appointment.

In order to understand and best help your child, it is important to have a thorough and accurate evaluation and report.

JERUSALEM ORGANIZATIONS THAT ASSIST SPECIAL NEEDS CHILDREN Aleh Rehabilitative care for disabled children HaRikmah 9, Romema 02-501-1000 Av Israel Center for children with impaired hearing, teaching deaf children through auditory verbal approach, guidance for cochlear implants, private hearing tests, hearing aid fittings and therapy 02-673-0244 Bizchut Promotes rights for people with disabilities. Offers information and advocacy services for people within the entire range of disabilities.

Kanfei Nesharim 3, 02-652-1308

Chaim V’Chessed Special Education Department Guidance and assistance for English speakers in Israel struggling with special education 072-CHESSED (072-243-7733) Count Me In – Beyachad For children with Down syndrome Shaul HaMelech 02-582-9983 Fax: 02-581-9164 Ezer Mizion Various programs and services for families and special needs children 03-614-4444 Kesher Information center for parents of children with special needs Yad Charutzim 4, 02-623-6116

Machon Mayim Chayim Therapeutic swimming and hydrotherapy, pool with wheelchair accessibility Moshav Beit Chilkiya, 08-859-4640 Machon Mikelson Assists children and adults with vision impairments: evaluations, guidance and lending library Hadassah Ein Kerem 02-625-7552 Shalva Assistance for families with children with special needs Ibn Denan 6, Har Nof, 02-6517607/9555 Ta’atzumot Helps empower families of children with special needs and provides therapies Givat Moshe 5, 02-537-0906

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Tvunot Child guidance and educational intervention 02-651-6837 Yad Sarah – Play Center Provides supervised play and instruction for children with motor and cognitive problems. The center has rooms for creative play, gross motor play, fine motor play, didactic play, computer games and lending library for toys.

Sderot Herzl 124, 02-644-4488 Yated (Yaldei Tismonet Down) English-speaking representative to help parents of children with Down syndrome. They provide advice and support.

Yad Charutzim 19, Talpiot 02-672-1115

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How to Break Through Denial in Addiction

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By Yonah Pollak

n my work regarding addictions, one of the major things I have to do is to help the client become aware of the destructive behavior he or she’s involved in, as well as the consequences of that behavior. This resistance in recognizing the behavior or the addiction (if it meets the criteria and symptomology of addiction) that the clients’ involved in is known as “denial”.

I find in my work, particularly with the younger population that acronyms are a very effective tool for people to learn and remember concepts.

One attractive way to present the idea of “being in denial”, is by using the acronym: Don’t Even kN ow

I Am Lying

Another technique that I’ve found very helpful in order to break denial and bring the client closer to the realistic consequences of his behavior is a method that I refer to as the “YETS”.

YETS This is a technique by which the counselor uses the client’s history and progression regarding a problematic behavior (drug abuse, drinking, sexual addiction, cigarette smoking, or any other behavior) in order to show that there are “no nevers” (I’ll never do that) regarding that behavior in the future. If involvement continues, then behaviors which the client (today) will say “I won’t ever do that”- in the future there’s a good chance that he will do it. This is based on his past history where he also would have said, “I’ll never do that”, and then we see that he eventually did do it. Therefore, we say that

ABOUT YONAH POLLAK Yonah Pollak, M.Sc., CASAP, earned a masters degree in psychology from California Coast University and has been involved in the field of addictions for the past 24 years. He is a Certified Addictions and Substance Abuse Professional (CASAP) and an Internationally Certified Alchohol and Drug Counselor (ICADC). He completed a full time 3 year internship at the Nachat Ruach drug rehabilitation program in Jerusalem. He provided both individual and group therapy for seven years as a member of the therapeutic staff of both the Kesher Yeshiva and the Tikvah Seminary, located in Jerusalem, which were specially designed programs to deal with the youth at risk population. Yonah provides consultation, supervision, and therapeutic services for a number of Yeshivot and Seminaries in the Jerusalem area based on his clinical approach which integrates cognitive -behavioral, psycho dynamic, reality therapy, and IFS, internal family systems therapy. He’s a member of the advisory board of the Kav L’Noar counseling and mentorship program, Shlavim and Amudim, and maintains a private practice in Jerusalem specializing in addictions and other behavioral and emotional problems. Yonah Pollak can be contacted at 054-763-5240.

there are “NO NEVERS”, only “YETS”- (I haven’t done it yet). This is a very powerful technique to break the client’s denial, because you can actually show him in his own life where similar circumstances like this have already occurred.

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Fitness & Nutrition

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Rivka Matluk’s Vision of Better Living through Exercise How an Individualized, Respectful and Attentive Approach to Exercise Optimizes Your Health, Inside and Out

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f you ask an average person why they exercise they are likely to answer: to lose weight, to look more trim, or to increase stamina. However, Rivka Matluk, exercise physiologist and yoga therapist, believes that these outcomes, positive though they are, reflect a limited view of the benefits of physical activity. “The power of exercise goes way beyond weight loss–I believe that it can help people be happier in their daily lives.”

This conviction led Rivka to pursue a Master’s Degree in exercise science and rehabilitation over 19 years ago. Her rich experience includes five years working in the field of cardiac rehabilitation in the USA, and since her Aliya, 13 years as an exercise teacher and personal trainer. Throughout her career, she has expanded her knowledge, so that she is now certified to teach yoga (including mat, chair, water yoga and therapeutic yoga), Pilates and Yogalates, a fusion of these two disciplines.

Rivka views these fitness regimens—and other forms of exercise—as powerful antidotes for the chronic conditions that crop up in the pressures of daily living. “The right exercise can help a person alleviate diseases such as scoliosis, hypertension, osteoarthritis and Type 2 diabetes.” Delving a little deeper about diabetes, a disease which is on the rise around the world,1 Rivka explains: “People with type 2 diabetes have too much glucose in their blood. When you are exercising, your muscles can consume this glucose, even without the presence of insulin, and thus exercise can reduce this excess.”

An avid walker, Rivka encourages healthy people to pursue a fitness routine that they enjoy. “If you want to bring your body into good health, you need to find a discipline that excites you.” Nonetheless, as is evident from her credentials, Rivka has an affinity for exercise that challenges both mind and body. “I love yoga and Pilates since, on top of all their other benefits, they tap into the mind-body connection.” Rivka adds that these types of exercises also help us be more attuned to signals from our bodies. “People who are trying to get fit might absorb a message from society that says, ‘Keep pushing; ignore the pain and fatigue.’ This is counterproductive. We need to respect our bodies’ limits.”

At the same time, Rivka acknowledges that there is a fine but unmistakable line between respecting the body’s signals and avoiding all physical challenge. “When you exercise, some discomfort comes with the territory, especially for beginners,” she says with a smile. On a more serious note she adds, “If we don’t challenge the body, we might lose our physical capacity. I saw this early in my career when I was working with a woman who was suffering from shoulder issues. She and her family had set up everything in the kitchen on the counter tops so that she would not have to extend her arm to reach anything. She

was scared of triggering pain. As a result of not being used, her shoulder joint became more restricted and she couldn’t reach her arm behind her. We worked together and in just three sessions, she regained her full range of motion.”

When working with her private clients to help them resolve specific ailments, Rivka draws upon her vast knowledge about physiology, accrued through years of training and experience. Beyond this, “I do research as needed about whatever issues they are going through so that I can provide the most effective assistance.”

Rivka’s students also benefit from a personalized approach.

She keeps her classes small, so that she can observe each person’s work. “During class, I demonstrate poses and exercises, but only part of the time. The rest of the time, I move around, trying to help each person, at whatever their level, perfect their movement. I also provide each student with individualized guidance about body awareness during daily living, so that they can feel better outside the classroom as well.”

Rivka’s students acknowledge that her ability to hone in on individual needs makes her classes stand out. As one student expressed, “Rivka recognizes that each student has their own skills and limitations. She provides individual attention and modifies movements for each student without judgment.” Another student echoed, “Rivka manages each class in a way that makes it work for students of varying levels, and encourages each student to take responsibility for her own progress, while constantly providing feedback.

I really feel a difference in my body after every class.”

Rivka’s warm personality is another factor that keeps people coming back, as one student shared, “Rivka loves and believes in what she teaches, and it’s contagious!”

Harnessing her enthusiasm, expertise and yes, compassion for her hard-working students, Rivka helps each individual be more connected to her mind and body. More specifically, she says, “My aim is that each student exits my class better equipped to function optimally throughout the day.”

ABOUT RIVKA MATLUK Rivka is a certified Yoga and Pilates Instructor with a Master’s in Exercise Science and Rehabilitation and certification as a Yoga Therapist. She has extensive experience working with individuals with diverse health issues in classes and on a one on one basis.

She can be reached at 050-992-1033 or matluk@bezeqint.net

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Heal Your Relationship with Food:

Aliza Eisenstein on the Non-Diet Approach

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liza Eisenstein is a nutritionist with over 18 years of experience, licensed in the US and Israel. Eschewing the dieting approach, she offers individual nutrition coaching and workshops for pre-teens, teens, and women with the goal of helping her clients develop a healthier relationship with food and implement sustainable changes.

How did you develop your unique approach to nutrition?

I kept seeing diets fail, again and again—for myself and many others. People were coming to me for diet guidelines and expecting to solve their weight ‘problem’ once and for all. Although unrealistic, that’s what was expected of me as a nutritionist. I felt stuck.

I went to a life coach, and started to see that my own beliefs about food and my relationships with others impacted not only my career, but also my eating habits. Once I was able to differentiate between physical hunger and the emotional sensation of wanting food, I could explore and tend to the emotion rather than silence it with food. I understood that this type of work was key to helping future clients. I trained as a life coach, and ever since, I’ve been offering my clients a much deeper and more effective approach to addressing their eating problems.

What’s wrong with dieting?

Research shows that if you go on a diet, you are actually more likely to gain weight in the long run. This is because restriction—a basic component of a weight-loss diets— triggers psychological and physiological responses that make most weight-loss diets a setup for certain failure.

It’s a vicious cycle where the repeated failure reinforces shame and inadequacy, which set us up for more failure.

How is your approach different from that of other nutritionists?

Hashem created us with internal cues that let us know when we need fuel and when we’ve had enough. Many of us learn to distrust those cues over time. I teach my clients that they can trust themselves to decide what, when and how much to eat; to recognize, understand and respond to their natural body cues rather than following external guidelines about when and what to eat; and to recognize and develop alternatives to emotional eating.

But what if someone feels that she can’t trust herself to decide what to eat?

There’s a big difference between eating on impulse and mindfully eating what you truly want to eat. Eating impulsively is when the thought arises that you want to eat something, and you act upon it without paying attention to your thoughts or feelings. Intuitive or mindful eating is asking yourself, “What do I want to eat now? Will I truly enjoy it? Will it feel good in my body?” If the answer to

those questions is yes, then you would go ahead and eat whatever it is , noticing how you feel while eating it. When you do this, you’ll start to notice when you’ve had enough: when you are satiated or no longer enjoying. It often takes some work to retrain ourselves and recognize cues, but every person can learn to trust themselves around food.

And when you do, you’ll discover that you will intuitively choose a balanced diet that provides just the right amount of calories for your body.

What does learning to trust yourself look like?

There are three components to becoming a mindful and intuitive eater: Granting yourself unconditional permission to eat: The default setting is I am allowed to eat this if I want it. This neutralizes the physiological responses to restriction and deprivation.

Listening to your body: Retraining yourself to hear what your body is telling you about hunger and fullness.

The key here is to learn how to be an unbiased observer: to notice, without judgement, how you eat in various circumstances, what you are thinking when you reach for food, etc. When you can do this, you are much more likely to make necessary changes without getting stuck in shame, guilt and frustration.

Managing emotional eating: My experience, both personal and professional, has shown me that it is not a lack of knowledge that makes people fail to eat healthfully; the huge challenge that so many face is how to manage themselves around food when emotions are running high. I help clients develop alternative skills to coping with emotions so they don’t have to turn to food.

ABOUT ALIZA Aliza Eisenstein is a Registered Dietitian/Nutritionist (RDN), and holds a Master’s degree from NYU. Prior to Aliyah, she taught in Stern College, and ran the Special Diets department at Camp HASC. Aliza currently runs a private practice, and has recently developed a program combining her experience in nutrition with coaching, to help women and girls eat right and feel good about themselves without the struggles of dieting.

Aliza can be reached at 054-842-3044 or aliza202@gmail.com

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Change Your Mind About Fitness Many people are resistant to exercise. They think it has to fit a certain model in order to be effective.

Personal trainer Jerome Wojtalik explains that getting in shape is all a matter of finding what works for you.

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xercise is not for everyone,” say people who associate the word “exercise” not unfondly with a nostalgic memory of leg warmers in the 1980s. Most people used to be content as spectators and considered their weekly carrying of shopping bags from the car to the front door as a “workout.”

But, today more and more people are embracing exercise, and gyms are popping up all over like mushrooms after the rain. Jerome Wojtalik, personal fitness trainer, has observed the worldwide shift in health awareness that has taken place over the last decade and welcomes the change. With a background in competitive sports—including rugby, American football, hockey, basketball and martial arts—he made Aliyah and became involved in the American Football League.

After obtaining trainer certification both in Israel and the US, Jerome began his career in fitness training for people between the ages of fourteen and sixty, from his home-based fitness studio in Jerusalem and in the homes of his clients.

FIT FOR A KING? Jerome emphasizes, “Fitness is not solely for bodybuilders and athletes; it’s for anyone who wants to feel good and live a healthier lifestyle. Today there are many gym chains around, which means a lot more competition and a larger variety of fitness packages, making memberships more attractive.

Others, who prefer fresh air or a sea view to the monotony and boredom of the treadmill or circuit, go running or walking—requiring only a good pair of sports shoes. “Everyone can find something that works for them. The main thing is to find an activity you like and be consistent. If you are comfortable with what you’re doing and feel like you are getting the results you want, go for it,” Jerome encourages. But a lot of people don’t know how to train properly or don’t have the self-discipline or willpower to do it alone. “Starting initially with a trainer takes off some of the pressure by having someone else teach you exactly what to do,” Jerome recommends.

However, Jerome doesn’t believe clients should have to rely on him forever. His goal is to offer a broad life change, sometimes working with clients on how to plan and balance exercise, sleep and work schedules. “The best thing I can do for a client is teach them to be self-sufficient. Some clients come 2-4 times a week with long term lofty goals.

Some come to me once a week, and in those situations, I give them an exercise schedule to do between sessions.

Others sign up for a shorter period of time to get in shape for a simcha for example, which helps with their short-term goals and teaches them how to be active on their own.”

THE GOOD, THE FAD AND THE UGLY There was a time in which long distance walks, light running or jogging were considered the most healthy and beneficial form of exercise for weight loss. Today high-intensity interval training is all the rage. Fitness is a science-based

moving industry and therefore trends come and go. While he does embrace new and beneficial forms of exercise, Jerome prefers to build an individualized workout for each client and promote a change in lifestyle. “I identify what works for each client, and then build them a fitness program that integrates a variety of disciplines, including HIIT, movement and mobility training, and even yoga, regardless of what’s ‘in’ at the time.”

Many people use exercise as a way to get in shape. Asked if “being in shape” can be a valid goal in of itself, Jerome says wisely, “It depends how you define ‘in shape.’ Working hard to maintain a fit, toned body is something to be proud of, but when you exercise right, you’ll get way more out of it than just a great selfie on Instagram.”

PUSH TO OPEN DOORS Physical training teaches us a lot about endurance, determination and accomplishment. “One of my clients started out at 140kg. He was too heavy to comfortably move around the football field and was in poor physical shape. In one year he lost about 34 kilos, became a starting player, fell in love with fitness and eventually became a trainer and coach.”

“The mental discipline we practice through physical training gives us tools to use in all aspects of our lives,” Jerome sums up his philosophy. “Your limit is always further than you think.

ABOUT JEROME Jerome Wojtalik has been a personal trainer for six years in Jerusalem. He specializes in working with athletes in various fields of sport. Jerome works with groups and individuals seeking to improve their fitness level.

Jerome can be reached at 050-709-1341.

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The Sky’s the Limit at Sky Gym Personalized regiments, dedicated trainers and a holistic approach make getting in shape and leading a healthier lifestyle no sweat.

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elcome to Sky Gym, a boutique workout venue in Jerusalem’s Talpiot neighborhood that specializes in personal fitness training.

Established by Meny and Lia Elbaz, a couple who’ve spent years studying the world of fitness and motivation and implementing this knowledge for more than 16 years, Sky Gym is a fully equipped fitness center, with all the weights, machines and gear you could possibly dream of. Yet, what truly sets this gym apart from the pack is its club-like nature: everyone who comes to train does so together with his or her own designated personal trainer, receiving individualized attention regardless of how many training sessions are going on simultaneously.

From the initial fitness assessment through fun, personalized, high-intensity training sessions, at Sky Gym, your journey to a healthier, more active and engaged lifestyle is limited only by the sky above and your drive to thrive.

A HOLISTIC APPROACH TO FITNESS Some fitness centers pride themselves on physical results, on building the body, sculpting it into a vision to behold. At Sky Gym, while trainees can work towards achieving the physique of their dreams, the real goal is far greater and all-encompassing. Here, the emphasis is primarily placed on living a healthy life, through a combination of physical activity, proper nutrition and the balancing of body, mind and soul.

“We have found that in order to achieve maximum results, we must integrate all elements relating to physical fitness,” Lia says, highlighting the gym’s holistic fitness approach. “From strength training, flexibility training and aerobics to healthy lifestyle education, including providing nutritional guidance and ensuring our trainees drink enough water and get quality sleep, we cover it all.” That they do, raising the bar of success by approaching fitness, health and wellbeing with a positive attitude. “It’s the combination of hard work and self-love and acceptance that we push for, that ultimately leads to the amazing results we see our trainees achieve,” she adds.

“What is most important to us is that our trainees believe that they can succeed,” Meny interjects. “Achieving self-confidence and self-efficacy is an even bigger win than their meeting technical goals.”

THE NEXT GENERATION OF FITNESS CENTERS When asked why establish a “personal training club,” as opposed to opening a regular gym simply staffed with great certified personal trainers, Meny explains, “As members of the fitness profession, we are constantly learning and acquiring new ways to enrich our toolset. While working in various fitness centers, Lia and I identified that out of all the individuals hitting the gym, those who engaged

in personal training sessions were those who stuck with their regiments over time, ultimately achieving desired results.” Conversely, those working out on their own were likely to quit the gym within three months’ time, he adds.

It is the close, intimate coaching, encouragement and correcting of improper training techniques that motivate trainees to keep at it—and what the Elbaz’s believe will serve as the catalyst for a new and exciting approach to the running of fitness centers, with Sky Gym leading the way.

PERSONALIZED CARE Trainees new to Sky Gym are privy to a comprehensive intake session, during which they undergo a physical examination (of muscle, fat, fluids, etc.), discuss their medical and fitness history, set personal goals and bring up general preferences. Taking all this into account, Meny creates a custom program that includes personalized fitness regimes and nutritional recommendations. And while trainers do end up managing up to three trainees at once—each engaged in their own tailored, goal-oriented program—the environment during workouts remains highly intimate, so trainees feel as if they are working out one-on-one. Sky Gym’s team of highly experienced professional personal trainers explain exercises, demonstrate how to use the equipment and coach each trainee, without missing a beat. And if for some reason a training session is skipped or cancelled or not scheduled, a phone call is always made, making sure the trainee is all right and hasn’t lost his motivation.

At Sky Gym, the trainers truly love what they do, believe in and live the healthy lifestyle they coach towards, and truly care about each and every individual they train.

ABOUT SKY GYM Sky Gym has been operating for nearly seven years. In addition to the gym, they have just opened a studio with classes of up to 12 people, preserving the personal touch.

The studio classes offered include uniquely developed, innovative classes with special equipment, traditional classes such as yoga and zumba, and more spiritual classes such as meditation and free dance.

For more information, visit www.skygym.co.il, Find us on Facebook: SkyGymJer, or stop in at Haparsa 3, Talpiot, Jerusalem (Rav Hen Mall). 02-5335220.

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Therapy

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The Importance of Dialogue and Collaboration

An Interview with Hillel Zeren Hillel Zeren has always been drawn to philosophy and has found that psychology offers a way to use philosophy to help people who were struggling with different aspects of life. While training, he found himself constantly drawn to approaches that focused on a person’s potential and aimed to provide help by accessing positive ways of emerging from the difficult grip of the problem.

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ell us about your work with teenagers.

I relate very deeply to the unique struggles of this age group. They have such a fresh perspective on life yet are often still seen as “just” children and their voices are silenced. Left unheard, they look for people and situations that will allow them to express their unique way of looking at the world. Sometimes this is healthy, but it commonly brings teenagers to difficult and unhealthy situations.

Without learning how to find a healthy expression for their needs, many teenagers descend deeply into a troublesome mindset. However, when offered a listening ear and tools for self-expression, growth and building confidence, it is amazing to watch confident, well-balanced young adults emerge.

Where do you currently work?

For the last seven and a half years, I have been the director of the Educational Psychology Department of the municipality of Kiryat Arba. I also run a private clinic in Gush Etzion and see clients in Jerusalem. Additionally, I facilitate workshops and seminars about collaborative dialogue, parenting skills, school psychology and more, in Israel and abroad.

What does your position as Director of the Educational Psychology Department in Kiryat Arba entail?

We are responsible for all psychological services in the Kiryat Arba school system. This includes working with teachers and school principals to cater to children’s emotional needs to enhance their learning ability. We provide various therapeutic services in schools and also act as liaisons between parents and schools to develop cooperative, comprehensive plans for individual children.

Tell us about your work with trauma victims? What methods do you use?

Very often, my role includes working with trauma victims.

I am recognized by Bituach Leumi as a licensed provider of therapy for victims of terror attacks and their families. This is very challenging work but crucial in helping people reclaim their lives after these horrific acts. During and after a terror attack, a victim is filled with fear, anger, sadness and a deep sense that the general order of their life has been disrupted. I work with various techniques such as memory restructuring

and the strengthening of personal agency and choice, which allows trauma victims to take a strong stand against the acts that were committed against them and enables them to feel empowered to reenter their lives from a place of hope and personal values, despite what the attack tried to take away.

What work can be done with kids on the autistic spectrum (ASD)? Do you see results?

My work in this field is mainly with children and teens and is often performed in conjunction with parental guidance. A child on the Autistic Spectrum (ASD) can be very challenging for parents as they require a very different skill set connected to relationships and communication.

The help I provide includes working individually with the child/teen in order to help them become more aware of the unique challenges they face when navigating social situations and how to handle the emotional responses that accompany this. I use a combination of Cognitive-Behavioral Therapy (CBT) as well as Narrative Therapy techniques to help the child to incorporate behaviors that can ease their challenges while enhancing their sense of personal identity in a positive way. The combination of understanding themselves and their struggles, combined with helpful preferred thoughts and behavior, and parental support, provides a new and resilient way of being in the world.

Tell us about your current work using dialogue and collaboration in families?

I have incorporated techniques of dialogue and collaboration when working with children, parents and schools in order to help people hear and understand each other even while disagreeing. Dialogue, in contrast to discussion, involves the ability to suspend one’s opinions in order to make space to hear the opinions of another. When done collaboratively with multiple participants (child-parent, child-parent-school, etc.) new possibilities arise out of the collective that could not have arisen from the old, stuck and usual ways of doing things.

ABOUT HILLEL ZEREN Hillel Zeren M.Sc. is a trained clinical psychologist and Director of the Educational Psychology Department of the municipality of Kiryat Arba.

Hillel can be reached at 054-759-0027 hillelzeren@gmail.com

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Miracles Can Happen

Sharon Wolfman Will Help You Recover from Pelvic Floor Dysfunction

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ifty year-old J.K. rarely left the house—only for emergencies and assorted treatments. She suffered from both urinary and fecal incontinence and was too ashamed and depressed to face the world.

25-year-old T.R. had been married for a year, and despite being declared completely healthy by doctors and psychologists, she had been unable to consummate her marriage due to severe pelvic floor pain.

Both of these women suffered from the same root condition: pelvic floor dysfunction.

The pelvic floor is a layer of muscles and other tissues stretching from the pubic bone to the tailbone. Its role is to support the abdominal and pelvic organs, such as the bladder, intestines, and the uterus in women, and to prevent incontinence.

Pelvic floor dysfunction can be caused by a variety of factors: childbirth, menopause, obesity, surgery, chronic coughing, poor posture and radiation treatments which can weaken or damage the tissues. Post-surgical scarring from abdominal surgeries such as C-sections and hysterectomies may also contribute to discomfort in the pelvic floor.

A weak or damaged pelvic floor can cause or exacerbate various symptoms and disorders, including problems relating to the urinary or bowel systems (like the incontinence experienced by J.K.), pelvic organ prolapse (when one of the pelvic organs drops out of the pelvic cavity), or difficulties relating to intimacy (like those experienced by T.R.).

Sharon Wolfman, a licensed clinical physiotherapist, has been specializing in pelvic floor rehabilitation for over 10 years. She helps men, women and children overcome problems related to pelvic floor dysfunction through pelvic floor physical therapy (PFPT). Sharon has been practicing for more than 30 years as a physical therapist at Clalit and Leumit clinics and with a variety of organizations such as Keren Or and the Child Development Center. She has certification in orthopedic and pelvic floor therapies as well as hydrotherapy, cranio-sacral therapy, osteopathy of the pelvic floor, and various treatments for children.

Awareness of pelvic floor dysfunction has increased somewhat in recent years, helping women understand that the problems they are experiencing may be related to the pelvic floor and can be addressed with PFPT. J.K., for example, came to Sharon after trying absolutely everything. After 10 treatments with exercise and some basic lifestyle changes, she reported regaining full control of her bodily functions and has returned with confidence to all her life activities.

Childbirth can be traumatic to the pelvic floor, especially if the birth was complicated. “Most postpartum women could benefit from pelvic floor physical therapy,” asserts Sharon. “Unfortunately, many kuppot do not cover this

therapy after childbirth. It’s important to continue raising awareness on the profound need for pelvic floor therapy.”

Women and men recovering from abdominal and pelvic surgeries can also usually benefit from rehabilitation of the pelvic floor.

Another painful phenomenon about which there is not yet enough awareness is pain during intercourse (such as vaginismus or vulvodynia) and other problems relating to intimacy. Sharon says that in her experience, most pain, including these types of discomforts, can be addressed with the right treatment.

T.R., the young woman mentioned at the beginning of the article, underwent intense treatment with Sharon that consisted of both physical and psychological therapy.

Today, she reports enjoyment and complete comfort with intimacy.

Though it may sound like it primarily affects women, pelvic floor dysfunction can affect people of any age or gender. Children sometimes suffer from incontinence for unknown reasons even after they’ve been successfully toilet-trained, causing accidents and bedwetting. This can cause a great deal of shame, embarrassment and frustration to both the child and parents. Children may also suffer from difficulty urinating, frequent bladder infections, not urinating enough during the day, or difficulty sensing bladder fullness. All these issues, says Sharon, can be addressed by teaching the children pelvic floor exercises.

So what does the treatment involve? Sharon assesses her patients and teaches them exercises that help strengthen or relax the pelvic floor muscles as necessary. “Patients often achieve a noticeable improvement after a few weeks,” she says. “Most patients need between six and nine treatments, with one treatment every few weeks.” Patients are assigned exercises to continue practicing at home. The exercises can be challenging, Sharon says, but they are generally not painful. Patients build stamina and endurance the more they practice.

“Pelvic floor dysfunction can be quite distressing,” says Sharon. “sometimes even painful. I am passionate about practicing PFPT because it consistently improves the lives of my clients in lasting and tangible ways.”

ABOUT SHARON WOLFMAN Sharon Wolfman is a physical therapist specializing in pelvic floor rehabilitation for men, women and children.

For more information, call 052-300-3160, visit jerusalemphysio.wixsite.com/jerusalemphysio, or email harbater1@gmail.com.

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Should I See a Psychologist?

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n our life, we often face obstacles which hinder our selfgrowth and healthy functioning and hold us back from being our best selves and doing what we would like to.

Below is a sample of those challenges.

PARENTING: • “Our eight year old drives us crazy. The minute he comes back from school the house turns upside down and there is constant crying and yelling all around. I can’t take it anymore. Help!”

• “My sweet kindergartener has not been herself. She has become withdrawn and cries a lot. She’s been having accidents and she also comes to my bed every night because of nightmares. What’s happening? What can I do for her?”

SELF-ESTEEM: • “I am extremely shy in public; I don’t dare say a word or express my opinion. I barely have any friends, and my self-esteem hinders me from dating. How can I help myself?”

• “I’m very disorganized, causing others to complain and make comments that put me down. I don’t complete tasks and have difficulty succeeding in school. Is there any hope for change?”

HEALTHY FUNCTIONING: • “I love my baby very much. However, since he was born regular tasks seem like a huge burden to me. I feel constantly drained and am not the same upbeat and spiritual person I used to be. I’m so despondent. Can I get my old self back?”

• “I grew up with an aggressive, demanding father and a critical mother, who were constantly fighting. Now that I’m married with children, I find myself yelling at my husband and children, and I realize that I am making some of the same mistakes, though I had promised myself I never would. How can I change my behavior?”

TRAUMA: • “My husband, my baby and I were in a car accident.

Only I was injured. A couple of months have passed and I’m still traumatized. I have constant flashbacks and am over-concerned about the wellbeing of my children. How can I overcome this overwhelming anxiety?”

Issues such as these and other obstacles that people face can be overcome with professional guidance, where clients learn how to function as strong, upright and positive individuals.

Here are some general tips that could help navigate through challenging situations which will give you a taste of ideas that can be further developed in therapy: Tip: Learn to be authoritative with your kids; it’s your right and duty. The family framework is not a democracy—Hashem gave you the task of teaching your children to honor their father and mother . Giving children clear

boundaries helps them feel secure and is essential for healthy development. Still, let us keep in mind that as parents we are not police officers, and that authority is an outcome of internal strength and should not be enacted as a power struggle.

Tip: Remember there is no such thing as a bad child, rather a child who feels bad. Children are inherently good, and as such, even when they behave inappropriately they really want to be good and please their parents. Sometimes parents will need guidance, and the child may need intervention, including taking medication to make him reach his potential.

Nobody likes the idea of taking medication, for themselves or their children.They may feel as if they’re poisoning the body, but in fact, very often it is supplying the body with something it lacks. In conjunction with seeing a therapist, when taking medication a person will fairly quickly be able to give the most of himself.

Tip: Learn to be assertive, ask for what you wish and stand by your opinions, without being aggressive. Remember, since it is of utmost importance to maintain shalom bayit—peace in the home, you should strive to achieve a win-win system within the family.

Tip: Learn to see the positive. Most stories in life have two sides, one positive and one negative. It is your choice how you decide to see a situation, yet often it is hard to make that choice alone. Professional help provides individuals with the tools to access their inner reserve of positive energy.

ABOUT YEHUDIT Mrs. Yehudit Kushelevsky is a psychologist who holds an M.A. in Child Psychology and Counseling, having studied under the world-renowned Swiss researcher in child developmental psychology, Professor Jean Piaget. She has worked in Israel as a school guidance counselor for 26 years, has taught in Beer-Sheba University, has run a course for school counseling studies in seminars, maintaining a private practice throughout.

Mrs. Kushelevsky specializes in cognitive and narrative therapy and EMDR therapy, as part of the techniques she uses. She has developed her own unique and effective approach, customized for each individual. Mrs. Kushelevsky has vast experience working with parents, children, teens, and women in all stages of life. She offers services in Hebrew, English, and French.

  

Her clinic is located in Bayit Vegan and she may be reached at: 02-6447505 (Messages can be left at this number).

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Facilitating Real, Lasting Change: An Interview with Ephraim Portnoy

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phraim Portnoy is an MCSW psychotherapist who provides individual and group therapy to patients, in addition to his work at Kiryat HaYeled children’s home in Jerusalem. He previously worked as a social worker at Social Services as well as in private practice.

What type of psychotherapy do you do?

I try to fit the therapy to the client. In general, when a client comes with a specific issue, it’s preferable to use evidence-based therapies, such as cognitive-behavioral therapy and its offshoots, such as acceptance-commitment therapy.

Some believe CBT is superficial and deals with the symptoms rather than the root of the problem; this misconception stems from a lack of understanding of CBT and how it views the roots and sources of our difficulties.

Sometimes a client might not have a clear, specific problem, he might just be feeling stuck or have a general need to figure things out. In these cases, I would use talk-based therapies, such as object-relationship or other psychodynamic frameworks. These therapies fit better for someone who is looking to develop their self-awareness.

Often, through talking things through, a client may come to a resolution on his own. Other times, he may choose to tackle some issues that came up through a more focused, CBT- or ACT-based therapy.

Who are your clients?

Lately, I’ve been seeing mostly teens, but in the past, I’ve worked with adults as well.

Do teens usually come on their own volition or only when prompted by a parent, teacher or other influential adult?

They almost always come when prompted to by an adult.

However, I find it important that the client himself initiate contact with me, even after a parent approaches me. He shouldn’t feel like he’s just being sent by his parent. If the teen doesn’t take an active step asking for help, the therapy ends up being forced.

The same thing applies to men in general. Men don’t usually look for therapy on their own, but I’ll have wives asking me to treat their husbands. I find that if the husband doesn’t afterwards take the initiative to call and ask for help, the therapy ends up feeling forced and is ineffective.

How long do your clients usually stay with you?

Contrary to popular belief, if a client has something specific bothering him, then real, lasting change can be achieved in just a few months. However, if a client’s motivation for seeking help is less defined, then they may benefit from more time.

What are issues that many teens struggle with, that if not addressed will easily follow them into adulthood?

Teens often struggle with trust issues, the ability to develop relationships based on mutual trust; understanding their place as an individual within society; and with issues involving sexuality.

How can being in a group cause clients to open up more than they would in an individual session?

The point of group therapy, or even therapy in general, isn’t necessarily to have someone “open up.”

In group therapy, the group provides the client an opportunity to become more aware of himself and how he reacts and feels in various situations and interactions such as: when he feels like talking and when he feels like listening, what he feels when he hears what other participants are saying, how he feels about the others reactions to him?

However, even in one-on-one therapy a client can learn about himself when he pays attention to how he reacts and feels in his interactions with the therapist. This helps him understand how he works with individuals, especially authority figures.

In some groups, people struggling with similar issues may bond and come together. When a participant learns how other people are dealing with and reacting to similar situations, it can help him learn more about himself and how he might take a healthier path in dealing with his own struggles.

In both individual and group therapy, I sometimes help the clients express themselves using games, toys and colors to express how they feel about things. In a group setting, I use games which involve all the participants.

Who would you not recommend group therapy for?

I believe that most people will benefit from group therapy, though an issue that might arise is breach of trust.

There are very few individuals who would break the trust of a group and they shouldn’t be part of one.

What do you enjoy most about your work?

Getting to know people, to empathize with their struggles and growth and the opportunity to have a meaningful role in someone else’s life.

ABOUT EPHRAIM Ephraim Portnoy is a Jerusalem-based psychotherapist trained in CBT and classical psychotherapies who works with teens, adults and couples.

Ephraim can be reached at 058-528-5228 or ephraimportnoy@gmail.com

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Overcoming Anxiety with Cognitive Behavioral Therapy (CBT)

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ell us about your professional training.

I grew up in Toronto, Canada and then moved to Montreal, where I completed a B.A. in psychology at McGill University. In 2002, I moved to Israel and subsequently to Sydney, Australia where I earned a Master’s and PhD in Clinical Psychology, while training under world leaders in the field of anxiety disorders. During this time, I published a book chapter as well as articles in leading peer-reviewed journals.

On returning to Israel in 2009, I began working as a psychologist through the Efrat municipality and received a license in School Psychology. I worked for nine years in Efrat, providing consultation services to paraprofessional staff and parents, as well as offering psychological assessment, parent counseling and treatment for children with learning difficulties, ADHD and behavioral issues.

What are your areas of specialization?

I have a general psychotherapy practice, but I specialize in the treatment of anxiety including: generalized anxiety disorder, social anxiety, separation anxiety, specific phobias, panic disorder, selective mutism, agoraphobia, obsessive-compulsive disorder (OCD), post traumatic stress disorder (PTSD), and test anxiety. I also have a great deal of experience treating olim with adjustment issues, as well as young adults studying in Israel for the year.

Everyone has some anxiety at times; at what point does it require treatment?

Feeling anxious is a normal, natural reaction to a stressful or dangerous situation. When worry is intense, persistent, and impairs functioning in home, school or social life, that’s when you may need to seek professional help. In regard to children, anxiety often presents with physical symptoms such as headaches, stomach aches, avoidance or acting out behaviors.

Tell us about your work in the school system.

I work with parents and children (ages 3-18) in numerous kindergartens and schools, thereby gaining an understanding of how the Israeli school system works and what services are offered for children with learning or emotional difficulties. When I treat a child or counsel parents, I am often in contact with the school staff in order to help them understand the child’s needs and relate to them effectively. The staff often suggest that parents take their child for an assessment or alternative therapy. There are numerous evaluations and therapies available and parents are often overwhelmed about how to get an assessment or find appropriate services.

I help guide families through this confusing process.

What therapy modalities do you use?

First and foremost, I strongly believe in having an evidence-based practice (EBP). Evidence-based therapy means that I adhere to psychological approaches which integrate the best available scientific research with clinical experience

in deciding the best course of treatment for a particular case.

For example, cognitive behavioral therapy (CBT) has been shown to be the most effective treatment for anxiety disorders, so when treating an anxious client, I would begin CBT and then integrate other techniques as needed. Similarly, dialectical behavior therapy (DBT) is the treatment of choice for borderline personality disorder (BPD), prolonged exposure (PE) is recommended for trauma related issues and so forth.

Having said that, therapy always needs to be tailored to the unique needs, family background and clinical presentation of the individual. Research has shown that evidence-based therapy is cost-effective. This makes sense since clients undergoing evidence-based therapy likely spend less time receiving treatment than those undergoing treatment plans which have not been scientifically shown to be effective.

What is Cognitive-Behavioral Therapy (CBT)?

CBT is a type of psychotherapy that focuses on changing unhelpful patterns of cognitions (e.g. thoughts, beliefs, attitudes) and emotions that influence behaviors. In this way, an individual can gain a greater sense of control over their emotions and actions. CBT is an action-oriented form of therapy in which the therapist’s role is to assist the client in practicing effective strategies to address their identified goals, and to decrease symptoms and associated distress.

CBT is recommended by the American Psychological Association as a treatment of choice for numerous psychological disorders. CBT focuses on the present and is structured, collaborative and tools/skills-building. It is generally shortterm (12-20 sessions); however, some clients with chronic or complex issues require longer term therapy.

Who is your clientele?

I provide therapy for children, adolescents, and adults in English and Hebrew. I am committed to providing evidence-based, high-quality, empathic psychological services, tailored to each client’s individual needs and goals.

I enjoy being part of each client’s journey towards living a productive and fulfilling life.

ABOUT THE COMPANY Dr. Natalie Gar is a Clinical and Educational Psychologist with an expertise in Cognitive-Behavioral Therapy (CBT) for anxiety and depressive disorders in children, adolescents, and adults. She currently maintains a private practice in Jerusalem and Gush Etzion.

Dr. Gar can be contacted at 054-440-3979 or drnataliegar@gmail.com

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Try on Your Teenage Glasses The teenage years can be a particularly challenging time for both the child and the parent.

David Kronish offers some advice on communicating effectively with your teen.

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By David Kronish

ver try looking at things from a different angle? That’s what we often have to do for a successful marriage.

Learn to listen—and keep quiet. Well, our teen and young adult children demand the same. As D. Sterlin with her insightful words puts it, “Teenagers are unpredictable”; they are smack in the middle of significant physiological, emotional and psychological changes, such that often they don’t even understand themselves. They look more toward having fun than playing it safe. Many teens lack risk awareness and tend to engage in precarious behavior, such as texting while driving or using substances. One of my own children once told me, “Abba, sometimes you just have to let go and enjoy life, despite the risks.”

At the bright young age of 20, or even 15, our young adult does not yet have two feet planted firmly on the ground— in other words, the maturity and insight of an adult. Trying to “fast-track” your teen or young adult child will often backfire, resulting in resentment and defiance.

The Ramchal, in Mesillat Yesharim, provides a metaphor for life experiences. He writes that life is like navigating through a maze. Our Chachamim—learned, wise and experienced people—are situated above the maze and can see the correct path and the way to arrive at the desired finished line. Our response, much of the time is, “Thanks, but no thanks” or “I’ll do it my way.” Well, that is exactly how the vast majority of our teens feel when we try to offer them advice and guidance.

What are teens and young adults saying when they “push back” or seem irritable, as they often do? They are trying to express what they may or may not be aware they are feeling. They want to be respected, simply because they are human beings. Don’t we adults often feel the same way?

So how do we show respect to our teenage children? By listening to them. By listening without planning our response to what they’re saying while they are saying it. We naturally feel more willing to share, and less of an urge to argue or explode, when the person we are speaking to is genuinely listening to us, and not just waiting for an opportunity to get in their own two cents. There is a time and a place for advice, but first teens must feel heard, understood and loved.

Naama Moses, a counselor, certified lecturer in CBT and columnist for Olam Katan (a weekly newspaper for teens) presents us with a brief summary of the steps needed to be a good listener and to foster positive and close relationships, all from the perspective of our teens: A. Be with me, here and now—let me feel your presence.

B. Be a discoverer—be interested in what I’m telling you;

try to understand me without being judgmental at all. I am a different person, with different life experiences, growing up in a different day and age.

C. Check in (reflect back) with me, to show you’ve understood me and that you care.

D. Listen to me, until I’m finished saying what I have to say. Sometimes, my most important thoughts will come at the end of what I’m telling you.

E. Please don’t rush to offer me solutions. That’s not what I want or need from you. At the moment I’m not looking for your wisdom, I need your unconditional love and acceptance.

Dr. Joshua Ritchie, director of the Refuah Institute and close student of the previous Amshinover Rebbe, added a few invaluable points in his booklet on creating harmonious relationships.

1. Be Encouraging Express admiration and appreciation for my qualities, accomplishments, values and courage.

Validate my feelings and endorse my positive aspirations.

2. Be Empowering Empower me by supporting me in making my own decisions. My successes will increase my self-respect, confidence, sense of responsibility and empowerment.

3. Be Optimistic Optimistically trust in my essential goodness.

4. Be Loving To love is to give, unconditionally. Your love for me will be nurturing and healing and will help me grow and develop When we truly listen, out of love and a desire to understand, it will ultimately lead to greater closeness and thereby a more honest and open relationship. And, as Dr. Baruch Shulem says in his book, The Jerusalem Formula, if we give positive feedback, couched in positive language, we exponentially increase the chances of developing open lines of communication. That leads to a desire—on both sides—to share what we feel and develop a closer relationship.

ABOUT THE AUTHOR David Kronish, M.S.W. was also trained in Israel in Therapy and Coaching. He has more than 20 years combined experience in the fields of Social Work and Education, having taught in elementary school, middle school and high school.

David can be reached at 052-977-3492 or david.kronish@gmail.com.

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Three Tools to Help You Take Control of Your Anxiety Suppose you are selected for a secret mission. What’s at stake? Only the safety of this entire planet. The task ahead requires extreme mental and physical capabilities… and you must face this challenge alone—tomorrow at noon. How do you think you’ll sleep tonight?

By Yonatan Sapir, MSc

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ossible scenarios of the upcoming task will probably be running through your mind. Your thoughts might be racing and difficult to control. You will probably be extremely distracted, finding it difficult to perform even the most mundane tasks. You might be irritable and find yourself emotionally disconnected from your friends and loved ones. Even your body will respond as the awesomeness of your challenge takes control of your mind—you’re sweating, your heart is racing, and you’re even shaking.

And since your mission is top-secret, nobody even understands what you’re going through. If you’re like me, you’re probably saying—no, screaming—“Pick somebody else!”

The symptoms I just described are commonly experienced by those who suffer from anxiety. Except they experience them when sitting in a classroom, playing ball, thinking about their finances, going on a date or even walking down the street. There is, however, a major difference between my hypothetical situation and the real-life examples. A person experiencing daily anxiety sees the rest of the world engaged in the same activities—without reacting the same way. He starts to think of himself as abnormal or crazy, and that only reinforces the anxiety. Many of my clients don’t understand what is happening to them.

All they know is that their mind seems on steroids, their body feels hijacked and they desperately want relief.

The process of healing requires strength and perseverance, but is achievable. Here are three important tools that can help begin that process: 1. Normalization 2. Mindfulness and 3. Faith. These tools help the client feel less overwhelmed by his symptoms, allowing him to gain more control over the problem until the situation improves.

Step one is normalizing. Often anxiety has an effect on self-image, and the sufferer develops harsh judgments about himself. These negative thoughts breed shame and create a cycle where anxiety breeds more anxiety. Additionally, these self-judgments are unfortunately often reinforced by others who lack a basic understanding of anxiety and its debilitating effects. Anxiety sufferers need to understand that they are not crazy and nothing is inherently wrong with them; they merely suffer from a common condition that 18% of Americans cope with on a daily basis and shouldn’t be more stigmatized than ailments such as headaches or arthritis. When the client internalizes this message, he rids himself of much of the shame that he has

learned to associate with anxiety.

The next tool is mindfulness. Mindfulness is the ability to be present and aware in any given situation. The brain reacts to an anxiety-provoking event as if it was in danger; the fight, flight or freeze response kicks in and the ability to think is reduced. Being able to run from or fight real danger is necessary but not in our day-to-day interactions, for example when going on an interview. Being able to take a step back and perceive the present circumstance in a detached non-judgmental way diminishes the sense of being overwhelmed. It is useful to engage in self-talk such as, “Now I am feeling scared. My heart is beating fast and I’m worried that I will make a fool of myself.” Trying to fight these feelings is usually counterproductive, but mindful awareness and acceptance of them can be calming and empowering.

Faith is an important tool because it gives us perspective.

We tend to think the way things are now are the way they’ll be forever, and many times that’s just not true. Faith in G-d who is in control and who loves us allows us to cultivate hope when we feel hopeless. This change of orientation encourages and motivates the client to continue on his path to effect meaningful change. Quite a few times, after feeling better, clients have told me, “I remember you told me in the beginning that the way I feel now is not the way it’s going to be forever.” This clearly was an important message for them.

A therapist can be an essential anchor in the often difficult process of change. When we feel understood, life seems less lonely and a little less overwhelming. Only the client can travel the road towards a better life; the therapist, however, can provide the road signs, illumination and encouragement along the way.

ABOUT THE AUTHOR Yonatan Sapir, MSc, is a psychotherapist specializing in treating anxiety. He is available to work with individuals, couples and adolescents in his Jerusalem or Beit Shemesh offices.

Yonatan can be contacted at 058-417-8538 or ysapir1@gmail.com.

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The REAL Game, or Life as Children Should Know It

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n a world full of harsh criticism and endless, unrealistic or unattainable goals, Rachel Gottesdiner is seeking to reintroduce positivity, containment and warmth to childhood. Her clinic, aptly titled, The REAL Game, seeks to unearth each child’s unique potential, direct focus to it and empower the child to achieve it, though active, imaginative play and carefully attuned therapeutic reflection.

Rachel’s patients may vary in age and come from different socio-economic and cultural backgrounds, but they all share a single common factor—low self-esteem.

LOW SELF-ESTEEM IS NOT A BIRTHRIGHT “There’s no such thing as being a perfect parent or educator,” Rachel says with conviction, “And there is no need to achieve perfection. Parents and teachers need only strive to do their best,” she continues, alluding to the good-enough parent theory of acclaimed psychoanalyst D.W. Winnicott, the matriarch of play therapy. The theory stipulates parental attunement to the child’s needs, fulfilled according to the child’s age and temperament. As the child grows, the parent is to consciously delay gratification of non-urgent demands, to help the child develop robust cognition, as well as a healthy concept of external reality that is separated from illusion.

“We live in an achievement-oriented, highly critical world,” Rachel explains. “Consequently, many parents and educators create a relentless atmosphere where ambition reigns supreme—and criticism abounds. No child is born with low self-esteem. Yet, by constantly pushing children to achieve, their self-esteem is pulverized at the hands of those who are supposed to lift them up, without their even knowing it.”

CONTAINMENT BUILDS ESTEEM, NOT CONSTRUCTIVE CRITICISM Rachel finds that any form of criticism is by definition destructive, slowly but relentlessly eating away at the child’s self-image. When coupled with an objective challenge, such as an attentional disorder, learning disability or the like, criticism often depletes the child’s self-esteem stores.

“What needs to be done is to return self-confidence and self-esteem to these children, by accepting and containing them,” Rachel says, highlighting the need for absolute authenticity throughout her therapeutic processes. “Used to not being trusted or valued by adults, these children are far more likely to internalize a harsh word over any positive phrases coming from the outside.”

BEATING TO THE PATIENT’S DRUM A prime example is that of Y.,an eight-year-old boy who entered Rachel’s clinic and headed straight to the drum set. Rachel was certain he’d take out his aggressions on the drums, but Y. proceeded to gently produce musical beats.

“When he finished playing, I told him: ‘Wow! You played a real tune,’ but he answered that his playing wasn’t great—looking utterly humiliated.” Throughout the remainder of the session, Rachel reflected Y.’s words and feelings back to him, devoid of judgement. She provided a safe space for his negative feelings. “In this way, we are able to experience the therapeutic journey together, which would never happen if I were to try and convince him that his words are untrue.” It is the containment and validation of the subjective experience that serves as a catalyst to Rachel’s clients’ progress.

AN ACTIVE APPROACH There is a need for active observation and work to improve a child’s self-esteem. At Rachel’s therapy clinic, she utilizes an illuminating therapeutic approach that she calls, “Yet.” “‘Yet’ is the opposite of rendering judgment and is based on the research of Professor Carol Dweck,” she says. Using the word in therapy enables and even invites change. Instead of using critical words to describe a shortcoming or failure, she reflects experiences back to her clients in terms of “not yet,” introducing possibility for future attainment.

This approach is equally effective during sessions with clients’ parents. “In many cases, to raise the client’s self-image, a change must be made to the parents’ interactions with the child,” Rachel explains. “Parents have the best of intentions, but they don’t always know the ideal way to speak or act. I instruct them to employ the “not yet” mantra when encouraging their children, helping them attribute significance to the time and effort spent working towards goals, even if they did not succeed in achieving them.” Through combined play or psychodrama and parenting sessions using her unique approach, Rachel continues to teach children the REAL game of life, full of containment, warmth and confidence, as they should know it.

ABOUT RACHEL GOTTESDINER Rachel Gottesidener holds a Master’s degree in psychodrama and play therapy. She harnesses the power of imaginative play to create an atmosphere of self-awareness and positive thinking for children, as well as for their parents at her clinic, The REAL Game. She also holds parenting sessions to enable parents to assume responsibility for their child’s emotional wellbeing and create authentic, lasting change.

Rachel can be reached at gorachel@neto.net.il or 054 846 0454

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Embracing Who We Are: Why Human Allowance Is Essential for Success

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By Judah Katz

hose of us who were raised in an environment of emotional stress often felt the need to protect ourselves from our painful childhood as we matured. As children, we craved unconditional love and acceptance, but we were often pressured to look and act a certain way in order to earn the love we so desperately needed. We were fraught with insecurities but weren’t given the voice or the platform to express them.

A visit to the dentist taught us that a shot of Novocain would numb the pain of the drill, and we applied that lesson to our emotions. We learned to hide and deny the ugly parts of ourselves to survive and avoid rejection. We learned from others how to turn off the bad feelings by turning on our phones, computers and other distractions.

In school, we were taught to be good boys and girls who sat nicely and always smiled. We learned that jealousy, anger and dissatisfaction with our lot was tantamount to weakness and even a lack of faith. We were left torn between the reality of what we were, and the ideal of what we were taught that we should be.

As we got older, these emotions could no longer be ignored, and they began to emerge from the unconscious. We found that we had trouble sleeping. We developed anxiety and panic attacks. We now needed higher doses of “Novocain” to drown out the pain that was trying to resurface. We once again made an effort to express ourselves, but again our feelings were met with apathy or even criticism by family and friends. We learned that expressing our pain would only make the pain worse, so we eventually learned to push it back down into the unconscious. The pain was temporarily subdued, but we continued to lose faith in our ability to cope.

Parents and teachers started to notice a hollow look in our eyes. It seemed that we now wanted only to sleep or stare at our phones. Baffled that this promising child from such a fine home wasn’t pursuing the successes they believed we deserved, they medicated us in an attempt to ‘fix’ the problem, or they sent us to therapy to be ‘healed’ and to undo a situation that they themselves helped to create.

The therapists themselves were also focused on solving our ‘problem’ so we could get back to doing and accomplishing. The hope being that once we started ‘succeeding’, we would finally be happy.

Unfortunately, the therapy has not helped. The issue was never an inability to ‘do’, rather an inability to BE. What was taken away from us at a young age was the freedom to BE like human BEINGS. All the accomplishments in the

world can’t affect this deepest desire to just be accepted and allowed to BE who we are.

One may ask, how is one meant to change if he accepts and loves himself as he is? What is the motivation for movement and growth in such a paradigm?

When we interact with ourselves from a place of acceptance and understanding, we give ourselves permission to be human. We understand that, like all humans, we can be both flawed and wonderful at the same time. We begin to appreciate and make room for the darker parts of our personalities, allowing ourselves opportunities to learn to cope with them. Instead of operating from desperation, we operate from inspiration. We are no longer needy; we can enjoy and share ourselves with the world without the need for approval and validation. This acceptance frees up the energy we had been expending on proving ourselves and is redirected to developing who we truly are.

When we are given space to be genuinely human, this initiates the healing process. There is now emotional energy to revisit the pain that was suppressed for so long, and expressing our deepest fears becomes easier. This method of ‘allowance’ begins the process of reconnecting with our true selves. In so doing, we build the emotional strength needed for true growth and success in our lives.

As a therapist, my practice is based on mindful self-acceptance and human allowance. I spend time with my clients cultivating a deep respect for the truths of their own reality. We create space together to explore, understand, and express feelings that were never allowed to be witnessed or heard. The disowned parts of themselves that were once shunned are now given the attention they deserve,making way to learn who they truly are, an experience they have so desperately craved.

ABOUT THE AUTHOR Judah Katz is a Jerusalem-based therapist who empowers clients to process life’s challenges through self-acceptance and mindfulness utilizing a holistic approach to psychotherapy.

To set an appointment or to join a mindfulness group contact him at judahkatz@gmail.com or 052-312-6021.

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How to Communicate Healthy Intimacy to Our Children What We Don’t (But Must) Talk About

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here’s just too much information out there, more accessible than ever before. And the more it propagates, the more protective of our children we become. Thousands of years ago, no topic was off-limits. Everything we needed to know was right there in the pages of Talmudic literature. The facts of life were discussed by the Gedolei Hador in the same way they examined the laws of interest on a loan, or what age could be considered gil chinuch.

Much of our childhood and adolescence as frum Jews— in elementary school, yeshiva, summer camp, simchas, and possibly even driving lessons—are experienced in the company of our own gender. So when young adults reach the age of dating and marriage, they’re navigating unchartered territory. With the joy of starting a new life together comes the challenge of both emotional and physical intimacy.

Marital Intimacy Educator and Counselor Abby Weisz is one of the first practitioners to lead the emergent trend in the Orthodox world of reestablishing Judaism’s age-old truth that advocates education and open communication.

EDUCATE AND COMMUNICATE “The topic of marital intimacy is held in the highest esteem

by Judaism,” says Abby. “It’s the key to Shalom Bayit and a healthy, loving relationship with one’s spouse. Because the topic is perceived as so private, people don’t speak about it and many couples continue to suffer. Many of my clinic hours are spent working with clients who have had problems in marital intimacy for even twenty years of marriage,” reveals Abby.

Abby recommends introducing age-appropriate discussions before issues crop up. “It’s important for children to feel comfortable talking about their bodies. Create a home where it’s okay to broach the subject. You don’t have to compromise your personal comfort level or social norms, but legitimizing and encouraging open dialogue about the body provides a healthy address and outlet. If and when a child needs information, they’ll feel safe talking to you and won’t be afraid to turn to you for guidance.” The goal is to learn to develop healthy relationships and communication skills.

There are many ways to set the scene for healthy discussion of these sensitive topics. Generalizing can steer a sensitive conversation without making anyone too uncomfortable. “Share with them that it’s common and normal to experience difficulties as young adults. Don’t push the subject but tell them that you’re happy to discuss it if they’d like to hear what you have to say.”

It’s never too late to establish an open channel of communication. “Ask friends and family for recommendations on chatan and kallah teachers who are well-informed and will speak openly. Coordinate between both teachers so

that both chatan and kallah are on the same page regarding the content of their hadracha,” is Abby’s recommendation. Therapists, as well as gynecologists, often work together with these teachers to ensure a holistic approach to a couple’s questions and challenges.

PREVENTING DISTANCE “Marriage is the first time we truly expose ourselves physically and emotionally to another person,” says Abby. “Being vulnerable and allowing our spouse to truly ‘see’ us is exactly what creates intimacy. Communication facilitates a safe space where vulnerability is a strength, not a weakness.”

Many emotional and physical factors can affect intimacy.

Messages from the media and distorted ideas about modesty can cause poor body image and an inability to connect to one’s physical self. If one spouse finds it hard to confront their own body, it can possibly affect them negatively when they are confronted with their spouse’s body. When there’s distance in a physical relationship, it often leads to distance in the emotional relationship and vice versa.

A history of past physical trauma can also hinder intimacy. “Not only abuse,” Abby clarifies, “But any unpleasant experience relating to our body can affect our ability to experience and enjoy intimacy.”

New couples need time to develop a language to communicate their emotional needs; to learn how to express themselves when hurt without being hurtful, and understand what pleases their spouse. Many often enter marriage with the understanding that physical intimacy is simple and easy. Misinformation, heightened emotions of excitement and curiosity that vie with anxiety and exhaustion, and the technical logistics involved can start a couple off on the wrong foot. “Don’t rush,” says Abby with her characteristic approachability and warmth. “Set your own pace. And don’t be afraid speak to each other. Learning takes time and sincere effort. This is the avodah of marriage and no other avodah is more worthwhile.”

ABOUT THE ABBY WEISZ Abby Weisz is a psychotherapist specializing in marital intimacy therapy and counseling. She has assisted hundreds of couples to enhance their physical and emotional relationship and communicate with their children about intimacy in a healthy way. For more information visit JewishIntimacy.com.

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Getting to Know Your Pain Pain is a sensation that no one wants to experience. At times, it can be severe and debilitating. It can sometimes be difficult to treat or eradicate. However, pain can be overcome. The first step to combating pain is to start to truly and accurately understand your pain.

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o, what is pain? Pain can be defined as an “emotional response to a stimulated nerve.” Pain is a subjective experience, which makes it difficult to describe. Using subjective measures to quantify and characterize it may also make it difficult to recognize subtle changes and improvements. When asked, “How is your pain today?’, a general subjective response like “Okay” or “Bad” is not sufficient to address and treat it. To accurately track and assess the current presenting symptoms and general progress, a person must make his pain more measureable by specifying the following information: 1. Where exactly is your pain? (Point with your finger) 2. How frequent is your pain? (How many times per day/ hour do you feel the pain?)

3. How long does your pain last? (If constant, that means you feel it even when you wake up to get a drink in the middle of the night.)

4. How intense is your pain on a scale from 0-10? (If you are really a 10 right now, then you should be crying on the floor.)

5. Is there anything that relieves the pain? (Such as changing position, sitting down)

One’s attitude when it comes to pain is clearly an important factor The next step is to understand your pain’s triggers— what induces the pain to begin. There are two main types of triggers: immediate onset and delayed onset. Immediate onset means that the pain is linked to a specific movement, activity or posture. Delayed onset is more of a non-specific pain, which comes on slowly and often cannot be linked to a specific movement, activity or posture. It is important to identify and categorize one’s trigger, since the treatment

approach would be different for each.

Researchers compared a group of patients who believed they were improving to a group of patients who did not believe they were improving. The group that believed they were improving recovered significantly faster. One’s attitude when it comes to pain is, therefore, clearly an important factor. As patients begin to view their pain in a more measureable manner, they can begin to take ownership of the pain, becoming aware of changes and thus gaining more of a sense of control—and hope for recovery.

Imagine living every day feeling great. My goal is to provide you with an opportunity to return to a pain-free life.

I offer personalized, hands-on manual physical therapy techniques, coupled with an appropriate exercise program.

I don’t just treat your pain; I find the source and work to ensure long-lasting changes. I value communication and providing my patients with the knowledge and tools they need to achieve their fullest potential as quickly as possible.

ABOUT ARYEH Aryeh Feldstein is a licensed physical therapist in Israel and New York. He received his training at Touro College in NY. He has taken extensive courses and specializes in Functional Manual Therapy, which is a personalized integrated evaluation and treatment system that promotes optimum human performance. He currently sees patients in his office in Ramat Beit Shemesh Alef or in their homes.

Aryeh can be reached at 058-781-9801, aryehpt@ gmail.com or through his website, aryehpt.com.

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Not Just Talking the Talk:

Al-Peh’s Movement to Promote Oral Motor Speech Therapy in Israel From Aristotle to Rabbi Yehuda HaLevi, philosophers have long hailed speech capability as the skill that separates humans from animals. Clear, eloquent speech is a powerful skill, crucial in our society.

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t’s easier for some than for others.

There are myriad reasons why a child might develop a speech impediment or pathology. Some children mispronounce sounds because of a hearing or auditory processing issue. Other children have cognitive or psychological issues that affect their ability to speak clearly and confidently.

Most speech therapists in Israel tend to work with clients on the cognitive-linguistic level—practicing language skills with their clients, enriching vocabulary, etc.

The problem is that there is another, very common reason why children have trouble speaking clearly—a reason often ignored or neglected in Israeli institutions. Speaking is a complex fine motor skill. It requires around 100 muscles in the face, lips, neck, chest and tongue to make very precise movements in perfect harmony. Some children, particularly those who suffer from other disorders that affect muscle tone and fine motor movement (such as Down Syndrome and Cerebral Palsy), have trouble speaking clearly due to a challenge that is strictly physiological—not cognitive or linguistic.

Freyda Weis (MSci) is a speech pathologist who specializes in oral motor therapy. Trained in the USA, she was dismayed to discover how little regard speech pathologists had for this field in the clinics where she worked. She witnessed countless patients coming in once or twice a week and making very little progress as their therapists addressed only the linguistic aspects of speech and neglected the motor aspect. She saw the same issue in rehabilitative preschools and daycares where children received speech therapy as part of their normal curriculum. “Kids can acquire linguistic skills in so many other contexts,” says Freyda. “If it’s just a matter of listening and practicing speech, they can do that with their teachers or with their parents. Speech therapists are supposed to be able to identify and address the root cause of the pathology.”

Seeing the dire need for more information and tools in this field, Freyda founded Al- Peh as a resource for all oral motor therapy in Israel. “The way I see it, it’s not just a business—it’s a movement,” she says, “to promote the study and practice of oral sensory motor therapy in Israel.” Aside from her clinical work with patients, she imports dozens of oral sensory tools unavailable anywhere else in Israel, and offers workshops, training courses and other resources to therapists and clients. Therapists also call or email to consult her on this area of expertise. Some of the courses and workshops she teaches herself; for some, she flies in experts from the US.

Originally, the workshops were intended for therapists only, but parents of children with speech issues started coming as well—because the therapists treating their children were not addressing the motor aspect of their child’s problem.

Oral motor therapy isn’t just about speech. Individuals with motor-related speech pathologies often experience difficulty feeding, chewing and swallowing. For this reason, oral motor therapy can also be beneficial to children who aren’t even close to speaking age yet. Infants who experience digestive discomfort or low weight gain are often diagnosed with colic, allergies or other digestive issues, when in fact, the problem might be caused by a motor problem—weak suck reflex, for example. Freyda is one of only two speech therapists in Israel trained in NOMAS (Neonatal Oral Motor Assessment Scale), and one of the only therapists qualified to work with preemies on feeding issues. Freyda is also a trained lactation coach. Freyda points out that in the United States, speech pathologists need to take a certain number of CEUs (continuing education units) to maintain their licenses. This is not true in Israel. “This is a field where you need to constantly update and enrich your knowledge,” she says. “Our job is to help people.

How can we help them if we don’t have the skills?”

In light of this, Freyda urges parents to learn about their child’s problem and find a therapist who has the right specialization. Not all speech therapists available through HMOs or institutions specialize in the relevant fields. Sometimes what the HMO or institution will offer is also helpful to the child, but oral motor therapy is necessary for clear speech and for safe and efficient swallowing. Freyda is happy to offer private supplementary therapy in such cases. Freyda also urges parents to take an active role in their child’s speech therapy, continuing the work at home.

ABOUT FREYDA WEIS Freyda Weis is a Jerusalem-based speech therapist and one of Israel’s few experts on Oral Facial Myology.

Freyda offers treatment of speech and swallowing disorders to individuals of all ages in the Jerusalem area. She can be reached at 052-5287-726.

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Get Moving:

How to Enhance Your Ability to Enjoy Life in the Golden Years

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here are many wonderful things about getting older: gaining perspective and wisdom, watching children grow up and start families of their own, and generally enjoying the fruits of many years of investment and labor.

It’s no secret, though, that there are also many challenges that come with aging, and one of those challenges is that our bodies don’t quite work the way they used to. There are more checkups, more symptoms and complaints, higher health risks—and among all these, decreased mobility.

As we age, we lose muscle mass, our joints may stiffen, and diseases or long-standing conditions may cause pain or affect the functioning of our nervous system. These issues can result in difficulty walking or getting in and out of chairs or bed, or increased risk of falling. In addition to safety risks, decreased mobility can have a serious detrimental effect on one’s quality of life. Being unable to dress or bathe oneself can cause embarrassment and a sense of powerlessness. Seniors may find visiting family members forced to run errands or perform basic tasks at the expense of simply enjoying their company. All this can raise the risk of sinking into a depression—which is a physical health risk as well as emotional.

In some cases, there are ways to work around the problem—assistive devices, such as walkers or wheelchairs; elevators; remote-controlled adjustable beds and armchairs, etc. But these solutions are band-aids; they can’t compare to treating the problem at the root and achieving increased independence for people by getting their bodies to function better. And there is a way to treat the problem at the root.

Physical activity and exercise has been proven to dramatically increase mobility, reduce health risks, and improve quality of life in the elderly. But how can someone who already has trouble moving engage in physical activity?

That’s where mobility specialists like Shoshana Shinnar come in. Shoshana is certified as an exercise physiologist with a specialty in working with arthritis and the elderly.

She worked as a dietitian for 40 years, but when she made Aliyah, she noticed that there were many people suffering from limitations she knew were unnecessary. Observing people on the street, she would think: “If only they would do this or that exercise daily, they wouldn’t have so much trouble walking.” She started working with friends she had met, and was so successful, she decided to dedicate herself to working with elderly Anglos in Jerusalem and the surrounding area to improve their mobility.

Shoshana sees clients in their homes and carries out an initial evaluation of their situation—including an assessment of the home environment, such as rugs and furniture,

to ensure maximum safety and fall prevention. Once she understands the clients’ limitations and challenges, she develops a personal exercise plan to meet their needs. The exercises she teaches are based on years of research and successful application by the AFAA (Aerobic and Fitness Association of America), and are designed to increase muscle tone, improve balance and enhance flexibility while remaining gentle, safe and practical for people who already suffer from limited mobility. She often employs simple household objects—like a broomstick—as equipment for the exercises.

For example, for clients who have difficulty getting up from a chair, Shoshana might recommend leg extensions (straightening the leg, flexing the foot and pointing it toward the ceiling while sitting on a chair) or hip marching (lifting each leg, with the knee bent, as high as comfortable while sitting in a chair) to target the thigh and leg muscles.

For clients who have difficulty walking due to balance issues, she might recommend practicing standing on one foot near a chair or a wall for support to prevent falling. She also encourages her clients to engage in fun physical activities together with friends or partners: flying kites, playing catch, or going for a walk or a swim together are all great ways to get moving while enjoying each other’s company.

“I once worked with a client, around 55 years old, who claimed to have a problem with her balance, and for years needed two guys to help her get up two flights of stairs to her friend’s sukkah. In my assessment, I identified a different problem, and assigned her exercises to do for 5 minutes every day. A few months later she called me up and told me that this year, she ‘forgot’ that she needed help and brought the food up to her friend’s sukkah by herself. Only when she knocked on the door did they remind her that in the past she had needed help!”

ABOUT SHOSHANA SHINNAR Shoshana Shinnar is the founder of Ow to Wow, a service that provides training to aging English speakers in Jerusalem and the surrounding area to help them regain mobility and independence.

Shoshana can be reached at 058-612-2014 or through her website ow-to-wow.co

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All Work and All Play One of the difficulties of aging is losing the ability to do the things you once enjoyed. Here’s how Zehava Waltzer uses recreational therapy to help seniors and adults with disabilities enhance their quality of life--by having fun.

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K, a former accountant and business owner, suffers from moderate dementia and is legally blind. His wife noticed that he had been losing interest in interacting with his children, grandchildren and great-grandchildren, opting to sit in front of the TV all day rather than expend the effort it required to continue engaging in activities he had once enjoyed. She became concerned, and began searching for ways to help him. She found Zehava Waltzer.

Zehava Waltzer works as recreational therapist/geriatric specialist. She brings over 20 years of experience working with adults and senior adults privately and in adult care settings. Research shows that older adults maintain a sharper mind and a higher level of social involvement when they engage in activities that are meaningful to them. People recovering from physical injuries or adapting to disabilities also stay healthier longer when they are physically and socially active. From this, we understand that there is a strong connection between health and recreation. Recreation Therapy (RT) is a type of therapy that harnesses this connection to promote better health in the elderly, the ill, and people with disabilities. Through play, recreation and leisure, RT helps individuals achieve psychological and physical recovery as well as health and well-being. Recreational therapists like Zehava use counseling techniques and activity-based interventions to maximize an individual’s functioning and promote quality of life.

During Zehava’s initial assessment, she discussed with EK and his wife what types of topics​a ​ nd activities had interested him over the years. She took this information and used it to build a program that included chair exercise, Jewish trivia and current events. As she got to know EK better, she also incorporated discussion of the Jewish holidays, singing, walks outside to enjoy the fresh air, among other activities.

RECREATIONAL THERAPY VS. OCCUPATIONAL THERAPY Recreational therapists use techniques different from those used in traditional physical or occupational therapy.

A recreational therapist might suggest yoga, an adventurous walk around the neighborhood (or to the mailbox) or dance to an individual wanting to improve their physical stamina. To improve fine motor skills, a recreational therapist may propose gardening, cooking or a craft project.

Instead of traditional psychological counseling, she might recommend singing, trivia or writing memoirs as an outlet for someone with a mental health condition. “We have the same treatment goals; we just achieve them differently,” Waltzer says. “We are more interactive, building on our clients’ strengths and interests in order to reach those goals.”

WHAT RECREATIONAL THERAPY DOES Broadly defined, RT means using purposeful recreation and leisure to address the specific needs and goals of individuals living with disabilities, based on a holistic framework focusing on all aspects of improving an individual’s health and functioning. Their needs may include, but are not limited to, mental health, physical rehabilitation, developing effective social skills and community integration. By providing structured and unstructured therapy-driven services, providers use therapeutic recreation for improving physical abilities, mental health, building confidence and promoting greater self-reliance.

WHAT IT INVOLVES Recreational therapy may take many different forms.

Therapeutic activities could include sports, crafts, dance, time spent with animals, stress reduction techniques, music, games and community outings, to name a few. These activities can provide mental and physical stimulation for clients, and some activities may help the patients develop specific skills. Sometimes, recreational therapy is used to help the client build confidence, enhance social skills, and even to integrate more into his or her community.

Recreational therapies may help clients recover basic motor functioning and reasoning abilities, build confidence, and socialize more effectively. Because of this great variety, individualized goals and treatment plans are crucial.

While Zehava finds that EK still needs encouragement, he no longer sits in front of the TV all day. Now his eyes light up when engaging in discussion about what’s going on in the world around him and he enjoys singing with his great-grandchildren. Thanks to Zehava’s intervention, he’s getting exercise and most importantly maintaining his physical, cognitive and social abilities through activities that bring him joy.

ABOUT THE THERAPIST Zehava Waltzer is a Jerusalem-based recreational therapist and geriatric specialist who helps seniors and adults with illness or disability improve or maintain cognitive and physical function through enjoyable activities.

To schedule a no-obligation, in-home assessment, call 058-763-8728, or email zwaltzer@gmail.com.

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Playing with Problems

By Batya Jacobs

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hen I was studying to become a therapist, I came across a line that was so shocking I still remember it: “A common countertransference (roughly being too influenced by your patient) of inexperienced therapists is the desire to cure the patient.” I thought to myself, “How silly of me, but isn’t that what we’re here for? If curing the patient isn’t our job, then what is?”

There are varying approaches to problems in the world of psychology. Some therapies see their goal as providing a practical solution to the problem; there’s even a therapy called “problem-solving therapy.” Classical therapies see problems as having deeper roots, and warn that a quick fix won’t last and the underlying cause will burst out in some other form. The mindfulness approach comes along to teach how to live with problems, finding the peace and serenity that comes with accepting the problem as part of your life.

And then there’s me.

When I left the airy-fairy university world, certificate in hand, I had to sort through the ever-expanding range of therapies and decide which approach to adopt. Should I mix and match? Should I stick with a single regimented approach? Perhaps a soupcon of art and music and drama?

The choices were endless.

But in my trainee experience, something always bothered me about the approaches I was asked to try. Somehow my clients and their lives didn’t fit any generality. “What shall I do?” they would ask me.

What shall you do? Perhaps I missed that lecture. How can I possibly know what you should do? Even if I have the same problem—something that happens all too frequently with us therapists—the two problems really aren’t the same: our lives are different; our way of doing things are different; our happily-ever-after is also likely to be different.

Was there an approach out there that took those differences into account? That’s when I discovered narrative therapy.

In narrative therapy, we see problems as a means to help our clients find out who they want to be and how to rewrite the stories of their lives.

Let me give you a few examples from my own life.

I have a problem I like to call the Tick-Tock Monster. I think of him as a giant-sized grandfather clock with a very impatient and angry-looking face. The later I am, the louder he ticks, and his chimes make the most deafening din if I’m off-schedule.

When my children were little, the pressure of that Tick-Tock Monster would have me transferring the decibels to my own voice. I would often catch myself shouting and hollering as the minute hand came close to school bus time or as winter Friday afternoons ate up their sparse minutes while the house-dwellers hardly lifted a finger to clear away the weekday mess.

The real me wanted peace and harmony. The real me want-

ed to send the children off to school with love and fun and joy. The real me wanted to have a joint project welcoming the Shabbos bride. But Tick-Tock ruined all that. It took me many years to recognize Mr. Tick-Tock and to build up the real me.

Once I knew what I wanted and worked towards my goal, the tick-tocks lost some of their urgency; the chimes were muffled, and my whole household became more peaceful.

Thanks to my training in narrative therapy, I was able to personify the problem, notice its sneaky tricks and understand what it was preventing me from achieving.

Then there is the tale of Mr. Come-Jump, who tried to prevent me from attending my own son’s chuppah. You see, my son and his fiancée had chosen a hall where the reception and chuppah were held on the roof. I have a fear of heights.

Tempting Mr. Come-Jump called me to the edge, cramping my stomach as he filled my imagination with sensations of falling. Unfortunately for him, I also have a well-established “Davka” streak. I wanted to be the hostess-with-the-mostest, welcoming my guests and calmly accompanying my future daughter-in-law to the chuppa. “Davka” saved the day! She stayed with me until we all went downstairs to eat and dance the night away. Mr. Come-Jump still troubles me sometimes, but I won that round.

Our lives are made up of the stories we tell ourselves, be they good or be they problematic. Noticing what problem stories prevent us from doing reveals out true values, beliefs and commitments. These are the building blocks of the stories that we want to live with. I work primarily with people living with depression, and we phrase it that way because depression is not who they are, it’s something they live with that sometimes prevents them from living the life they wish.

By engaging with their problems, sometimes even lightheartedly, they can diminish the stories depression tells them, creating a richer, happier story to live by.

ABOUT BATYA JACOBS Batya Jacobs is a Narrative Therapist with a degree in Psychology from University College Cardiff and a degree in Social Work from the Hebrew University Jerusalem.

Her main areas of practice include depression, trauma, abuse, marriage counseling as well as schizophrenia and other issues including SSA. Batya currently works at the Jerusalem Narrative Therapy Institute (JNTI) under the guidance of HaRav Zev Leff . She works in both Hebrew and in English.

Batya can be reached at cjacobsfamily@gmail.com or 054 672 0249

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Doctors, Dentists & Eye Care

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Behind the Frame, Beyond the Eyes Not everyone knows how to wink but we all know how to blink. Have you ever stopped to think if you’re doing it right? Optometrist Naomi London specializes in prevention and treatment of Dry Eye Disease, a disorder that’s becoming increasingly prevalent simply because we lack awareness.

O

ptometrists. They still make you wear those ridiculous, awkward glasses while you guess the numbers that are projected on the opposite wall.

They make you rest your chin on a plastic strap, lean your forehead against a curved arch and ask you to stare, unblinking, at the colored image at the end of a little tunnel, that recedes and expands, focuses and blurs. And you’re never sure if you did it right.

Optical tests might not have changed much in the last twenty years, but the world has evolved and today our vision is facing new demands. While thirty years ago, people held newspapers at arms’ length, or watched television a few feet away, today our lives are ruled by compact hand-held devices and, paradoxically, increasingly gargantuan TV screens. Naomi London, specialist optometrist and owner of Naomi Vision Boutique, has witnessed the change in how we use our eyes and firmly believes that no technological advancement (or online refracting app) can ever replace the human component in eye and optical health.

In 1986, a young Naomi made Aliya with her family to Jerusalem, and always envisioned herself working with people and making a real difference in their lives. “After searching for a profession for almost a year, I decided to pursue optometry. It might sound like a dreary job, but optometry is much more than just getting the numbers right. It’s direct interaction with people and helping them to maintain the gift of sight!”

Naomi Vision Boutique sits on a quaint alley in Jerusalem’s city center and has been designed to make you feel at home. As you walk in, the layout and ingenious coffee and jellybean corner make you feel welcome and at ease (clearly this is not a dentist’s office). Naomi has made sure that the human touch is reflected even in the ambience of the place.

INSIGHTS FROM THE INSIDE Naomi specializes in various eye care services including vision therapy and treatment for an increasing number of eye syndromes.

One of the hot topics in the field over the past few years is Dry Eye Disease, or DED, which manifests in symptoms that include itchy or burning eyes, fluctuating vision, foreign body sensation, redness or lid inflammation. There has been an explosion in the number of patients suffering from various stages and symptoms of the disease. And while doctors usually prescribe classic eye drops—artificial tears—Naomi has joined the academic and research community to try and understand the causes and progression of the disease, and provide

comprehensive treatment and rehabilitation solutions.

Individual tailoring of treatment is essential for maximum efficacy and success. Here too, the same objective data collected from two different people will result in a unique solution for each.

“We’re starting to understand the irreversible damage that can result if DED is misdiagnosed, ignored, underestimated or handled with palliative solutions only,” says Naomi. “Blinking is a protective mechanism for our eyes, but about 30% of my patients have an ‘incomplete blink.’

It might sound obvious, but when you blink, make sure both lids touch. Just a fraction of a second of a complete blink is enough to benefit from all a blink can offer!”

FASHION OR VISION? Glasses are a popular accessory and Naomi wants her clients to look good behind their frames. But her main objective is to understand each client and their individual needs. “The prescription is just one piece of the puzzle. We guide clients in choosing a frame that sits properly on their nose and ears and is the right size for their face. We evaluate a client’s individual lifestyle when we choose the lens, material and coating. We even need to consider a client’s natural head posture and cut the lenses accordingly. We train clients how to utilize their lenses to full capacity which helps the brain adjust as quickly as possible. And we follow up to fine tune and adjust if needed.”

“If you think about human sight and the mechanics of vision, it’s truly mind-blowing,” Naomi’s eyes light up, “But more than simply healing the body, my job is to treat people. To look beyond the eyes and see the person behind the frame. That’s my vision.”

ABOUT NAOMI Naomi graduated from the Optometry College at Bar Ilan University in 1998. She performs eye examinations for all ages and offers services for glasses, contact lenses, vision therapy and dry eye therapy.

Naomi Vision Boutique is located at Even Israel 5 in the center of Jerusalem.

They can be reached at 02-500-4333, store@naomi-vb.com, or www.naomi-vb.com.

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Vision Therapy How to See Effortlessly

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By Gedalya Shindler

s my vision normal?

We take it for granted that we see the same way as everyone else; but do we? How do you know that you or your child is seeing normally? This question can be subdivided into two areas, visual efficiency and visual perception.

This article will focus on visual efficiency.

Many people are not using their eyes appropriately, which can lead to reduced efficiency, comprehension or performance. This can negatively affect academic performance, or productivity at work, and cause pain or discomfort.

Understood simply, visual efficiency means the ability to point and focus the eyes at the object of interest, so that we see a clear and single visual image, maintain focus, and move the eyes accurately towards the next point of interest. Sounds straightforward enough, but for many people this is a real challenge and stress to the visual system, especially in today’s world, where we are expected to spend so much time analyzing close objects on our computer screens, in books and (worst of all) on our phones.

Our eye muscles are designed to be in equilibrium for distance viewing. Close work is a challenge to the visual system, and people react to this challenge in different ways. The lucky ones manage to deal with it without any problems; they never require glasses until middle-age, they never have vision-related headaches and can enjoy reading for as long as they wish without fatiguing. You may even know some people like this. Most of us, however, react to visual stress in one way or another. Some develop myopia (nearsightedness). Some avoid extended close work, survive on the minimum, or even drop out of school.

Others contend with the stress and suffer headache, eye strain or other symptoms.

How can we measure visual stress?

At Shindler Insight, I perform a battery of tests which probe the efficiency of the visual system. While I’m certainly very interested in determining the best prescription for acute distance vision, I am far more interested in analyzing the strengths and weaknesses at near, since that is where the challenges lie. To converge the eyes accurately has different facets, and one test alone is not sufficient to paint a meaningful picture of the ability to do so. Likewise, the skill to focus on a close target cannot be adequately tested through one test alone. The interpretation of the results takes expert training and experience, in order to accurately diagnose and treat the problem.

Can visual stress be treated?

Treatment will depend on the diagnosis. Often it is found that the full distance prescription is not helpful for close work, and can even add to the stress. In situations like this, bifocal or multifocal prescriptions can be issued to reduce the visual stress, and in some cases is sufficient.

In many cases, particularly where there is a weakness in eye convergence, vision therapy is recommended.

So what is vision therapy?

Vision therapy is a process through which you are taught how to use your eyes in an effortless manner, in order to better cope with the daily stress your eyes are subjected to. It’s a process where your visual skills will be broken down so that you can understand each part, learn how to release the stresses, and subsequently apply all the parts effortlessly together. The programs tend to be short, averaging three months or so, with long-lasting results. It must be effortless, since vision is a means to an end; if we are expending effort on our vision, it will come at the expense of efficiency in the very task we need the vision for.

How do I know if my child needs vision therapy?

If your child’s intelligence exceeds their reading performance, complains of headaches, double vision, dizziness, eye ache, blur (but does not need glasses, or already has), difficulty copying from the board, words moving on the page, blinks too much, or has an eye turn, they should have an assessment. Vision therapy can also help patients who have had a head injury or a stroke, and can even help elite athletes improve their performance!

ABOUT GEDALYA Gedalya Shindler BSc (Hons) MCOptom is a British trained Optometrist. He works as a Clinical Instructor at the Contact Lens Department at Hadassah College, Jerusalem. His private clinic, Shindler Insight, is situated in Ramat Beit Shemesh where he continues to find inventive solutions for patients who suffer from symptoms curable with vision therapy, patients who have struggled to find wearable contact lenses, and for patients who would like an accurate glasses prescription.

Gedalya can be reached at 02-540-6166 or gedalya@shindlerinsight.com Visit his website www.shindlerinsight.com

PROFILES

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DR. ELIYAHU GHERMAN, D.D.S Field

YEARS OF

Dentistry

PRACTICE

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Specialty

Orthodontics (American certified) Education

New York University College of Dentistry Montefiore Medical Center 3 year Post Graduate Orthodontic Residency Dr. Eliyahu Gherman practices orthodontics in Israel and the United States. He received his dental training at New York University College of Dentistry. While at NYUCD, Dr. Gherman was the first recipient of a grant from the United States Government to conduct research at the National Institute of Dental Research where he had the privilege of working side by side with NASA researchers. Dr. Gherman then completed his residency in Orthodontics and Dentofacial Orthopedics at Montefiore Medical Center.

MOTTO

Orthodontics is not just a science, but an art.

GOALS

To create beautiful smiles.

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Jerusalem: 02-561-9770 smiledocg@gmail.com Gush Etzion: 02-999-5284 gushbraces@gmail.com

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Massage

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Harmony Through Supportive Touch: An Interview with Zen Shiatsu Practitioner Eran Karnieli

Zen shiatsu is a healing method that effects powerful change in the body and spirit despite being gentle and non-intrusive. Here’s how Eran Karinali discovered its subtle power and uses it to heal his patients.

E

ran Karnieli’s life turned around when he discovered shiatsu. Today, he is a seasoned practitioner and instructor of Zen shiatsu, and currently co-manages the “Maga” school for shiatsu practitioners in Jerusalem. He also offers consultation and support to individuals and groups on leading a healthier lifestyle, as a life coach and NLP practitioner, and he practices and teaches Seishin Kitaido—a body discipline combining the principles of the Japanese martial arts with other movement disciplines for transformative expression.

Tell us about your professional background.

I’m a Zen shiatsu practitioner with more than 10 years of experience. I was trained at the “Maga” school, the largest in Israel for the study of Zen shiatsu, and in recent years I have been involved in its management. Today, aside from my clinical work, I teach shiatsu and coaching as well as Seishin Kitaido—a discipline that borders between martial arts and movement disciplines.

What is Zen shiatsu and what are its benefits?

During a Zen shiatsu treatment, the patient lies, fully and comfortably clothed, on a futon mattress on the floor, so he feels safe and close to the earth. The practitioner skillfully moves his weight around vertically through his hands, thumbs, forearms, and even knees, along the patient’s body, so there is mutual support: The practitioner is supported by the patient, and simultaneously, the contact gives the patient a natural sense of being supported. This delicate balance allows the practitioner to pay attention and immediately respond to anything happening in the patient’s body, while at the same time providing touch therapy that has a deep and gentle presence. The treatment has a deep influence even though it is not experienced as intrusive, and that’s what makes it so effective in changing the patient’s condition. Sometimes talk therapy, medications, or other manipulation will not bring about such results. Often patients initially come to alleviate pain, but after that has been achieved they realize that shiatsu is also an excellent way to nurture their general health.

Zen shiatsu is based on the philosophy of Traditional Oriental Medicine, which was built on thousands of years of ongoing exploration and the perception of the body as a closed ecosystem in which each functional system influences and is influenced by the other systems within the body. Precise diagnosis, done through gentle touch, helps the practitioner understand which system needs the most support, so other systems will support it and return the patient to harmony, restoring vitality to the body.

Zen shiatsu therapy doesn’t focus on symptoms, but

rather nurturing the body’s natural health and resilience by supporting its basic functions. Presence through touch encourages the body to channel its resources toward its central needs, and the result is vitality, which relieves and sometimes eliminates symptoms such as pain, weakness, sleep problems, respiratory problems, digestive problems, emotional distress or depression, a tendency toward illness, gynecological problems and more. Shiatsu is particularly effective for maintaining the body’s health and emotional resilience. The treatment is appropriate for patients of all ages, from the very young to the elderly. Additionally, it’s effective as a supportive treatment for fertility, pregnancy, and birth.

What brought you to this field?

When I was young, I felt lost. During my academic studies, I was not a happy, confident person with a clear path in life. I stumbled across shiatsu, and fell in love. Through shiatsu, I was able to invite joy back into my life; I observed how important honest, attentive touch is for our basic existence, and the more precise it is, the more it helps us lead a better life. I witness this daily with my clients and students.

How do you build a treatment plan that is adapted to the specific needs of your client?

The client normally comes to me with a primary complaint. This is the complaint he feels is limiting him, but it may not necessarily be the root of the problem. In Zen shiatsu, we diagnose the patient through touch, particularly through exploration of the abdominal cavity (called “hara” in Japanese). I interview the patient about his experiences, and combining this information with what I perceive through touch, I identify what isn’t functioning properly and what systems are overcompensating, and start my treatment from there.

We build a treatment plan adapted to the needs of the patient from information gathered in the initial consultations and in discussion with the patient.

ABOUT ERAN KARNIELI Eran Karnieli is a shiatsu practitioner and instructor with over 10 years of experience as well as a practitioner and instructor of kitaido, a life coach, and an NLP practitioner.

Eran can be reached at 052-402-0557 or karnieli1@gmail.com

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The Magic Touch A mother’s loving touch has the power to work wonders for her baby’s health and wellbeing.

B

aby massage is a practice that has been used for centuries in many diverse cultures for healing and development. We often think of massage in terms of physical therapy or as a pampering experience, but it’s much more than that. The benefits of skin contact for the brain—especially in infants—is remarkable. In fact, you could say it is vital. And the science backs this up. Jerusalem-based massage therapist Udi Rothstein tells us more.

THE BRAIN-BODY CONNECTION Drawing on the findings of scores of scientists and psychologists, Ashley Montagu demonstrates the importance of tactile experience (or the lack of) for the healthy behavioral development of the individual. In his book Touching: The Human Significance of the Skin, he shows that many adult health and wellbeing problems originate in the lack of proper skin stimulation by parents during the child’s early years.

Udi elaborates: “Skin sensitivity is one of the earliest developed and most fundamental functions of the body and the first means of communication between parent and child. It develops synchrony—the shared interaction between mother and infant—which allows us to create, and later in life identify, healthy social attachments.”

Touch creates actual chemical changes in the infant and parent. Skin contact involves the immune system, the stress system and the oxytocin system. Sensory stimulation speeds the process of coating the nerves, enhancing rapid neural firing and improving brain-body communication. Many OTs say that baby massage therefore reduces the necessity of therapies when older.

A recent study performed by Dr. Ruth Feldman at the Center for Developmental, Social and Relationship Neuroscience in Herzliya demonstrated the importance of touch for human infants. Here, preemies who received “kangaroo” or skin-to-skin care from their mothers had a better connection with their mother, better adjustment abilities, lower cortisol levels and lower ADD rates as measured at seven points in time—over the following ten years!

AIDING THE IMMUNE SYSTEM There is a plethora of health benefits associated specifically with infant massage, too. Research conducted by Miami’s Touch Research Institute shows that massage stimulates the immune system, in turn increasing an infant’s resistance to infection. Massage also results in enhanced growth in preemies (an average of 47% greater weight gain per day!), decreased autoimmune problems, increased lung function, and decreased glucose levels in infants with diabetes. In addition, hospital stay averaged six days less.

It is argued that in earlier times before there was a pill available for every ailment, massage functioned as an immunity booster for infants. Today, in our medication-centric world, massage has been underused, but it remains an ef-

fective and powerful—not to mention natural—technique for harnessing the body’s own defences against disease.

DEVELOPMENTAL BOOST Who doesn’t want their infant to be the next child genius?

We wait eagerly for every milestone in our child’s development and spend hundreds if not thousands of shekels on toys that claim to develop babies’ brains. But massage is proven to be one of the most effective techniques for boosting child development. This is why the kupot cholim have started subsidizing massage and why they now offer it in hospitals.

Research neuroscientist Dr. Lise Eliot writes that “regular, early massage may have important cognitive benefits for babies of all gestational ages…. Children show lower anxiety and stress levels, better mood, improved sleep patterns, and higher levels of attentiveness when treated to a daily massage by their parents.”

Udi agrees: “The outcomes are astounding in terms of bonding, communication, and development. The child requires fewer therapies in the long and short term, and develops better and faster. I witnessed this in my own children that I did massage with – they reached developmental milestones much more quickly.”

STARTING EARLY The loving interaction between parent and child—particularly touch, our very first developed sense—is essential for our babies’ brains to develop.

Most brain growth and development occurs after birth, particularly in the regions controlling language, emotion and abstract thought. Synapses develop extremely quickly during a child’s early years; cells connect through new experiences and the amount of stimulation received by age three dictates the amount of growth in each region of the brain.

Udi explains: “A signal is sent to our baby’s brain when his or her skin is touched, telling it to make connections and grow. Therefore it’s so important to start as early as possible. With massage, a baby gets the right stimulation, input and interaction for optimal brain development.”

When you watch baby massage being practiced, you’ll see the baby’s tension being instantly released. Massage communicates strength, maternal confidence and love with just enough pressure to be comfortable, soothing, and stimulating.

ABOUT UDI Udi Rothstein is a Jerusalem-based massage therapist who specializes in baby massage. She offers workshops for mothers to give them the confidence and techniques to effectively massage their babies themselves. Udi can be reached at 050-417-0907.

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Off to a Great Start:

How to Facilitate a Good Experience Nursing Your Baby Nursing a baby can be one of the greatest joys of new motherhood, but it can also be a source of difficulty and frustration. Lactation consultant Bunye Fridman provides some tips for starting off on the right foot.

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here is a common idea that women breastfeed for the baby’s sake, given all the health benefits that have been associated with it and are widely known. But women also nurse their babies because they find it enjoyable! The physical and emotional closeness they feel while nursing strengthens the bond with their babies and creates an experience of joy, love and giving that they remember fondly for the rest of their lives—even if they were only able to nurse for a short time.

Women have always had the maternal instict to nurse their babies after giving birth. Part of the reason they feel a natural urge to do so is because nursing triggers the secretion of oxytocin, the hormone that helps the uterus contract properly after birth. This prevents excessive bleeding and helps the woman heal and return to her pre-pregnancy figure.

Nursing right after birth has also been shown to facilitate optimal thermal regulation in babies. Babies maintain their temperature better when held skin-to-skin than when kept in a warm crib.

THE PERFECT FIRST FOOD The early milk, called colostrum, is the perfect food for a newborn baby: it is higher in protein, vitamins and minerals than the mature milk that comes in later (or the formula that is made to provide the same nutrients). As opposed to the white, creamy, mature milk, colostrum is somewhat sticky and ranges in color from clear to deep yellow. Because it is so concentrated, babies only need a little, and don’t require any supplementation. The chemical composition of colostrum helps keep babies’ blood sugar steady and serves as a perfect laxative, which is important to help babies clear out meconium—the waste that builds up in their digestive systems over the course of the pregnancy.

Nursing babies in general have more frequent and softer stools than their formula-fed peers, and this can help prevent certain problems such as jaundice. While newborns do fine without colostrum, it can provide an extra boost of nutrition to get them off to a great start in life.

FACILITATING HEALTHY LACTATION Fascinating research in Sweden found that babies nurse best when they are placed on their mothers’ bellies and allowed to crawl up and latch on independently. They are born with all the reflexes they need for this process, and they are born alert and seeking comfort. Left to their own devices, they often achieve an excellent latch.

To prevent any issues with breastfeeding, it’s important to avoid separating the mother and baby after the birth as much as possible. Choosing a hospital that offers “rooming-in” rather than taking the baby away to sleep in a nursery at night can help facilitate healthy lactation and bonding. You can continue this at home by having the baby sleep in the room with you. If something happens that makes it necessary for the baby and mother to be separated, it may be difficult for the baby to readjust and start nursing right away. Give the baby two hours of skin-to-skin time when together again. Nursing as soon as you can and as frequently as you can after birth can also make lactation easier.

Additionally, it’s important to avoid confusing the baby by switching back and forth between nursing and bottle-feeding. Extracting milk from a bottle is easier than nursing, so babies who get used to bottle-feeding may have trouble readjusting their sucking technique, and may subsequently refuse to go back to nursing.

Keeping your baby close by helps you notice the cues that tell you when your baby is hungry. You’ll see that she is stirring, waking up, moving around or rubbing her mouth, and you’ll hear her make little sounds—it’s best not to wait for her to cry. When you notice these signs, pick her up and let her eat. Babies need to nurse about 10-12 times over a 24-hour period. If he sleeps a lot, you may need to wake him for feedings; sleepy babies who don’t eat enough may have problems such as jaundice or poor weight gain.

If you experience any problems with breastfeeding, such as pain or discomfort, or if your baby is particularly fussy or not gaining weight well—don’t hesitate to get help! A certified lactation consultant can help diagnose any issues and set you on track for a healthy and enjoyable nursing experience for both you and your baby.

ABOUT THE AUTHOR Bunye Fridman is a certified Lactation Consultant. She received her certification from the American Academy of Pediatrics and has been practicing for 14 years. Bunye is a published author and speaks Hebrew, English and Yiddish. She works all over central Israel and is available for phone consultations.

Bunye can be reached at 052-769-7114

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