Jewish press health by alas md

A Publication of

December 2010

Autoimmue Diseases: A Challenge to 21st Century Medicine By Joel Mandel

The story of modern medicine has been a succession of triumphs over deadly and debilitating diseases and conditions which once ravaged all of mankind. Until these diseases were conquered, they limited the life expectancy of those who lived before the dawn of modern medicine to a few decades,

Coping with Loss By Malky Haimoff

There have been several recent studies that demonstrate that loneliness directly aﬀects health. The loneliness caused by the loss of a beloved spouse can be a real danger to a senior citizen, whether it is a sudden loss or following a long illness. According to a 2006 University of Chicago study of people ages 50-68, those measuring higher on a loneliness scale exhibited higher blood pressure, a major risk factor for heart disease. And a recent study by Laurie Theeke of the West Virginia University School of Nursing found that the most important factor in determining loneliness among those over 50 is marriage. Marriage or a strong social circle provides a much-needed support system to the elderly. Once widowed, a person’s social life and friends become even more important to their health to ensure that they do not become overcome by their sadness and lose their own identity to grief and isolation. Trusted friends and relatives can help a senior citizen deal with day-to-day details of life, such as paying bills and maintaining the house. They can provide company or physical assistance when shopping for food and other necessities, and accompany them to medical appointments, too. Equally important is the social outlet they provide, serving as a sounding board for any issues that come up and as entertainment to keep each other intellectually and emotionally stimulated. When recovering from loss, a person needs their Continued on p.12

and degraded the quality of life for young and old alike. The early milestones in the development of medical science include the introduction of vaccination by an English doctor, Edward Jenner, in 1796 to provide immunity to smallpox, which had been, up to that point, one of the scourges of mankind. Deadly smallpox epidemics had swept across Europe over the previous

1000 years. But thanks to inoculation, smallpox was eradicated so thoroughly that there have been no fatal cases reported anywhere in the world since 1978. With the development of the germ theory of disease in the latter 1800’s by Louis Pasteur and Robert Koch, medical science gained an understanding of how microbe-caused deadly diseases Continued on p.26

The Key to Limiting US Restore Health Care Costs: Direct Accountability By Yaakov Kornreich

When Barack Obama ran for president in 2008, one of his major campaign promises was to pass a comprehensive health care reform bill meant to address two main problems with the American health care system. First, it has left tens of millions of citizens under age 65 and above the national poverty level without health insurance coverage. Second, the many ineﬃciencies and wasteful administrative complexities of the US system mean that health care here consumes a far larger percentage of this country’s economic resources than other developed countries that arguably oﬀer better medical care to more of their citizens at a lower total cost. The merits and disadvantages of a mandatory universal health care system have been a source of political and ideological controversy for many years, but the ruinous rise of the cost of health care to the US economy in recent years is a painful reality which is not in dispute.

One of President Obama’s most compelling arguments for passing comprehensive health care reform was the need to bring spiraling medical costs under control before they literally bankrupted the US government and made it impossible for US businesses to compete in the international marketplace. However, political realities forced Obama to compromise or eliminate many of the key cost-saving features in the ﬁnal version of the health care bill that he signed into law on March 30, 2010. As a result,

the cost of health care to the US economy is predicted to keep rising steeply over the next decade and beyond. How did we get into this situation? The roots of the problem go back to the 1930’s, when the federal government passed laws oﬀering economic incentives to businesses that provided health care coverage to their employees. At the time, the move was considered to be an ingenious alternative to socialized medicine. PopContinued on p.6

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At a Glance

Table of Contents Medical and Health News . .4

L’Chayim to Life

Issues - Op Eds

Health Care Careers for Frum People . . . . . . . . . . . . . . . .18

Medicare Doctors’ Crisis Critical . . . .7 Time to Get Serious About Recess . .7

Indigestion Remedies

Raising Our Children

TUMMY ACHE! Indigestion can have many causes. Symptoms include bloating, nausea and vomiting, gas, acidic taste, a growling stomach, burning in the stomach or upper abdomen, and abdominal pain. There are a many diﬀerent natural and over-the-counter remedies, and the eﬀectiveness of each of them seems to vary widely depending on who is taking them.

New Hope for Cystic Fibrosis . . . . . .8

Bolster Immune System with Food . . . . . . . . . . . . . . . . . . . . .20 Your Dentist and Sleep Apnea . . . . .21

Mind, Body & Soul The Unfocussed Child . . . . . . . . . . .22 Caffeine Robbing Children of Sleep. .9 Placentophagia: Postpartum Healing10

Golden Years Community Senior Programs . . . . .12

Denial and Mental Illness . . . . . . . .23 Raising Secure Children . . . . . . . . .24 Coping with an Anxious Child . . . . .24 Couples’ Quandary . . . . . . . . . . . . .25 “Sticker Shock” Leading to More Prescription Abandonments . . . . . .13

Health Provider Bulletin. . 28-29

Making Sense of Medicare Part D . .14

Health & Living Checklists30 From the Doctor’s Desk . .31

Pooled Income Trust . . . . . . . . . . . .15 Supplement Publisher Moshe Klass sales@jewishpress.com Senior Editor Yaakov Kornreich yaakovk@aol.com Associate Editor Malky Haimoﬀ Mental Health Consultant Chaim Sender Editorial Staﬀ Tova Ross Contributing Writers Sheryl Mayer Izzy Bromberg Esther Hornstein

ATTENTION DOCTORS Do you want extra copies for your waiting rooms or to give out? Email Your Request to: magazine@jewishpress.com

NATURAL REMEDIES: 1. Fennel / Fennel Seed – Fennel sooths digestion by helping the body fight gas, cramps and acid indigestion. It is also a common ingredient in “gripe water,” a traditional treatment for infant colic. Dosage: 1 to 1 1/2 tsp. of seeds per day, or fennel leaves can be used to make tea. 2. Lemon Balm – Lemon balm is a member of the mint family and is known to reduce stress and anxiety and ease indigestion. It is commonly mixed with other calming herbs to help promote relaxation. Evidence suggests that it may help treat indigestion, too. Dosage: Capsules: 300 - 500 mg dried lemon balm, 3 times daily, or use 1/4 - 1 tsp. of dried lemon balm in hot water to make tea. Drink up to 4 times daily. 3. Turmeric – Turmeric has traditionally been used for to aid digestion and soothe heartburn, stomach pain, diarrhea, intestinal gas, and stomach bloating. According to the NYU Langone Medical Center, turmeric stimulates gallbladder contractions, which provides relief from indigestion. Dosage: 500 mg of turmeric 4 times daily. 4. Ginger – Ginger is commonly recommended to help prevent or treat nausea and vomiting. It is also effective as a digestive aid for mild stomach upset. Dosage: 1 to 4 grams of powdered ginger daily, divided into 2 to 4 doses per day. 5. Artichoke Leaf – Traditionally, the leaves of the artichoke plant (not the leaves of the bud, which is the part that we eat) have been used to stimulate the kidneys and the flow of bile from the liver and gallbladder, which helps move digestion along. Studies have shown that artichoke leaf extract is effective for alleviating symptoms of indigestion. Dosage: 6 grams of the dried herb or its equivalent per day, divided into 3 doses. Artichoke leaf extracts should be taken according to label instructions. 6. Peppermint – Studies have shown that Peppermint successfully soothes an upset stomach by relaxing the abdominal muscles. Most studies have involved irritable bowel syndrome (IBS), for which peppermint oil has shown considerable promise. However, if your symptoms of indigestion are related to a condition called gastro-esophageal reflux disease or GERD, peppermint should not be used since it relaxes the esophageal muscles, which can exacerbate the symptoms. Dosage: 1 or 2 capsules of peppermint oil 3 times daily within 1 hour after eating. If making tea from dried leaves, use 2 tsp. for 1 cup of water and drink after heavy meals. Continued on page 30

4 | December 2010

HEALTH LIVING

Medical and Health News COMPILED BY TOVA ROSS, MALKY HAIMOFF AND STAFF

Surgeon General Emphasizes Dangers of Smoking Likely FDA Endorsement of Contrave, a New WeightLoss Drug Contrave, a new weight-loss drug made by Orexigen Therapeutics, was just endorsed by a federal advisory panel. Contrave was found to help patients who took the drug for a year

The Surgeon General recently released new warnings about the dangers of tobacco use, as President Obama and his administration continue to wage a campaign against smoking. The new report, which is over 700 pages long, details how tobacco damages the body’s organs and causes a host of diseases, including cancer and heart attacks, and describes what makes it so addictive. Surgeon General Regina Benjamin released a statement that said, “The chemicals in tobacco smoke reach your lungs quickly every time you inhale, causing damage immediately. Inhaling even the smallest amount of tobacco smoke can also damage your DNA, which can lead to cancer.” At a press brieﬁng, Dr. Benjamin added, “One cigarette or exposure to second-hand smoke may cause a heart attack. We didn’t know that before.” Some of the ﬁndings validated earlier discoveries. Tobacco smoke has over 7,000 chemicals, some of which

are toxic and cause cancer. Even n a secondhand whiff of the smoke can n harm someone’s body. Smoking makes akes it more difficult for diabetics to control their blood sugar; more difficult ult for women who are trying to conceive; nceive; increases risk of miscarriages, preremature babies, and babies beeing born underweight with pos-sibly damaged lungs and brains. s. Those who think they’re takking a safer route with filtered low w tar and light cigarettes are fool-ing themselves, as there is no evvidence that those types of cigaarettes are any less dangerous. The Surgeon General’s new w report comes on the heels of the e FDA’s recent campaign to place e more graphic and larger warnnings on cigarette packages, in n the hopes of preventing future re smokers and reminding experirienced smokers of the dangers rs associated with the habit. According to the federal Cennters for Disease Control and Prere-

vention, about 46 million American adults smoke, and smoking kills about 443,000 people each year.

Women Confused Over Mammogram Recommendations Though annual mammograms have long been recommended for women ages 40 and over, a study sponsored by Medco Health Solutions Inc. found that last year, half of American womlose up to five percent more weight than those who took a placebo for the same amount of time. According to the FDA, this benefit outweighs the risks involved with the drug, which include increased blood pressure and heart rate. The development of heart problems is a longtime concern of those who follow the development of weight-loss drugs. Two previous weight-loss drugs that came before the panel, lorcaserin and Qnexa, were rejected due to safety concerns. The FDA, though not required to follow the panel’s suggestion, typically does; an official agency vote on Contrave is expected soon.

en 40 and older did not submit to the screening for breast cancer. The reason? Researchers said it was because many women have been confused by the debate over the screen-

ings’ eﬀectiveness. Last year, the Preventative Task Force advised women 50 and older to get a mammogram every year or two, and women younger than 50 to go for a screening only if they carry certain risk factors. Milayna Suber, the lead author of the Medco study, stated, “This study shows the need to put programs in place to educate women and remind them to do it.” The American Cancer Society estimates that almost 40,000 women will die from the disease this year, and 207,000 people will be diagnosed. Mammography allows for earlier detection and earlier treatment if breast cancer is found. The National Quality Measures Clearinghouse of the Department of Health and Human Services has shown that mammography has been proven to reduce death rates due to breast cancer by up to 30 percent among women 40 or older.

HEALTH LIVING

December 2010 | 5

Medical and Health News continued

Debate Over Vitamin D Intake Continues Though Vitamin D has been praised and increased intake has been encouraged, new official recommendations are cautioning people against getting too much of the vitamin. A committee from the Institute of Medicine has concluded that most people need only 600 international units of Vitamin D each day, while those older than 70 should get about 800. Vitamin D is an essential nutrient that is activated by the skin when it receives sunlight, though the amount a person gets is also inﬂuenced by factors such as age and skin pigmentation. The Institute of Medicine’s committee did not recommend a daily amount of exposure to sunshine, however, citing

concerns over the potential for skin cancer. The 14 committee members said that most people receive adequate levels of Vitamin D from common foods, such as fortiﬁed-milk and fatty ﬁsh, as well as Vitamin D supplements. Many doctors and advocates of increased Vitamin D consumption still feel that the committee’s recommendations are not high enough, and theorize that there is no downside to increasing Vitamin D levels.

ADHD Tie to Adult Obesity Suspected Young adults with a history of attention deﬁcit hyperactivity disorder (ADHD) are more likely than the rest of their peers to be obese, according to the ﬁndings of a study that tracked more than 11,000 young adults since adolescence. Researchers from Duke University in Durham, NC began the study in 1995, when the participants were in high school. They were interviewed again in 2001-2002, when their average age was 23. They were interviewed a third time six to seven years later. The young adults who said they had three or more ADHD-like symptoms, particularly hyperactivity or impulsive behavior during childhood, had a higher rate of obesity than those who reported no such symptoms. Of those with ADHD symptoms, 41% were obese, compared with 34% among those who reported no such childhood symptoms. The results, reported in the International Journal of Obesity, confirm several smaller studies that determined that both children and adults with ADHD have an elevated obesity rate. According to the Centers for

Disease Control and Prevention, 3-7% of school-aged children in the US suffer from ADHD. While no direct cause and effect relationship between ADHD and obesity conditions has been established, it is plausible based upon behavioral considerations, since individuals with ADHD typically suffer from the kind of impulsive behavior that often leads to excess weight gain. The lead researcher, Dr. Bernard Fuemmeler, director of the pediatric psychology and family health promotion lab at Duke, said, “hyperactivity and impulsive symptoms seem to be driving this relationship. Do people with these symptoms have a more difficult time stopping themselves from having that second helping? Do they have a more difficult time making decisions about whether to get a ‘reward’ now or put it off to later?” In addition, Dr. Fuemmeler points out that both ADHD and eating behavior are believed to be related to the brain’s dopamine system, suggesting a possible biological connection between ADHD and obesity.

Red Cross Bans Blood Donations From People with Chronic Fatigue Syndrome Though blood donations are usually welcome and muchneeded, the American Red Cross has announced that it is prohibiting people with chronic fatigue syndrome from donating their blood. This measure is being taken as a safety precaution to reduce the risk of transmitting a virus that was found to be connected to the disease. People with chronic fatigue syndrome are more likely to carry the virus, xenotropic murine leukemia-related virus, than others, although medical researchers are not certain that the virus actually causes the disease.

Millions of American have chronic fatigue syndrome; symptoms include prolonged tiredness and severe fatigue, as well as body and muscle aches.

Radio Treatment May Control High Blood Pressure Researches have reported that a quick blast of radio waves applied to nerves in the kidney can significantly reduce high blood pressure in patients who do not respond to conventional high blood pressure medications. The radio waves are applied to the nerves by a tiny device inside a catheter that is threaded through a blood vessel in the groin to the kidney, in much the same way that an angioplasty procedure opens clogged cardiac arteries. Once the device is in place in the artery leading to the kidney, it emits short bursts of low-power radio waves that destroy the nerves lining the blood vessel. The device is rotated to make sure that no area receives too much energy. The affected nerves control the body’s “fight or flight” response of the sympathetic nervous system, which raises the body’s blood pressure and heart rate in a crisis situation. The destruction of the nerves permanently relaxes certain blood vessels, thereby lowering the patient’s blood pressure. In a study in which the radio waves were applied to 106 patients whose blood pressure top number (systolic) averaged 178 despite taking an average of five high blood pressure drugs daily, after six months, 84% of those treated had drops of at least 10 points. Thirty-nine percent had their systolic blood pressure lowered below 140, which is the cutoff that defines high blood pressure. The average reduction was 32 points (systolic) and 12 points

(diastolic-the lower blood pressure number) over a period of six months. These results are much better than the less-than-10-point average systolic drop which results from the use of many high blood pressure drugs. The radio treatment also improves blood-sugar control, making it even more beneﬁcial for diabetics with high blood pressure. The results of the study were presented at a recent conference of the American Heart Association held in Chicago, and were published by the British medical journal Lancet. The treatment is being developed by Ardian Inc., a private company based in Mountain View, CA. It was approved two years ago in Europe and is just now coming into wide use there, as doctors have by now become trained in the procedure. According to Dr. Murray Esler of the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, in an earlier pilot study, the blood pressure of patients who had the procedure performed at least 2 1/2 years ago remains at the improved, lower levels. He also reported that the side eﬀects of the treatment “were almost zero.” However, Dr. Esler warned that even with the radio treatment, “most of this group are still on medications. They are not cured. If you tried this out on milder hypertensives, maybe you could cure it. That is a dream, but we are thinking about it.”

6 | December 2010

HEALTH LIVING

Issues - Op Eds

Limiting US Health Care Costs Continued from p.1

ularizing employer-provided health care met two different objectives at once. It provided health care to American workers and their families in the prime of their lives with little or no outof-pocket expense to those being covered, and it provided business owners and executives something to offer to satisfy unions in lieu of their demands for higher wages. Employer-provided coverage was also practical because, at that time, health care was very cheap, compared to its cost today. The medications in use were far simpler and less effective than the ones we now have, but they also had the virtue of being far more inexpensive. Hospital stays were typically longer, but much less costly than they are now. There was also much less reliance on the relatively primitive, by today’s standards, medical equipment and procedures that were available at the time. Health care costs in those times were also low because critically ill patients typically died quickly. Medical science did not yet know how to extend their lives indefinitely with the heroic and extremely expensive machines and procedures routinely used today. Employer-provided health insurance became even more popular during the subsequent war and immediate postwar eras, when wage increases in union contracts were constrained by government-imposed wage and price controls. The result is that today, 160 million Americans, who comprise 62% of the population under age 65, receive their health coverage through their employers. This employer-provided health care model, in many ways, was an “accident of history.” Medical economist Uwe Reinhardt of Princeton University says, “If we had to do it over again, no policy analyst would recommend this model.” For some of the reasons cited above, health care today is inherently much more expensive than it was when employer-provided insurance first came into vogue. Some of that added expense is unavoidable. Hospital stays, for example, are inherently labor-intensive, and it still takes about the same amount of time now as it did then for doctors to do a thorough examination on their patients.

But there are other medical costs today that should be subject to substantial reductions due to the economies of scale, but which remain much more expensive than they should be because of a curious feature of the employer-provided health insurance system. Health care is one of the few major services in the free-market American economy today which is not paid for directly by the person receiving it. As a result, most people do not care what the health care they receive actually costs, because they believe their insurance is paying for most of it. They know, for example, what their doctor charges for an office appointment, or the list price of the drugs they buy at their local pharmacy. They also know how much they are being charged as a co-pay, or the deductibles on their health insurance policies. They do a little quick subtraction and come to the conclusion that the high price they are paying for their health insurance is probably worth it, in the long run. While they may complain when the next insurance premium hike is announced, most still believe that the overall US health care system is working for their benefit. But it’s not that simple. I first became aware of this after I was forced a few years ago to change my insurance policy to a new provider. The lab which processed the blood tests I took during my next routine office visit to my primary care doctor mistakenly billed my old insurance company. When the old insurance company refused to pay, months after the lab tests were run, they sent me the bill. (I have since come to expect this as a routine occurrence.) I was shocked when I realized that the lab was asking me to pay more than $700 for what were routine tests that my doctor orders for me at least once a year. When the coverage mix-up eventually got straightened out, my insurance company sent me a statement showing how they settled the bill. I was outraged to discover that the lab in the end accepted a payment from my insurance company of a little more than $100. The lab had billed me, as an individual consumer, in excess of 500% more than the amount which was ultimately paid by my insurance company. I had never paid much attention before to the benefit reports which my insurance company sent me, but I started following them more closely to see if that outrageous lab charge was just a fluke. It wasn’t. In some areas, like lab tests, the markup to the retail customer over the “wholesale” price actually paid by the insurance company was consistently outrageous, while in other areas, like charges for office visits to doctors, they were more reasonable.

Then I noticed something else hidden in plain sight in those benefits reports. Because the insurance companies get such steep discounts from the health care providers, the co-pays which come out of my own pocket for these services actually represent a larger fraction of what my health care provider actually receives for their services than the amount my insurance pays. Here are two actual examples from my August insurance company benefit statement: For a routine lab test ordered by my doctor during an office visit, the lab sent my insurance company a bill for $115. The statement shows that the lab gave my insurance company a discount of $98.89 on the bill. The lab also sent me a direct bill for the $10 co-pay required this year for the first time by my insurance policy. In the end, my insurance company paid the lab only $6.11 and the lab accepted that plus my copay as payment in full. Let’s do the math. The lab actually got paid a total of $16.11 on a $115 bill, a discount of about 85%, and I paid 62% of the final net cost out of my own pocket. This leads me to ask the following question: Wouldn’t I have been much better off if the lab had billed me directly for the whole $16.11, or even $20 for the test they ran, and I paid it all, just like my other bills? In other words, am I getting my money’s worth for the roughly $1,000 a month I am paying in family coverage health insurance premiums through an employer-type health insurance plan? Let’s take another example from the same August statement – the charge for a routine office visit to my urologist. He billed my insurance company the odd amount of $124.39. My insurance company’s discount off that bill was $68.48, a more reasonable 55%. But here is the kicker. This year, my insurance company upped my co-pay to $50 for visits to specialists, so the balance that my insurance company paid my urologist was only $5.91. That is only about 10.5% of the amount my doctor actually received for my visit. Again, I have to ask, wouldn’t I have been better off if I had just paid my doctor the total of $55.91, or even as much as $75, for the visit, and spared myself the need to pay a $1000 monthly health insurance premium? Are the huge charges for lab tests and the latest medications and hightech imaging techniques justified or even real? Are they being deliberately inflated and manipulated in a conspiracy to camouflage blatant profiteering by those who are adept at gaming the system? The disconnect and lack of transparency between the recipients of health

services and the parties who are supposed to pay for them is one of the root causes of this country’s health care cost crisis. The inflated prices, hidden discounts, and arcane rules which lend themselves to outrageous exploitation are rife throughout the health system. However, we as consumers and voters are either not aware of them, or don’t care because we assume that the costs are somebody else’s problem. They are not. They have reached the point where they represent a dire threat to the long term economic competitiveness and viability of our country. Many of us had hoped that the passage of health care reform would have put an end to this situation. It did not. There will be some real benefits from the reform package. A few of the most egregious practices by health insurance companies will be reined in. Many families who have lost their health care coverage will now receive it, largely at public expense. However, in the process of drafting the new law, each of the major players in the system, including the hospitals, medical associations, pharmaceutical companies, unions and health insurance companies cut back-room deals with the White House and congressional leaders to protect many of their most lucrative practices. As a result, these practices will continue to drive up the cost of medical care in this country at an unsustainable rate for the foreseeable futureMost of these costs are not nearly as obvious as the ones revealed by my monthly insurance benefit statement. They are hidden by the complexity of the rate-setting policies and regulations already in place. Naturally, they are also zealously protected by the political influence of the special interests which profit from them. Establishing real accountability and getting fair value for the vast amount of money being paid into our health care system, even now that “Obamacare” is a reality, will not be easy. The first thing that is needed is a much stronger sense of personal responsibility by each of us about this issue. As the actual consumers of health care, we must demand transparency and a halt to the gross overcharges and exploitation by various health care providers, special interests and third parties that, if left uncontrolled, threaten to eventually bankrupt our country and ruin us all. Yaakov Kornreich is a veteran Anglo-Jewish journalist. He is the Senior Editor of Building Blocks, published by the Jewish Press, and this Health & Living supplement. He can be contacted at yaakovk@aol.com.

HEALTH LIVING

December 2010 | 7

Issues

Medicare Doctors’ Crisis Becoming Critical Want an appointment with kidney specialist Adam Weinstein? If you are covered by Medicare, expect to wait eight weeks to be seen. Geriatric specialist Michael Trahos has reduced his appointments for his Medicare patients from once every three months to just twice a year. Highly rated primary care doctor Linda Yau and her associates recently announced that they will no longer be accepting new Medicare patients. All give the same reason: The reduction in payment rates by Medicare, which has forced them to rely more heavily on their patients with private insurance, or who pay them directly. According to Dr. Yau, she and her colleagues feel they have no choice. “It’s not easy. But you realize you either do this or you don’t stay in business,” she said. Doctors across the country have increasingly been turning away Medicare patients. They are doing so even without the implementation of the Sustainable Growth Rate (SGR) plan which Congress adopted in 1997, which, if it were allowed to go into eﬀect, would cut Medicare payments to primary care doctors by another 25% starting on January 1st. Those phased reductions were halted by Congress passing stopgap “doc ﬁxes” every year since 2002. However, SGR still remains on the books, and represents a continuing threat to every doctor for whom Medicare patients make up a large portion of their practice. Even without the SGR cuts, the Medicare payment rate to doctors has

not kept pace with the growing cost of running a medical practice. According to Medicare’s own statistics, doctors’ expenses rose 18% from 2000 to 2008, while Medicare’s physician fees rose by only 5% over the same period. The shrinking profit margin between their expenses and income has reached a critical point for many doctors. “Physicians are having to make really gut-wrenching decisions about whether they can aﬀord to see as many Medicare patients,” said Cecil Wilson, president of the American Medical Association. The problem is worst for primary care doctors, who have fewer ways than specialists to supplement their income. Specialists can generally bill Medicare and private insurance more for procedures based on new technology, leading to a growing disparity between their average income and that of general practitioners. Primary-care doctors typically make about $190,000 a year from all sources, while kidney specialists earn $300,000, and radiologists close to $500,000. Many experts blame this disparity, and the growing shortage of primary care doctors, on Medicare’s payment rates. So far, the impact of this informal doctors’ boycott of Medicare patients on seniors’ access to medical care has been relatively small. However, a recent survey conducted by the American Medical Association indicates that nearly one-third of primary-care doctors are now restricting the number of new Medicare patients they are accepting in their practice, or reducing

the frequency of visits they permit for existing Medicare patients. More doctors are making these painful decisions every day. Dr. Trahos, the geriatric specialist, admits that he is uncomfortable cutting back routine checkups on his healthy Medicare patients to twice a year. “Is it the proper thing to do? Probably not,” he told a Washington Post reporter. “These are patients who should be scheduled for proper maintenance every three months.” Dr. Weinstein, the kidney specialist, has devoted more of his practice to doing consulting work, which is much more profitable. But that means he has far less time to see his Medicare patients, who make up 70% of his practice, and he can no longer take the time to personally answer their phone calls. “It has definitely made my patients feel more distant from me, and I don’t know how to deal with that,” Weinstein admitted. For Dr. Yau, the decision to stop accepting the Medicare payment rate was based on two considerations. The first was the feeling that she deserved to be fairly compensated for her many years of training and professional expertise. The second was a refusal to compensate for inadequate Medicare payments by cutting back on the quality of medical care she gives to her patients. Because they insist on higher payments, Dr. Yau and her associates can keep their scheduled number of visits low enough so that their patients can

be given emergency appointments the same day. They also can allocate a halfhour for each office visit, instead of the 15 minutes on which the Medicare reimbursements are based. By contrast, some Medicare doctors are so overbooked that their patients are warned to expect to wait up to three hours after their appointed time for an office visit before they will actually be seen by their physician. In a recent Washington Post op-ed, veteran geriatrician Jerald Winakur describes the problem in stark terms: “Geriatricians are a vanishing breed. More of them retire each year than are trained.” Geriatrics is the lowest-paying specialty in all of adult medicine. As a result, medical students who graduate with huge student loans to repay feel they have no choice but to enter more lucrative areas of medicine. Because Medicare payments to doctors have remained essentially flat since 2001, while doctors’ operating costs continue to rise, many physicians are now forced to treat their Medicare patients as virtual charity cases. Dr. Winakur says that his patients are well aware of these trends, and that, “not a day goes by when one of my aging patients doesn’t ask me, ‘You’re not going to retire, are you?’” Dr. Winakur responds to these pleas by declaring, “I want to be there, I really do. But for me and other primarycare doctors around the country, this is a critical time. Congress must act to fix this unfair and ailing system for the long term.”

Time for Our Yeshivos to Get Serious – About Recess By Yaakov Kornreich

Our yeshivos have done a wonderful job of raising the level of Torah knowledge of our children. They have created a new golden age of Torah scholarship in America, which far surpasses, at least in the number of Torah scholars it has developed, the peak reached by the great yeshivos of Eastern Europe before the Holocaust. Our children enjoy the beneﬁt of an unprecedented variety of chinuch aids and techniques to help them to master their Torah lessons. They are further encouraged by the practice in our community of setting Torah learning as our highest priory, for young and old alike. Yet, there are other goals which our yeshivos need to promote, in ad-

dition to their Torah lessons. Children need healthy bodies in order for their minds to develop properly, and the key to that health is regular, vigorous exercise. The standard recommendation is for all school-age children to participate in active play for at least an hour a day. That includes all kinds of physical activity, including ball playing, running, jumping, gymnastics, swimming and other athletic sports. These activities offer many physical benefits, improving balance, coordination, strength, and endurance, and team sports also teach valuable social skills. There is another good reason for yeshivos to devote a significant amount of time and effort in their daily schedules to physical education. “Recess” is about much more than just play. It aids

our children’s ability to learn Torah. Exercise stimulates the brain’s metabolism. Tests show that active children have improved memory. Exercise, in moderation, will also help our yeshiva children to maintain their concentration through their school day – which has been extended by their double curriculum. According to Brooklyn pediatrician Dr. Stuart Ditchek, some of America’s leading Torah authorities, including Rabbi Avigdor Miller, zt”l, and Rabbi Shmuel Kaminetzky, also recognized the value of exercise. Dr. Ditchek recommends that our yeshivos schedule regular workouts for their student at least three times a week. In addition to all of the other beneﬁts mentioned above, establishing an active lifestyle that will help our chil-

dren to avoid developing the sedentary habits which will eventually rob them of their health and shorten their lives. The epidemic of obesity leading to the early development of heart disease and stroke has cost us the lives of too many of our young adults. It is up to our yeshivos to help us save our children from that tragic fate by encouraging them to partake in the many beneﬁts of sports and exercise, as a regularly scheduled part of their daily school routine. Yaakov Kornreich is a veteran Anglo-Jewish journalist. He is the Senior Editor of Building Blocks, published by the Jewish Press, and this Health & Living supplement. He can be contacted at yaakovk@ aol.com.

8 | December 2010

HEALTH LIVING

Raising Our Children

Drug Offers New Hope for Cystic Fibrosis A new drug called VX-770 now in Phase II clinical trials for FDA approval has shown promise in treating the underlying cause of a specific type of cystic fibrosis. Only 4-5% of cystic fibrosis patients have the particular G551D mutation against which the drug is targeted. However, if successful, VX-770 would make possible similar drugs, some of which are already under development, that target the more common genetic variants of the disease. Cystic fibrosis is a progressive, inherited disease affecting about 30,000 US children and adults, and is prevalent among both Ashkenazi and Sephardic Jews. It is caused by a defect in the CF gene, which produces the CFTR (cystic fibrosis transmembrane conductance regulator) protein, which aides in the transport of salt and fluids in the cells of the lungs and digestive tract. In healthy cells, chloride ions moving out of cells are followed by water, which keeps the mucus around the cell hydrated. However, in people with cystic fibrosis, the chloride ions and water in the

lungs stay trapped inside the cell, causing the mucus to become thick, sticky and dehydrated. Over time, the mucus builds up in the lungs and in the pancreas, interfering with the breakdown and absorption of food, and causing both breathing and digestive problems. The accumulation of the mucus in the lungs makes cystic fibrosis sufferers prone to serious and recurrent infections which, over time, destroy the ability of the lungs to function. While new medications to treat the infections have extended the average life expectancy for people with cystic fibrosis from six months in 1959 to 37 years today, there are still no treatments that specifically target the CFTR protein. VX-770 is designed to duplicate the function of the CFTR protein by opening the channels to allow both the chloride ions and the water to escape the cells in the lungs. It was developed thanks to funding from the Cystic Fibrosis Foundation by Vertex Pharmaceuticals, which screened hundreds of thousands of molecules

Autism Signs Detected in MRI Scans Doctors have been able to detect signs of autism in children using an MRI to track brain activity. In a controlled study of 60 males, ages 8-26, half of whom had been diagnosed with mild autism and half who showed no signs of it, the MRI scan identified the condition 94% of the time. By using the MRI, doctors were able to trace thought activity by following the path of electrical impulses in the child’s brain. According to the study’s lead author, Dr. Nicholas Lange of Harvard University, the MRI looked at water diffusion along the axons, the nerve fibers that transmit signals in the brain, to see how the brain was processing the information in those areas responsible for language, social functioning and emotional behavior. In those subjects with autism, the signals moved in multiple directions rather than in a single path, offering a possible expla-

nation for why it takes someone with autism more time to process certain information, Dr. Lange said. Dr. Janet Lainhart, another participating researcher at the University of Utah, said, “This type of research basically brings autism into modern medicine.... These results are not ready for clinical use, but they are the best thus far in terms of ﬁnding an important biological basis for the disorder. However, we don’t want to raise anyone’s false hope that they can walk into a clinic and ask that this test be done.” A separate study by British scientists published earlier this year in the Journal of Neuroscience was able to use MRI scans to detect telltale signs in more than 90% of autism patients who were previously diagnosed using standard intelligence tests, psychiatric interviews, physical examinations and blood tests.

in the lab until it came up with one with the desired properties. The trials showed that cystic fibrosis patients with the targeted G331D mutation had improved lung function, and generally reported feeling better. They also showed reduced levels of chloride in their sweat, indicating the drug was working as intended on the cellular level. The results of the Phase II study were published in the New England Journal of Medicine. Dr. Frank Accurso was the lead researcher in the study. He is a professor of pediatrics at University of Colorado Denver and The Children’s Hospital in Denver. The journal article was accompanied by an editorial, written by Dr. Michael J. Welsh, who wrote that the research represented “a milestone along the pathway of discovery leading to better preventions, treatments and cures.” Phase III trials of VX-770 are expected to be completed within a few months, and if they are successful, Vertex is expected to apply for FDA approval for the treatment before the end of 2011.

Meanwhile, Phase II trials for a similar molecule designed to treat people with the DF508 mutation, the cause of the most common form of cystic fibrosis, have already begun.

New Insight into Deadly Childhood Brain Tumor US scientists have completed a genetic analysis of the most common type of brain cancer in children, which leads to the development of a tumor known as a medulloblastoma, or MB. The analysis shows that MB tumors have fewer mutations than solid adult tumors, which means that research to understand what triggers this cancer and how to treat it most effectively should be easier than in most other forms of cancer. Each year this form of cancer strikes 1 in every 200,000 children below the age of 15. MB accounts for 10-20% of all primary tumors among children. The five-year survival rate is

around 80% for patients older than three, but for infants the survival rate is just 30%. MB tumors begin in the cerebellum portion of the brain, the area responsible for controlling balance and motor functions. According to lead researcher Dr. Victor E. Velculescu, associate professor at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, “we now have the pieces of the puzzle which are altered in this particular tumor type. What we have to do is figure out how these pieces can be put together and come up with new avenues for targeted therapies that take advantage of these differences.”

HEALTH LIVING

December 2010 | 9

Raising Our Children continued

Caffeine Robbing Children of Their Sleep Three-quarters of children ages 5 to 12 consume enough caffeine, mainly from soft drinks, to keep them up at night. Also, the more caffeine they consumed, the less they slept, according to a study published in the Journal of Pediatrics. Children ages 8 to 12 consume, on average, about 109 milligrams of caffeine, the equivalent of nearly three 12-ounce cans of soda per day. Children ages 5 to 7 took in about half that amount of caffeine per day. The study’s author, Dr. William J. Warzak, a professor of psychology in the department of pediatrics at the University of Nebraska Medical Center in Omaha, said, “I would suggest that parents simply be prudent and regulate the amount of caffeine their children consume.” Dr. Warzak added that, “most of the research into the health effects of caffeine has been with adults [and] there really is very little pertaining to children.”

Ihuoma U. Eneli, MD, medical director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital in Columbus, OH, also believes that aside from sleep problems, caffeine can produce anxiety symptoms in children. Avram Traum, a pediatric nephrologist at MassGeneral Hospital for Children in Boston, was just as concerned with the connection between the drinking of soda and the increase in obesity and high blood pressure in children. “There is no reason that school-aged children need caﬀeine. Period,” he says. The occasional cup of soda on a special occasion is OK, but children should not drink caﬀeine on a daily basis. There is a growing movement by several states to extend their sales taxes to the purchase of soda and other sweetened beverages, which, like other groceries, are currently exempt from state sales taxes. This movement has been motivated mostly by the high

Depression During Pregnancy Impacts the Baby

show symptoms of depression to contact a therapist to reduce the impact of depression upon the baby.

Babies born to mothers who suffered bouts of depression during pregnancy had higher levels of stress hormones, decreased muscle tone and other neurological and behavioral impacts. In a study led by Dr. Delia M. Vazquez, a professor of psychiatry and pediatrics at the University of Michigan School of Medicine, researchers found a clear correlation between depression in pregnant women and the development of a baby’s neuroendocrine system, which controls its stress responses, moods and emotions. The study included 154 pregnant women, who were examined for symptoms of depression at 28, 32 and 37 weeks of pregnancy, and again when they gave birth. Umbilical cord blood samples were taken at birth to measure stress hormone levels, with follow-up neurobehavioral tests conducted at the age of two weeks, to assess the infant’s motor skills and responses to stimuli. Up to one in ﬁve women experience depression during pregnancy, and postpartum depression is even more common. The authors of the study, which was published in the journal Infant Behavior and Development, urged pregnant women who

Preterm Births Still Too High A new report from the March of Dimes indicates a small but signiﬁcant reduction in the percentage of premature births in the US. The percentage fell from 12.8% in 2006 to 12.3% in 2008, which translates into 21,000 fewer preterm births each year. That is still far from the government’s goal, to reduce premature births to no more than 7.6% of all births. More than half a million US babies are currently born premature each year. The normal term of pregnancy is 39 weeks, and any baby born prior to 37 weeks is considered to be premature. Those babies born more than a month early face the greatest risk of death and lifelong health problems. But even those born just a few weeks early are subject to breathing problems, jaundice and learning or behavioral delays. March of Dimes president Dr. Jennifer Howse noted that most of the improvement came among babies born just a few weeks early, and was due to doctors and hospitals being more careful to avoid scheduling elective deliveries from induced labor or ﬁrst-time Caesarian sections too soon.

sugar content in soda rather than the caﬀeine. New York City Mayor Michael Bloomberg’s proposal earlier this year to ban sugared drinks from groceries that could be purchased by city residents using food stamps is another

such eﬀort. The main goal of these initiatives is to create a ﬁnancial disincentive for the consumption of unhealthy snack foods which are fueling the current epidemic of obesity, especially among young people.

10 | December 2010

HEALTH LIVING Raising Our Children continued

Placentophagia: Ingestion of the Placenta WHY THE ORTHODOX WORLD COULD USE THIS OLD PRACTICE FOR MODERN POSTPARTUM HEALING. By Esther Hornstein, L.Ac., MSAc.

The placenta, otherwise known as the afterbirth, transmits the blood, nutrients and gasses to the growing fetus in the womb. After the baby is delivered, most American hospitals discard the placenta or store it for future use as a source for stem cells. In China, India and other Asian countries, the placenta is carefully preserved for the mother’s later medicinal use. Traditional Chinese Medicine attributes postpartum depression (also known as baby blues) to the extensive loss of blood and energy in the process of giving birth. This makes the mother fragile and vulnerable during the postpartum period. Chinese medicine has been using the placenta medicinally for thousands of years to help mothers with severely debilitated health and insufficient lactation. The Benefits The undeniable health benefits of the practice is now convincing more American mothers to preserve and ingest their own placenta, a process known as placentophagia, as a part of their postpartum recovery. The placenta contains vitamins and minerals that help fight depression, and it is rich in iron and protein. Placentophagia decreases or prevents postpartum depression, increases breast milk production, restores energy, fights iron deficiency and aids restful sleep. The Necessity for Prevention Today, one out of eight mothers experience postpartum depression. It leaves them feeling dread, anxiety, fear and apathy towards their baby, and interferes with their ability to function in their home and social lives. Sometimes, the mother’s depression becomes so overwhelming that it can give rise to thoughts of harming her baby or herself. Treatment options for nursing mothers are often limited to counseling, because many of the most effective anti-depressant medications such as Paxil, Prozac and Celexa could harm the baby through the breast milk.

In families where the time between pregnancies is short, they take a cumulative toll on the mother’s health. She is predisposed to becoming weaker and more vulnerable after each birth. Placentophagia is a safe way to help her to quickly regain the energy she has lost after each birth and to reduce the risk of postpartum depression, without posing any danger to the baby. The Research A 1954 medical study found that 86% of 210 women with insufficient milk supply experienced a positive increase in their milk production within a matter of days after they ingested dried placenta. More recent research has discovered that placentophagia could enhance pain tolerance by increasing substances activated during childbirth which are beneficial to the postpartum healing process. A study conducted by the National Institutes of Health (NIH) found that during the last trimester of pregnancy, the placenta in an expecting mother produces three times the normal amount of the stress-reducing hormone CRH (Corticotropin-Releasing Hormone) which is generally produced by the hypothalamus. The research suggests that if the hypothalamus had stopped producing normal amounts of the hormone by the end of the pregnancy, postpartum depression could be triggered by a sharp drop in the levels of CRH in the mother’s bloodstream after childbirth. Kashruth considerations In non-Jewish cultures, the placenta is used as an ingredient in a culinary dish fed to the new mother, but that is not acceptable halachically. However, some authorities approve a process in which the placenta has been cooked (traditionally with ginger root, lemon and cayenne pepper to enhance the healing properties), cut, dried, crushed into a powder and placed into vegetarian gel capsules for the new mother to ingest. Even after being processed, the powder retains the placenta’s health benefits to the mother. My Rav, Rabbi Dovid Kornreich of Yeshiva Toras Moshe of Jerusalem, has given me a heter (allow-

ance) to ingest capsules containing powder made in this fashion from my own placenta, as a purely medicinal preventive measure. He has written a teshuva (responsum) on the topic. Readers considering placentophagia should first consult with their rabbi. Practicality in the hospital setting Until recently, many American hospitals were reluctant to allow mothers to take home their placenta after childbirth, out of concern that it could be classified as a bio-hazard material and potentially expose them to lawsuits. However, they have become more accommodating to such requests due to the efforts of Placenta Benefits, a national lobby and advocacy group. Placenta Benefits distributes a legal waiver which mitigates the legal issues that may arise for a hospital by allowing a mother to take home her placenta. It also trains women to perform the placenta encapsulation process. Birthing centers are usually far more willing than hospitals to let the mother take home her placenta. If you choose to take your placenta home after giving birth, it must be refrigerated. You will need a cooler of ice and double zip-lock freezer bags labeled (with your name and the contents) to keep the raw placenta from rotting. If the placenta will not be processed into capsules within two days of the birth, it is best to freeze it in the meantime. A mother’s health is invaluable to her family, and she has an obligation to them to take the necessary measures to preserve it. Placentophagia may be new to our community, but it is a time-tested method for quickly restoring the health of mothers after childbirth, and reducing their risk of postpartum depression. Remember a happy and healthy mother makes for a happier and healthier baby. If you would like a copy of Rabbi Dovid Kornreich’s teshuva on the halachic considerations in placentophagia, instructions on how you can encapsulate your own placenta, or the legal issues involved, please e-mail AcupuncturEsther@gmail.com.

US Outlaws Drop-Side Baby Cribs The Consumer Product Safety Commission (CPSC) has announced tough new standards for baby cribs, including a ban on all models with sides that drop down. Drop-side cribs have been implicated in the deaths of at least 32 infant deaths from falls or strangulation since 2000. These cribs allow one side to be raised or lowered on tracks, providing parents with easier access to the bed. The agency said that it has received reports over the past three years of dozens of crib-related fatalities, almost all of which resulted when a baby’s head or neck became entrapped due to a malfunction of the drop-side mechanism. The new rules make it illegal to sell

a crib with drop down sides or which do not pass new tests on the durability of slats and mattresses. The rules also make it illegal to sell second-hand cribs which do not meet the new safety standards. The new standards will go into effect in six months. Hotels and childcare centers will be given two years to replace their existing cribs which do not meet the standards with new ones that do. Since 2007, the CPSC has recalled more than 11 million cribs in more than 20 separate actions. Consumer groups hailed the new regulations, which they say give the US the toughest crib safety standards in the world.

HEALTH LIVING

December 2010 | 11

Raising Our Children continued

Labels on Nonprescription Medications Still Unclear and death. Yin said that in view of the industry’s failure to make the necessary changes, “The FDA may need to set standards and regulate these products.” A separate study published in the journal Pediatrics found that the number of children under four taken to the emergency room after being given too much cough and cold medicine was reduced by half after the manufacturers took medications designed for that age group oﬀ the market. In late 2007, the manufacturers stopped selling cold and cough medications for use on kids less than two years old, and later extended the withdrawal to include kids less than four years old. The main danger from these medications was from the reaction to an overdose of antihistamines or decongestants. Based upon reports from about 60 hospitals across the United States, the study estimated that in the 14 months before the 2007 withdrawal, about 2,800 kids younger than two years old had to be taken to the emergency room after ingesting cough and cold medicines. In the 14 months after the ban went into eﬀect, the number dropped

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to approximately 1,250 kids. The study recommended that the packaging of cough and cold medicines made for older kids and adults that are still on the market be designed to make it much harder for kids to get into them and take a dangerous amount. The study published in Pedi-

atrics also seconded the call for clearer dosing instructions, especially for kids who are old enough to take them on their own, in order to further reduce the number of cases of children being given or taking for themselves an accidental overdose of cough and cold medication.

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According to a study published in the Journal of the American Medical Association, one year after the Food and Drug Administration (FDA) issued voluntary guidelines for the manufacturers of over-the-counter medications, the suggested changes have not yet been made. The guidelines call for manufacturers to provide clearer dosing directions and to include appropriate measuring devices with the products, but almost none of the products on the market are now in compliance. It is still far too diﬃcult to follow the directions on the labels of 200 liquid over-thecounter medicines for children under 12, including virtually all of the popular cough-and-cold, pain-relieving, allergy and stomach drugs on the market. “Almost all the products had inconsistencies,” said Dr. H. Shonna Yin, who lead the study, and who is an assistant professor of pediatrics at NYU School of Medicine. Dr. Yin noted that as a result of these inconsistencies, parents make dosing errors in giving these medications to their children about 50% of the time. While most of these errors aren’t serious, overdosing on acetaminophen, for example, can lead to liver failure

12 | December 2010

HEALTH LIVING

Golden Years

Coping with Loss Continued from p.1

friends to demonstrate unconditional love and support and provide relief from unrelenting grief. In fact, this might be an opportunity to get reacquainted with old friendships. When faced with loss, a person rebuilding her life should take time to remember all the activities she enjoys, even the hobbies she may have ignored for some time while dealing with her loved one’s illness. She should think of which friends or acquaintances might be interested in the same activities and invite them along. Or she can go alone and meet likeminded new friends. Senior Programs – There are wonderful programs for seniors in our community. Here are some to consider:

In our local communities, there are quite a few programs for seniors seeking company and activities. Some meet every day, and others meet several days a week. Each one provides opportunities for seniors to get out of their homes and leave the loneliness behind. Whether someone attends with a friend or makes new friends there, it is a wonderful opportunity to talk to others, eat good food, and enjoy a wide array of programming. Seniors can participate in discussions on politics and world affairs, enjoy special musical performances, watch weekly movie screenings, and take art or computer lessons, plus keep fit with exercise and dance classes. Some programs organize special trips to local museums or other attractions. Many programs offer Torah classes by well-known community rabbis or chavrusah (partner) learning with other seniors. These programs offer both distractions from grief, as well as fresh stimulation and excitement. Afternoon Chevra x7450

718-438-2020

Volunteer opportunities at local organizations or hospitals can give new inspiration to someone with extra time on their hands. Bikur Cholim organizations always appreciate extra help in their office or with various programs visiting the sick. Seniors can also contact local schools and yeshivos to find out about volunteering to help with annual dinner arrangements and mailings. Going with a friend to stuff envelopes, make phone calls, and enjoy a lively school environment may be just what is needed to remove someone from their grief. If a grief-stricken senior is having a hard time getting back to himself and can’t re-establish a connection with old friends, a few sessions with a grief counselor or a support group can very beneficial. They can provide reassurance that the devastation one is feeling is a normal response and does not have to take over the rest of one’s life. A support group will show them that 90 Bennett Avenue New York, NY 10033 Tel. 212-923-5715

• AGUDATH ISRAEL OF AMERICA • BORO PARK Y The Boro Park Y Senior Center offers hot lunch, daily activities and special trips. In addition, there is a special program for holocaust survivors, Club Nissim, which meets several times a week. Thursday afternoons are popular with men who come for the “Afternoon Chevra,” a group that oﬀers hot kugel along with lively Torah discussions. Boro Park Y 4912 14th Avenue Brooklyn, NY 11219 Seniors Program 718-435-3804 Club Nissim 718-438-5921

Agudath Israel runs 3 senior day programs that provide a hot lunch, daily activities and special programming. The Boro Park branch also oﬀers Torah classes for men. • Boro Park Senior Citizen Center 5602 11th Avenue Brooklyn, NY 11219 Tel. 718-854-7430 • Brookdale Senior Citizen Center 817 Avenue H Brooklyn, NY 11230 Tel. 718-434-8670 • Moriah Older Adult Luncheon Club (Washington Heights)

others are experiencing the same feelings of loss, too. Be careful to avoid making big decisions right after losing a partner, unless a plan was already in motion. For example, seniors should not move to a new community without giving themselves some time to recover from their loss. Remarrying, or major investment decisions such as purchasing a retirement home are better postponed until emotions are less fragile and the feelings of intense grief have subsided. Most important to a person’s wellbeing following the loss of a loved one is maintaining social connections with family and friends – old or new. These relationships are crucial to combating loneliness and ensuring a healthy, fulﬁlling future life. Malky Haimoff is Associate Editor of Health & Living. She can be reached at malky.haimoff@gmail.com.

swimming and exercise on Tuesdays and Thursdays. There are occasional special events, musical performances, trips and lectures, too.

• JEWISH ASSOCIATION FOR SERVICES FOR THE AGED JASA

Bergen County Y, a Jewish Community Center

JASA operates 21 senior centers in the NY metropolitan area. Each location oﬀers hot lunch, daily activities and special trips. JASA also has an Institute of Judaic Studies with 6- or 12-week courses centered around Jewish values and history. Special lectures and programs are also oﬀered. For locations in the NY metropolitan area, call 212-273-5272.

605 Pascack Road Township Washington, New Jersey 07676 201-666-6610 ext. 263

• BERGEN COUNTY Y The YJCC seniors program offers hot lunch, organized activities and

Volunteer Opportunities Bikur Cholim of Boro Park, Brooklyn, NY 718-438-2020 Sephardic Bikur Holim of Brooklyn, NY 718-787-1100 Bikur Cholim of Far Rockaway / 5 Towns 718-327-5989 Bikur Cholim of Teaneck, NJ 201-836-4950

Health Insurance: Understanding Your Medicare Choices For those who will soon reach their 65th birthday, making them eligible for Medicare beneﬁts for the ﬁrst time, the various regulations and requirements of the program can be both confusing and frustrating. Here are six key points to keep in mind when getting started with Medicare: 1. Medicare is not free. Every Medicare plan will charge you co-pays and deductibles. Traditional Medicare has a 20% co-insurance requirement as well as hospital and outpatient out-of-pocket deductible payments. These are laid out clearly in a book published by the government each year. 2. The enrollment process takes

time. It is not a good idea to procrastinate enrolling in a Medicare program until the annual deadline or you get sick and needs the insurance coverage. Individuals are given six months, starting three months before their 65th birthday, to enroll in the Part B (medical insurance) part of the program. It is best to give yourself plenty of time to explore all of your options so that you can make the best choice to fit your particular circumstances. 3. Medicare benefits can vary significantly. Every Medicare beneficiary must choose between original or traditional Medicare, a Medicare Advantage plan, and an optional private Medicare Sup-

plement policy. These are the basic segments of the program: • Medicare Part A: This is coverage for hospital stays only, provided by basic Medicare. • Medicare Part B: This is available for an additional monthly premium and provides basic medical insurance, covering such things as doctor visits. • Medicare Part C, also know as Medicare Advantage: This is a combination of hospital and medical coverage (parts A and B) provided by private insurance companies in an HMO format. Some of these plans also include prescription drug (part D) benefits. Medicare Advantage plans may offer seniors one or more of a variety of attractive benefits, such as free membership in a

gym, or the waiver of certain prescription drug co-pays, that are not part of the traditional Medicare program. The downside is that they limit the patient’s choice of health care providers. • Medicare Part D: Optional coverage, at an additional price, for prescription drugs. • Medicare Supplement or Medigap insurance: Private insurance coverage which picks up some of the co-pays, deductibles and other items not included in basic Medicare Part A, B and D coverage. 4. Waiting to enroll can be costly. If you do not enroll in Medicare within the original six month period around your 65th birthday, you will be Continued on p.13

HEALTH LIVING

December 2010 | 13

Golden Years continued

“Sticker Shock” Leading to More Prescription Abandonments Researchers have found that just over 3% of prescriptions in this country are ﬁlled but never picked up from the pharmacy. They believe that the phenomenon, called prescription “abandonment,” is a significant contributor to the larger problem of patients who fail to take their prescribed medications. The lead researcher in the study, Dr. William H. Shrank, of Harvard Medical School and Brigham and Women’s Hospital in Boston, said that his study found that the highest priced prescription drugs were the ones most likely to be left unclaimed at the pharmacy, along with ﬁrst-time prescriptions for a particular type of medication. The study was prompted by a desire to discover why people with chronic health problems, including high blood pressure, diabetes and heart disease, commonly fail to take their medications as prescribed, and

Understanding Medicare Choices Continued from p.12

required to pay a 1% penalty surcharge on the Medicare policy you eventually choose. The penalty increases for each month you do not yet enroll and stays with you permanently. As a result, even seniors who do not need the coverage at the time of their 65th birthday are generally advised to enroll in the cheapest available plan in the program as soon as they become eligible. This way they avoid the higher costs they would face later, when they would need the coverage. 5. Not every health-care provider will accept Medicare. With optional Medicare Supplement insurance coverage, you can go to any health-care provider you choose, as long as they accept Medicare. If you have a Medicare Advantage plan, you must use the health providers in your plan’s HMO network. That is why it is important to make sure, before you enroll, that you are satisfied with the choice of doctors and hospitals in that network. 6. Traditional Medicare won’t cover all of your health-care needs. It will not pay for cosmetic surgery, alternative medicines or membership in fitness centers. However, some Medicare Advantage programs do offer such benefits. When you enroll in Medicare, you

its goal was to flag problems that doctors and pharmacists could address. The researchers used data on 10.3 million prescriptions filled by more than 5 million patients in 2008 at CVS Caremark, a national retail pharmacy chain that also funded the study. It found that 3.3% of prescriptions were not picked up by the patient after two weeks. New prescriptions were nearly three times as likely as others to be abandoned, but the most important factor was price: Drugs costing more than $50, and those requiring a copayment of $40 to $50, were three to five times more likely to be abandoned than those with no co-payment. This leads Shrank to believe that a major factor in drug abandonment is “sticker shock” because “patients often don’t know the cost of a drug until they arrive at the pharmacy.” As a result, he and the other aumust stick with the choices you have made until the end of the calendar year, when you are given the option to switch to another plan during an open enrollment period. The open enrollment period for 2011 ends on December 31, 2010, for most Medicare plans. Current Medicare patients who miss that deadline will have to wait until the start of the open enrollment period at the end of 2011 if they want to change their coverage. Valid reasons for changing to a different Medicare plan include: • a change in medications to those not included in your current Part D plan • a new medical condition • a move to a new location Medicare plans can also change from year to year. Premium, co-pay and deductible costs for each plan can go up, or down, and prescription drugs can be added or dropped from the list of those covered. In addition, some Medicare plans are discontinued by providers while new ones are introduced. Before switching to a new Medicare Advantage plan, talk to your current doctors and pharmacist to find out whether they are part of its HMO network. For more information about all of your Medicare choices, go online to Medicare.gov, call Medicare directly at (800) 633-4227, or consult a health insurance agent.

thors of the study urge pharmacists to work more closely with doctors to make them more aware of specific drug prices and lower cost alterna-

tives. They also urged doctors to make sure their patients understand why they are being put on a prescription drug for the ﬁrst time.

14 | December 2010

HEALTH LIVING Golden Years continued

Making Sense of Medicare Part D By Izzy Bromberg

So you are turning 65 – good for you! Until 120 years! Now as part of the right of passage you have to start thinking about your Medicare benefits, which include Part A, B, C and D. Overwhelmed? A bit confused? Well it is very confusing and perhaps not exactly what you were expecting. This article will give a brief overview of Medicare and its eligibility, but it will focus on Medicare Part D, the prescription drug program. Read on… Medicare is a federal health insurance program for people age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). According to the federal Centers for Medicare & Medicaid Services (CMS), Medicare serves about 40 million beneficiaries. To be eligible, you or your spouse must have worked for at least 10 years in Medicare-covered employment, be age 65 or older, and be a citizen or permanent resident of the United States. Medicare has four parts: Part A is Hospital Insurance. This covers inpatient hospital stays (at least overnight), including a semiprivate room, food, tests, and doctor’s fees. Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still working.

Annual Costs in 2010 Under Standard Design for Part D Prescription Drugs Under Medicare For drug costs between…

You pay…

Up to…

Your total costs (not including premium)

$0 and $310

100%

$310

$0 to $310

$310 - $2,830

25%

$630

$310 to $940

$2,830 - $6,440

100%

$3,610

$940 to $4,550

Over $6,440

No limit

$4,550 plus

5% over $6,440

No limit

$4,550 plus

Parts C, commonly known as Medicare Advantage plans, is another way for beneficiaries to receive their Part A, B and D benefits. Medicare beneficiaries have the option to receive their Medicare benefits through private health insurance plans, instead of the traditional Medicare fee for service program plan (Parts A and B). These programs are known as “Medicare+Choice” or “Part C” plans. Part D covers prescription drugs. Part D: Prescription Drug plans Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is automatically eligible for Part D. In order to receive this benefit, a person must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and have the option not to cover some drugs at all. Most Part D plans have a coverage gap (the so-called “doughnut hole”). The chart below shows how Part D coverage varies depending on how much you have spent on prescription drugs so far during the current year. In addition to the above deductibles and co-payments, there is a monthly Part D premium that must be paid. Monthly Part D and cost-sharing amounts are not uniform nationwide, but vary across plans and regions. In 2010, the national average monthly Part D premium for all plans (includ-

ing PDPs and MA-PD plans) was $31.94. (Actual PDP premiums vary across plans and regions, ranging from a low of $8.80 in Oregon and Washington to a high of $120.20 in Delaware, Maryland, and Washington, DC.) So what does this mean for you? Let’s look at two examples: Example 1: Joe takes Lipitor, Plavix and Janumet. The local Costco costs for these medications are $530 a month. This means Joe will spend $6360 annually. Under Medicare Part D he will pay as follows: Joe’s Annual Medication $6360 Cost at Costco

Joe’s Annual Cost when $2400 purchased from a Foreign Pharmacy*

Medicare Deductible $310 $310-$2830 (25% deduct$630 ible) $2830- $6440 (100%) $3530

Medicare Deductible $310-$2830 (25% deductible) $2830- $6440 (100%) Yearly Premium (avg. monthly premium is $32) Joe Pays Out of Pocket

Yearly Premium (avg. monthly premium is $32) $384

Joe Pays Out of Pocket $4854

$0 $0 $0 $384 $2784

Joe is paying about 76% of his bill out of pocket! He does not beneﬁt from crossing the “gap” as his total annual bill is only $6360, below the cut-oﬀ to reach the 5% co-pay. If Joe would have bought his medications from a foreign pharmacy instead, he would have saved $2070 (and he would have not had to deal with reimbursements). Example 2: Sally takes Actonel, Lexapro and Nexium. The local Costco costs for these medications are $402 monthly. This means Sally will spend $4824 annually. Under Medicare Part D she will pay as follows: Sally’s Annual Medica- $4824 tion Cost at Costco Medicare Deductible

$310

$310-$2830 (25% de$630 ductible) $2830- $6440 (100%)

$1994

Sally’s Annual Cost when purchased from a Foreign $1560 Pharmacy*

Medicare Deductible

$310-$2830 (25% de- $0 ductible) $2830- $6440 (100%) $0

Yearly Premium (avg. monthly premium is $32) $384

Yearly Premium (avg. monthly premium is $384 $32)

Sally Pays Out of Pock- $3318 et

Sally Pays Out of Pock- $1944 et

Sally is paying about 68% of her bill out of pocket! She, too, does not beneﬁt from crossing the “gap” as her total annual bill is only $4824, also below the cut-oﬀ to reach the 5% co-pay. If Sally would have bought her medications from a foreign pharmacy she would have saved $1374 (and would have not had to deal with reimbursements). The cost for these drugs through other Medicare Part D (PDP or MA-PD) programs will vary. You should do your own research, matching up the prescription drugs you are currently taking and the costs and drugs covered by the plans available in your area. According to the health care reform bill, which still faces many legislative challenges, in 2010 Part D enrollees with any out-of-pocket spending in the coverage gap will receive a $250 rebate. Beginning in 2011, Part D enrollees will receive a 50% discount Continued on p.15

HEALTH LIVING

December 2010 | 15

Golden Years continued

The Pooled Income Trust Option

Your Income Should Not Deter You From Applying for Medicaid! For over 15 years, I have worked with individuals and families to assist them with their applications for Medicaid and other government entitlement programs. Often, the ﬁrst question I hear from a consumer is, “How can I apply for Medicaid for my mother? Her social security check is over a thousand dollars.” Most people are not aware that income is the last thing senior citizens or people with disabilities need to worry about when considering whether or not to apply for Medicaid. No matter their income, senior citizens or people with disabilities can qualify for Medicaid under a program that goes by several names: Surplus, Spenddown or the Excess Income program. Even if a Medicaid applicant has a monthly income over the allowable limit, the monthly overage can be paid each month by the applicant, who can then qualify for active Medicaid based on the adjusted income amount. One can pay the overage directly to Medic-

Medicare Part D Continued from p.14

on the total cost of brand-name drugs in the coverage gap, as agreed to by pharmaceutical manufacturers. Over time, Medicare will gradually phase in additional subsidies in the coverage gap for brand-name drugs (beginning in 2013) and generic drugs (beginning in 2011), reducing the beneﬁciary coinsurance rate from 100 percent in 2010 to 25 percent by 2020. In addition, between 2014 and 2019, the law reduces the out-of-pocket amount that qualiﬁes an enrollee for catastrophic coverage, further re-

aid or, if receiving services from a home care agency, one can pay it to them. However, anyone whose monthly income exceeds the limit by $300 or more should explore the Pooled Income Trust option. The Pooled Trust option has existed for a number of years, but has gained popularity recently. These trust accounts are managed by various non-proﬁt organizations that are overseen by the government. Here is how the trust works. If, for example, the Medicaid allowable income is $800 and a person’s monthly earnings total $1,300, he is over the allowable limit by $500. The applicant can establish a trust by depositing $500 each month into an account managed by the non-proﬁt organization. By placing his excess income into the trust account, he enables Medicaid to deem his income as being only $800 – allowing him to qualify for the program. What happens to the $500 placed in the trust? It is now available to the applicant to pay his monthly recurring expenses, such as rent, mortgage, utilities and grocery bills. The consumer works ducing out-of-pocket costs for those with relatively high prescription drug expenses. *Based upon prices obtained from TownDrugStore.com – December 2010

directly with the non-profit organization to determine which bills he wants paid by the trust and he must submit those monthly bills to the organization in a timely fashion. The bills can be paid only once the non-profit is in receipt of the $500. Be aware that there are some setup costs involved in establishing the trust, as well as monthly maintenance fees charged by the non-profit to cover their administrative costs. Each organization sets its own fees, but they are usually minimal. In addition, once the monthly overage is deposited into the trust account, it cannot be withdrawn

or used for any other purpose. A Pooled Trust is a win-win option for most seniors. Once it is established, the consumer does not have to pay a monthly surplus directly to Medicaid, and the money deposited in the trust goes toward his own monthly expenses, which he would otherwise have to pay anyways. Most significantly, he qualifies to enroll in the Medicaid program and take advantage of its many benefits. Because of the many advantages described here, Medicaid has seen the increased utilization of the Pooled Trust and is now processing them in a much more timely fashion than when the Trust first became an option. Martin Schwartz is CEO of Stay At Home Solutions, Inc. He has 15 years of Medicaid planning experience and is certified as a Medicaid pre-screener by the NYC Medical Assistance Program. Mr. Schwartz can be reached at 718-758-3910.

MEADOW PARK REHABILITATION & HEALTH CARE CENTER

Izzy Bromberg is head of sales at TownDrugStore.com, an online pharmacy based in Israel. TownDrugstore.com offers toll free phone support and guaran-

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Important Medicare Facts Most people have to enroll in Medicare. The enrollment period begins three months before you turn age 65 (or right away if you require regular dialysis or a kidney transplant) and continues for seven months. To apply for Medicare, contact any Social Security Administration oﬃce. If you don’t enroll during these 10 months, you’ll have to wait until the three months beginning on Jan. 1, and your Part B coverage won’t start until July. Medicare Plan Finder - https://www.medicare.gov/ﬁnd-a-plan/questions/home.aspx For additional information, call the Medicare Choices Helpline at (800) 633-4227 and ask for a Medicare handbook.

Watch our Video & Virtual Tour at www.mprcare.com

• Short-Term Rehab & Long-Term Care • Under Frum Ownership & Operation • Judaic Library for Study and Leisure • Tehilim Groups • Weekly Bikur Cholim Visits • Special Shiurim Delivered by Inspiring Guest Speakers • Special Monthly and Holiday Events • NEW! Torah Conferencing Network Shiurim for Residents and the Community • Shabbos Programming Dr. Zeitlin, Medical Director Under the VAAD Horabanim of Queens (VHQ) 78-10 164th Street, Fresh Meadows, New York For further information please contact Akiva Goldstein 718.591.8300 Ext. 248

dena.graphix 718.701.1125

By Martin Schwartz

16 | December 2010

HEALTH LIVING

December 2010 | 17

18 | December 2010

HEALTH LIVING

L’Chayim to Life Health Care – Can it Be a Career for the Frum Person? By Mutty Burstein

“My son, the doctor,” said with a beaming smile, is often heard amongst Jewish mothers kvelling about their kids. But why not “my daughter, the nurse,” or even “my son, the nurse,” or occupational therapist, or home health aide, or any of the ancillary health care careers? Today, more than ever, there is a need for health care workers who are not just knowledgeable about kashrus and Shabbos, but rather are keeping Kosher and observing Shabbos themselves. Centuries ago, when Bubbe was too sick, weak or forgetful to take care of herself, the family stepped in and took care of her. Families lived together or close by, mothers were home with their children, children had shorter school days (if at all), and everyone pitched in to help with everything from tending to the chickens to bringing Bubbe her tea.

Decades ago, if the family could not take care of Bubbe, she was sent to a nursing home – a drastic solution and one that often had dire consequences. Today, most families cannot commit to taking care of Bubbe for a variety of practical reasons – work, school, space, ﬁnances. But the other available options for Bubbe have vastly improved. Nursing homes have become much more consumer-driven and friendly. Assisted living facilities that provide independence as well as much-needed supervision have sprung up all over the country and around the world. The home care industry, allowing patients to remain at home, has blossomed into one of the mainstays of eldercare. At the forefront of the success of these options for Bubbe are the healthcare workers who provide the day-to-day care of the patients they serve, tending to their every need from organizing their medications to changing their clothes to administering life-saving

treatments, and everything in between. From the patient’s and family’s perspective, who better than a like-minded “landsman” to take care of Bubbe? Skills can be taught, compassion can be inherent, but someone who understands the Jewish lifecycles because she lives them, too, and some-

one who can help Zeide put on his teﬁllin because he puts them on himself each day before going to work – that kind of empathy and understanding is priceless. Whatever your contact has been Continued on p.19

Precautions for Passengers Flying to Israel

HUGE SALE GOING ON NOW!

Deep Vein Thrombosis (DVT) is a serious medical condition which has become more prevalent with the advent of frequent travel to Israel. According to Dr. Enrico Ascher, head of the Vascular Institute at Maimonides Hospital in Brooklyn, NY, a passenger on any flight lasting more than five hours is at increased risk for the formation of a blood clot, usually in a deep vein in the legs, but sometimes in the abdomen. The clot can break free and travel to the lungs, causing a life-threatening pulmonary embolism. Those at highest risk of DVT during long flights are the elderly, those with a family history of thrombophlebitis, or those who have had episodes of superficial or deep vein thrombosis. To avoid DVT, Dr. Ascher advises all passengers on long flights to get out of their seats and walk around the cabin every few hours. He also encourag-

es passengers to drink plenty of water and abstain from alcoholic beverages during the flight. Studies have shown that passengers breathing the dehumidified air in a pressurized cabin tend to get dehydrated, thickening their blood. This increases the risk of forming blood clots. Dr. Ascher also has an urgent recommendation for anyone who notices a swelling in their legs soon after completing a long flight. He says that they should assume the worst, and go directly to the nearest hospital to request an ultrasound examination by a vascular surgeon of both their legs and their abdomen for the possible presence of blood clots. In addition, he says that anyone with a high risk of thrombosis should consult with their physician prior to their flight. Their doctor may prescribe an injection of the blood thinner heparin as a measure to prevent DVT.

HEALTH LIVING

December 2010 | 19

L’Chayim to Life continued Career for Frum Person Continued from p.18

with the health care system, whether as a patient or a caregiver, you are sure to have stories of people you have met along the way who have either gone out of their way to accommodate your religious needs or who have been completely clueless, or worse, callous. Often, the different behaviors are a reflection of training through cultural sensitivity classes and other venues, or due to repeated exposure to the Jewish community in certain facilities and neighborhoods. (At other times the behaviors are a reflection of a lack of training and limited or no exposure to the community.) Yet, there is nothing like having a competent health care professional who can “speak your language” to provide the care you need. From the healthcare worker’s perspective, what better way to make a living than to get paid to do chessed (kindness), bikur cholim (visiting the sick), and bring smiles to everyone’s faces? My wife, a nurse, enjoys a spiritually, emotionally and financially rewarding career in women’s health. She and her friends who are also Orthodox Jewish nurses often recount how, when they walk into a room of a Jewish pa-

tient, they often encounter a nervous patient suddenly looking calmer and saying “ahhhh, a heimishe (familiar) nurse!” This allows the patient to dispense with a whole set of explanations and get right to the heart of the matter. Jewish nurses are keen to the spiritual needs of their patients, often helping with Shabbos arrangements while providing wound care. As my wife can attest, it is a great feeling to take care of the whole patient, not just the wounds. This allows her to get much more out of the experience than a paycheck, and she is grateful for the z’chus (merit) of taking care of “her own.” Career opportunities abound for religious people to pursue in healthcare. In today’s shaky economy there is one thing on which all analysts agree: healthcare, especially eldercare, is where the growth and the new jobs are booming. Salaries for healthcare workers continue to rise as the needs continue to grow. Often, these positions come with generous beneﬁts packages as well. Hospitals and clinics in the metropolitan area have become more sensitive to the needs of the Orthodox community and are not just providing “chesed rooms,” but are also more open to accommodating the needs of their Shabbos-observant staﬀ.

Nursing, traditionally a woman’s career, is now seen as a viable and worthwhile career for men. In my work in homecare, I have seen a growing demand by the Orthodox community for male nurses and home health aides in order to maintain the dignity and modesty of our male clients. In addition, many homecare clients of both genders are requesting heimishe caregivers because they feel more comfortable having someone in their home who understands and shares their lifestyle, as well as respects it. It is not just Bubbe and Zeide. Unfortunately, there are many sick children who also need care. There are adolescents and young adults who are sick or physically and/or mentally disabled who need health care of varying types, from nursing to thera-

pies to daily care. Parents want what is best for their children. If given the choice of equally competent and caring professionals, they choose someone who shares their morals, values and customs, and who might sing Uncle Moishe songs to calm down a scared child while dressing his wounds. Our community is full of smart, motivated, compassionate people – young and old – who can use their talents to give back to our own community in immeasurable ways, while making a decent living and having a fulfilling career. Each of us should reach out to those we know who are contemplating a career, whether a young person choosing a first career, someone looking for a change, or even a casualty of the current national job crisis who needs to find something different. Make them aware of the needs right here in our own backyard. Mutty Burstein is the Education Outreach Manager in the Patient Relations Department at Americare CSS, a Certified Home Health Agency serving the NY metropolitan area. Mutty can be reached at 917-287-1636 or mburstein@americareny.com.

20 | December 2010

HEALTH LIVING L’Chayim to Life continued

Bolster Your Immune System… with Food! By Sheryl Mayer MS RD CDN

Improve your immune system’s ability to fight viruses like the common cold and flu by ensuring that your diet includes certain foods. Doctors focus on helping people feel better with medications after getting sick. A dietitian’s goal is to enhance health and immunity with food, and hopefully prevent people from getting sick in the first place. Here are some simple ways to bolster your immune system through proper nutrition. First, adequate protein intake is imperative for cell and tissue repair. Individuals with low protein intake have been found to have weaker immune systems due to poorer T-cell function. Good sources of proteins include lean chicken, low fat cottage cheese, and eggs. Although coffee is the drink of choice for many of us, it may be smarter to drink two to three cups of tea daily. Tea is packed with polyphenols, a type of antioxidant that protects cells. Antioxidants help to protect the body from damage from free radicals, leaving the cells healthy and strong to fight off disease. All tea has these beneficial properties, but white and green teas are the most concentrated and have the most potent effect. If you don’t like the taste of tea, add honey or sugar to taste. Avoid using powdered tea mixes, as these contain very little, if any of these healthy antioxidants. Spice it up! Chopping, dicing and mincing garlic releases the compound allicin, which is another strong and beneficial antioxidant. Add chopped garlic to soups, stews, stir fries and salads. It not only tastes good, but it is really helpful in boosting your immune system. Eat some nuts! Almonds, cashews, sunflower seeds, and Brazil nuts are all

high in zinc which increases the quantity and quality of infection fighting Tcells. These nuts also have antioxidant and antiviral properties. However, because of their high fat content, just a few nuts per day is all you should eat in order to provide the daily requirement for zinc. Yogurt and kefir have probiotics, which are beneficial bacterial strains that can substantially improve your immune system. Make sure to choose yogurts that claim to have “live and active cultures.” The more cultures added to the yogurt, the better it is for you. Read the label to make sure that the yogurt you buy does, in fact, contain these healthy cultures. Frozen yogurt contains little of the good bacteria, and most of the cultures are rendered inactive during the freezing process. Cultures are very delicate and cannot withstand freezing, heating or an extended shelf life. Pay attention to the expiration date on the label, and eat the yogurt soon after you buy it to ensure that you get the most benefit from the cultures while they are still live and active. Citrus fruits are a diet must, especially during cold and flu season. Fruits like pink grapefruits, oranges, and mangos are all rich in antioxidants like vitamin C. Several studies have shown that consumption of food rich in vitamin C can help prevent illness and decrease the duration of a cold or flu if it does strike. Brightly colored fruits and vegetables such as blueberries, purple grapes, spinach and beets are the richest in antioxidants and protective benefits. It is a healthy practice to add these colorful ingredients to your everyday recipes. For example, throw some blueberries into your muffins or pancakes in the morning, or add spinach to your omelet or stir fry. Eating a rainbow of these foods daily may substantially improve

immunity and overall health. Try to keep your consumption of alcohol to no more than one drink per day. Too much alcohol intake impairs the function of the cilia in the lungs, thus lessening the body’s natural defenses. It makes you more vulnerable to the more serious complications of the ﬂu, such as pneumonia. Avoid excess sugar intake, which can suppress the immune system by suppressing the ability of white blood cells/phagocytes to function at optimum levels. Stay away from refined white ﬂour products (like white bread, white rice, and pasta) and add more whole grains (such as whole wheat bread and pasta, brown rice, and barley) to your diet. A daily multivitamin can help supplement your diet with any nutrients

that are lacking. There are many kosher vitamins on the market that can help ensure that you are getting adequate nutrition. Lastly, get enough rest, exercise and eat a variety of healthy foods daily, making sure not to skip any meals. Sheryl Mayer MS RD CDN is a registered dietitian with an M.S. in Health and Nutrition. She is the owner and president of Nutritionista Inc., a nutrition consulting service, which specializes in digestive disorders such as chronic reﬂux and IBS, as well as dietary interventions for those with high cholesterol, food allergies, hypertension and obesity. She is an Oxford provider. Sheryl can be reached at 917-344-0022 or www.NutritionistaInc.com.

“Immunity Smoothie” Recipe

Four immune supporting foods – orange juice, green tea, yogurt and blueberries – make this a nutrient-packed breakfast or snack. For an extra boost, blend in a handful of spinach leaves.

You’ll never know it’s in there! For kids, the smoothie can be frozen in ice pop molds and served that way. ¾ cup frozen blueberries ½ cup ice ½ cup plain low-fat yogurt with live and active cultures 2 T orange juice 2 T freshly brewed green tea 1 T honey Blend all ingredients until smooth. If thinner consistency is preferred, add an additional ½ cup of juice or tea. Use additional honey or sweetener to taste. Serve immediately. Garnish with slices of lemon or kiwi. SERVES 1 Per serving: 230 calories, 2g fat, 1g saturated fat, 7g protein, 3.5g ﬁber, 38g carbohydrates

A Guide to Winter Health Challenges During the winter months, we face these additional challenges in maintaining our health:

family members, ﬁlling what are supposed to be happy occasions with anxiety and stress.

DEPRESSION While the December holiday season is often a time for celebration, it can be an especially diﬃcult period for those who don’t have close friends or family with whom to mark happy occasions. They tend to feel particularly lonely and abandoned at this time of year. Even participating in these celebrations can be a stressful experience for those who have a dysfunctional relationship with their

HEART ATTACK A study recently published in the British Medical Journal found that cold weather increases the risk for heart attack. Researchers found that for every 1-degree Celsius (1.8-degrees Fahrenheit) drop in the average daily temperature, the risk of heart attack increases by 2%. Another winter heart attack risk for those people who are not used to strenuous exercise is shoveling snow.

HIGH BLOOD PRESSURE According to a study published last winter in the journal Frontiers in Bioscience, a drastic drop in temperature can aggravate high blood pressure, triggering complications such as heart failure and stroke. Cold will also cause blood vessels to constrict, which could cause weakened areas of those blood vessels, called aneurysms, to rupture. This causes a stroke if it happens in the brain. SEASONAL AFFECTIVE DISORDER According to the American Psycho-

logical Association (APA), people with this type of depression suﬀer dampened moods during the winter months, due to the shortened length of the daytime periods. They tend to sleep more or feel more lazy than normal in the winter months. The condition is treated using light therapy – exposure to extremely bright light a few times a day to alleviate the symptoms. THE FLU In the northern hemisphere, people always seem to get inﬂuenza during Continued on p.21

HEALTH LIVING

December 2010 | 21

L’Chayim to Life continued

Do You Wake Up Tired?

Your Dentist Can Help You Sleep Better! By Zev W. Maybruch, DDS

In today’s high-pressured society, we dream of balancing the stresses of our personal lives and our workplaces. We search for ways to manage the plethora of demands of the day-to-day. One of the best ways to start on this quest is by exploring something basic that we often take for granted – getting a good night’s sleep. It is common to have trouble getting sufficient, restful sleep, no matter how much time one actually spends in bed. For many people, the solution to this common problem can be found by visiting their dentist. That’s right – their dentist! After talking to many of my patients about the quality of their sleep, I came to an astounding conclusion. A very large percentage of people over age 40 are plagued by poor sleep. Furthermore, they are largely unaware of this, and they are confused about why they don’t feel rested when they wake up in the morning. Due to these discoveries, I now ask my patients four questions: 1. Do you snore when you sleep? 2. Do you wake up tired? 3. Have you fallen asleep unexpectedly during the day? 4. Are you willing to take a small step to get high quality sleep at night? The first three questions assist me in recognizing the most common symptoms of a serious disorder known as sleep apnea. The Greek word “apnea” means “without breath.” People with sleep apnea stop breathing repeatedly during their sleep. This can happen hundreds of times during the night, often for a minute or longer. Yet, many who suffer from sleep apnea are not aware of these breathing interruptions.

Winter Health Challenges

The interruption of proper breathing during sleep significantly affects sleep quality and places a life-threatening stress on the heart. In addition, lack of proper sleep often impacts many other areas of a person’s life, including clear-headedness at work and relationships with spouse and family. This serious medical condition can be treated very simply by a specially trained dentist. Overweight males over 40 are most likely to have this disorder. However, women and children and individuals of all ages and weights can experience severe cases of sleep apnea, as well. Furthermore, there are several other factors which contribute to a person developing sleep apnea. These include: • Having a family history of sleep apnea. • Gastro-esophageal reflux, or GERD. • Nasal obstruction due to a deviated septum, allergies, or sinus problems. There are two types of sleep apnea: • Obstructive sleep apnea (OSA): The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses durinfection against the disease.

Continued from p.20

the winter months, from November to March. Researchers at the Mount Sinai School of Medicine in New York City found that low humidity and cold temperatures are conducive to the survival and transmission of the influenza virus. This year, public health experts have produced extra doses of influenza vaccine and made them available at local pharmacies in addition to doctor’s offices and health clinics. Don’t wait for a flu outbreak in your area to get inoculated, since it takes some time for the vaccine to provide

HIGH CHOLESTEROL A 2004 study found that cholesterol levels are highest in the winter and lowest in the summer. The reason for this change in levels is not clear. PSORIASIS Winter is an especially difficult time for the 7.5 million people in the United States who suffer from psoriasis, a disease that causes red lesions and scaly skin. The dry air, decreased sunlight and colder temperatures of the winter months can prompt flare-ups of the disease.

ing sleep. • Central sleep apnea: In this form, the airway remains clear. The problem is a failure to signal the muscles to breathe, due to instability in the brain’s respiratory control center. A member of the American Academy of Dental Sleep Medicine with specific training in dealing with sleep apnea is best qualified to deal with its symptoms. In many cases, the diagnostic tests, treatment and related costs will qualify for reimbursement from a patient’s dental or medical insurance plan. If the dentist suspects that a patient has this problem, he will prescribe tests to confirm the diagnosis. Once sleep apnea is confirmed, the dentist will often create a small appliance for the patient to use while sleeping. The purpose of this unobtrusive device is to keep the air passages open during sleep so that natural breathing occurs. This form of treatment is called Oral Appliance Therapy (OAT) and is usually most effective in patients with mild to moderate ob-

structive sleep apnea. In extreme cases, the dentist will refer the patient to a pulmonologist to prescribe a CPAP machine. This apparatus provides a pressurized air flow through a face mask while the patient sleeps overnight, forcing air into the lungs. Sleeping with the mask takes some getting used to, but it is accompanied by a significant lifestyle improvement. The common problem of sleep apnea has major ramifications, yet usually can be solved relatively easily. It is important that we take care of ourselves so that we are happy and supportive to others, both at work and at home. As Shakespeare said “We are such stuff as dreams are made on; and our little life is rounded with a sleep.” Dr. Zev W. Maybruch graduated from the prestigious Temple University School of Dentistry in 1972. He has been practicing general dentistry in Kew Gardens Hills, NY for over 30 years. He is a member of the American Academy of Dental Sleep Medicine and an expert in sleep apnea. Dr. Maybruch is available for sleep apnea consultations as well as presentations to groups on this topic. He can be reached at 718-2638300 or via www.drmaybruch.com.

22 | December 2010

HEALTH LIVING

Mind, Body & Soul

The Unfocussed Child By Ronen Hizami, MD

The phone call every parent dreads. “Mr. and Mrs. Cohen, we need you to come in to the school for a meeting about your Yanky.” With trepidation, the parents arrive at the school. They are aware that Yanky has always been a happy and bouncy boy, but he never caused too much trouble at home or in the neighborhood. What could be happening with a second grader to warrant a meeting at the school? At the meeting, both the rebbe and English teacher report that Yanky is disruptive to the class. He is always moving, talks in the middle of class and makes the other boys laugh. His learning isn’t as good as it should be. Somehow he manages to get B’s on his exams, but he doesn’t seem to be applying himself. He just spaces out in class, when he isn’t causing trouble. When the menahel (supervisor) tried speaking with him, he replied in an inappropriate tone, and he told the principal

to mind his own business. The school recommended that the Cohens have Yanky evaluated by a qualified mental health professional Mr. and Mrs. Cohen are very upset. They don’t understand why the school is making such a big deal about these problems. He is just a kid. Aren’t kids still allowed to be kids? The school is just too strict. If they would just be more flexible, everything would be fine. The Cohens have been given an opportunity to potentially save themselves and their child a lot of trouble in the future. They leave the school with a dilemma. Should they take their child for an evaluation? But their child isn’t crazy! If word gets out, what will it do for prospects for a good shidduch, not just for Yanky, but for his siblings as well? CHOICE A: The Cohens decide to speak with their pediatrician, who refers them to a local child psychiatrist for evaluation. The psychiatrist meets with the parents and thoroughly reviews Yanky’s developmental, medical, academic and behavioral histories. The parents and teachers fill out

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standardized rating scales, and after receiving permission from the parents, the psychiatrist speaks with the school faculty and administration about their concerns. The rating scales are indicators for symptoms of inattention, hyperactivity and impulsivity. The ratings are consistent between teachers and parents. The child is then brought in for the evaluation. In the evaluation session with the psychiatrist, Yanky presents as a cheerful boy who is unable to stay seated. He can not keep from exploring the room and touching everything, even when asked to stop. Yanky is careless in his reading and other tasks he is given within the session. After carefully reviewing the data, the psychiatrist informs the parents that their child is suffering from Attention-Deficit/ Hyperactivity Disorder (ADHD). He educates the parents about the research findings regarding the natural course of the condition and the various treatments available. After considering their treatment choices, the parents agree to follow the recommendations and Yanky is started on the medication Concerta. They see the psychiatrist again after two weeks and the dosage is adjusted. The school and parents agree that Yanky is doing much better. Yanky is then referred to a time-limited social skills group. After three months, Yanky is functioning at a level consistent with the rest of his class, both academically and socially. Over the next several years, Yanky continues to develop typically. In eleventh grade the psychiatrist, school and parents agree that he no longer needs the medication and it is discontinued. Yanky goes on to have a successful life and lives up to his full potential. CHOICE B: The Cohens decide to ignore the school recommendations and Yanky is never evaluated. He is not accepted back to the school for third grade. His elementary school career is marked by three school changes, and by the time he enters seventh grade, Yanky is convinced that he is a bad kid. He is always getting in trouble, both in and out of school. He is suspended repeatedly for being disruptive in class. Numerous well-meaning individuals have tried to help him, but he defies everyone and refuses to follow anyone’s rules. He is not interested in learning and doesn’t want to keep Shabbos anymore. In eighth grade he starts hanging out with kids who abuse drugs, and he starts drinking alcohol and experimenting with marijuana. He drops out of school completely at 14 and continues to abuse substances. He spends the next two years in and out of drug rehabilitation programs. Finally, at 16 years of age he is diagnosed

as having ADHD and is treated with Concerta. At this point he starts to improve, but requires long-term therapy to deal with his substance addictions, low selfesteem and ADHD. He eventually becomes a productive member of society. While Attention-Deficit/Hyperactivity Disorder afflicts 10% of schoolaged children, it affects 100% of their parents and siblings. Children with ADHD are not bad kids. The coordination center of the brain is not working fast enough. Imagine a symphony orchestra with maestros at every instrument, but the conductor has taken cold medicine and just can’t keep up. The music would sound horrible. This is analogous to the physiological abnormality in the brains of individuals with ADHD. This results in problems maintaining attention and/or hyperactivity/impulsivity. Most of these children have other problems as well. They tend to suffer from anxiety disorders, mood disorders, disruptive disorders and learning disabilities. These problems, left untreated, generally lead to greater difficulties over time. Children who do not receive treatment are more likely to become “at-risk” teens, develop addiction problems and become demoralized. Adults with untreated ADHD have higher rates of substance abuse, car accidents, relationship difficulties and financial problems. Yes, parents, the most effective single intervention for ADHD is medication! Certain psychotherapy modalities, classroom strategies and parenting interventions are also used. The treatments available tend to be welltolerated and effective, but they require the expertise of a medical professional specifically trained in the diagnosis and management of ADHD. Rejecting the advice to have a child showing symptoms of ADHD professionally evaluated often results in years of lost opportunities and unnecessary pain. Admittedly, the two choices listed above are at opposite extremes. Most cases fall somewhere in the middle. Not every untreated case will end in addiction. Not every treated case ends up improving as quickly. Nonetheless, which parent wouldn’t choose to provide evidence-based treatment for their child’s condition? Which parent wouldn’t choose to help prevent immense suffering to the entire family? Dr. Ronen Hizami is a child, adolescent and adult psychiatrist practicing in Brooklyn and New City, NY and can be reached at 718-645-5138.

HEALTH LIVING

December 2010 | 23

Mind, Body & Soul continued

Denial and Mental Illness By Rabbi Chaim Steinmetz

Nineteen-year-old Nechoma has been in Israel for a year in seminary. Nechoma is on her way home for a sister’s wedding and to visit her family for Chanukah. On the whole, her time in seminary has been great. Nechoma has tried to make the best of all the new opportunities that the institution has to offer, while balancing academics and social life. The only problem is that Nechoma is often anxious, and this hinders her ability to relax. She is constantly worrying about things that others do not worry about. This has led her to spend more and more time alone in her room. At times, the anxiety becomes so great that she cannot enjoy the seminary experience. When Nechoma arrives home, her excited parents want her to share her new experiences, activities and friends. Nechoma obliges them with a few stories, but knows deep down that she is describing things more positively than she actually experienced. She finally attempts to broach the subject of her anxiety and how it affects her daily life. Her parents listen, but minimize the problem as part of the normal adjustments to the seminary year. This gives Nechoma some comfort, but soon she begins feeling overwhelmed and anxious again. Little do any of them know that Nechoma’s reclusiveness and symptoms are early warning signs of a much larger problem. Her parents’ reaction has invalidated her feelings, which has made her feel like she is imagining things. What Nechoma has tried to express is actually one of the warning signs of mental illness, but it is not uncommon for parents to reject the idea. “Not my child” is an all-too-common reaction, but mental illness can happen to any child of any family. Nechoma and her parents celebrate Chanukah and the family wedding together. It soon becomes clear, though, that there is “something the matter” with Nechoma. She is either spending an unusual amount of time alone in her room, or she is in the house, cleaning vigorously and chattering away at an unusual speed. Her parents are concerned by this behavior. They do not understand why she is not out socializing or shopping with her friends.

They try to talk with Nechoma and express their concern, but Nechoma has now convinced herself that she doesn’t have a problem. Her parents want to believe her and try to agree, and the whole family tries to ignore Nechoma’s dysfunctional behavior. They become steeped in denial. One sister comments hopefully that “Nechoma is just overly stressed out from school.” Her aunt states that she is in high gear because she is trying to get a lot of things accomplished during the short time she is here in America. Nobody in the family is willing to admit that Nechoma might have a serious issue that needs more help than they can provide. This is the point where Nechoma’s parents need to see past their denial and consult a professional. An evaluation is needed to help determine what may ease Nechoma’s anxiety and her constant suffering. Yes, help may mean accepting a therapist’s suggestion of medication as part of an appropriate treatment plan. While that may be difficult to accept, such a decision could avoid a graver situation and avoid greater suffering for Nechoma and those who love her. Such an intervention is Nechoma’s best chance for a brighter future. However, many parents would let

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treatment that can relieve their suffering and lead them back to emotional health. The person him/herself doesn’t understand that they have a serious problem until the pain becomes so great that it overpowers the denial. The problem is that once such a low point is reached, it takes even longer to get relief or to recover. As with many medical problems, the longer we wait to start the treatment for a psychological disorder, the longer it will take for the treatment to be effective. Denial is a serious problem, as is lack of education – and the two go hand in hand. That is why there are several organizations in the Jewish community today which promote awareness of mental illness. If you or a loved one is exhibiting unusual behavior that seems as though it might be a mental illness, contact one of the organizations listed here as soon as possible for a suitable referral. Don’t let denial keep you or your loved ones sick and suffering.

such a problem go on for much too long, adding to their child’s emotional suffering. There can be many reasons for such a tragic decision. It can be denial or pure ignorance about mental illness. Sometimes it can be pride, concern for shidduchim, or just wishful thinking that the child is simply going through a passing phase. Whatever the case may be, the earlier mental illness is detected and treated, the less damage it does. Nechoma is showing classic symptoms of Bi-polar Disorder, which can quickly lead to more serious consequences unless treated. The unfortunate reality is that too often, a person suﬀering from mental illness hits rock bottom before he or she gets the proper

Rabbi Chaim Steinmetz is the director of Darkah, which provides transitional housing to Orthodox Jewish young women between the ages of 1830 who suffer from mood and behavioral disorders. He can be reached at 718-431-0539, or via email at csteinmetz@darkah.org.

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24 | December 2010

HEALTH LIVING Mind, Body & Soul continued

Raising Secure Children By Mirel Goldstein, LPC

It is well-known that children who are comfortably and securely attached to their parents do much better at growing up and thriving than children who are not secure. According to Psychiatrist John Bowlby and a large body of research on children, securely attached children easily go back and forth between turning to their parents for emotional support and expressing their independence. In more recent years, Psychologist Peter Fonagy and his colleagues have highlighted some of the things that parents can do to help their children become secure. Here are some tips from this body of research on mentalization and marked contingent mirroring: Try to see your child as a separate person from you. When you imagine how your child feels in a particular situation, try to ask yourself: Is my child showing me that this is how he or she feels, or am I simply assuming that my child feels the way I would feel in this situation? Or, ask yourself, “How do I know that my child is feeling the way I think he is?” Whenever reasonable, respond to what your child is asking for. Children who ask for things and get them learn that they can go after their goals in an assertive way and that the world will respond to them. It is important for children to learn that they can play an

active role in getting the things they need in life; this encourages an active instead of passive way of interacting with the world. (This is especially true for babies who cannot use words; as children develop language, you can say “no” to them some of the time and still convey that their desires are valid through your words.) Find words for strong emotions. Parents who are good at talking about feelings (especially strong ones), instead of acting on their feelings or ignoring them, tend to have children who are more secure. Don’t confuse intentions and effects. When a two-year-old bites someone and it hurts him, this does not mean that the two-year-old intended to cause pain. He may just be frustrated and not know how else to express his frustration. Or, if your toddler is throwing a tantrum in the supermarket and you feel embarrassed, this does not mean that your toddler is intending to embarrass you. He or she may simply be tired, hungry, or bored and not know how to cope with those feelings. Similarly, if your child doesn’t listen when you ask him to do something and you feel frustrated, this does not necessarily mean that your child is trying to frustrate you. He may be busy with something else and preoccupied, upset about something, or simply not understanding what you are asking. It

is important to try to separate what is going on in your child’s mind from how his actions affect you. Separate between actions and feelings or wishes. Understand and validate feelings even when they cannot be acted upon. If you’re the kind of person who only cares about what you should do about things (not how you feel or what you think), then this will be challenging for you. In attachment relationships, understanding what a person wants, feels, or thinks is just as important as focusing on actions or outward behaviors. If your child wants a toy and he cannot have it, it’s still important to understand that he wants it and to communicate this understanding. Reflect the Same and the Opposite Feeling at the Same Time. When you reflect your child’s feelings, it’s important to convey both your understanding of how he or she feels, and a different feeling at the same time. This is called“marked contingent mirroring” and it lets your child know that you are showing him how he seems to be feeling, and not expressing a feeling of your own. It also shows him that his feelings are not contagious and that they can be coped with. For example, if a toddler falls down and is about to cry and looks over at his mother, it is not helpful for the mother to become hysterical or anxious. This will increase the child’s feelings of fear, and he also won’t know whether

Coping With Your Anxious Child By Milcah Harari

“Time for bed, girls!” As Chani heard these words, she panicked: her heart started to race, her stomach churned, and a cold sweat began to form all over her body. It was nighttime, the part of the day she dreaded most, when she would lie awake consumed with worries. Chani desperately wanted to sleep, but she couldn’t. She turned her head to the side, but there they were: those four numbers, glowing bright red and blinking repeatedly. Minute by minute, the alarm clock taunted her: 8:30…8:33…9:00…9:36. She wanted so badly to fall asleep, but every night her mind repeated this same agonizing routine. Every night, she experienced terrifying and inescapable thoughts. Although Chani frantically tried to distract herself from the gnawing anxieties that kept creeping up, nothing seemed to calm her down. The alarm clock’s red numbers kept blinking. The questions did not stop. “What

was that noise? What if there is a robber waiting right outside my bedroom door?” “What if something terrible is about to happen? Will I die if I didn’t eat enough dinner tonight?” More and more thoughts raced through Chani’s mind until she couldn’t take it anymore. She ran as fast as she could to the one place she thought was safe – her parents’ bedroom. Many children like Chani experience a level of anxiety that interferes with their ability to lead a normal life. Anxious children become highly distressed in many situations where distress doesn’t seem warranted. Children with recurring thoughts of anxiety are unable to go about their daily routines. Fearful and nervous, they begin making excuses in order to avoid situations which they deem anxiety-provoking. They may develop stomachaches or headaches and feel too sick to attend school or participate in activities that make them feel nervous. In stressful situations, visibly dis-

tressed children will constantly ask themselves “what if” questions. Generally, such questions do not go away with attempts by a parent to logically respond to the question or to console the child. Putting these anxious children to sleep at night becomes a diﬃcult and frustrating chore; often, children with anxiety do not want to go to sleep alone as they are afraid of the worries and nightmares that will keep them up throughout the night. Parents should strive to have the same expectations of an anxious child as they do from the other children in the family. This is crucial for the child’s overall development; it is important, therefore, that the anxious children not assume the role of the “sick child” in the family, and that parents be careful in demonstrating special treatment. At the same time, however, it is necessary for a parent to validate his/her child’s fears and allow the child to express any feelings and worries. Simply telling your child not to worry will not alleviate the anxiety that the child is feeling at that particular moment.

the feelings of fear belong to him or to his mother. At the same time, it is not helpful to dismiss the child’s feelings, because then he doesn’t learn to stop and pay attention to them. A potentially helpful response is to say to the child, “Oh, no, you fell down!” and then pick the child up with a smile on your face. This shows that you realize that the child is scared, but also that you are not scared yourself and believe that everything will be okay. Similarly, if your child comes home and says dejectedly “I didn’t get picked for the team again! Nobody likes me,” it is not helpful to feel rejected for your child. This will increase his feelings of rejection, or distract him from his own feelings and focus him on yours. A helpful response might be, “Hmm, it sounds like not getting picked for the team today has you pretty upset,” in a calm and relaxed tone of voice, showing understanding and keeping things in perspective for him at the same time. By keeping your own emotions in check, being reﬂective, and putting yourself in your child’s shoes, you help your child to adopt healthy attitudes and actions, build their self-confidence and strengthen your parent-child relationship. Mirel Goldstein, MS, MA, LPC is a licensed therapist with a private practice in Passaic, NJ. She specializes in treating long-standing personal and relationship issues. Mirel can be reached at 303-204-7039 or via her website, www.goldsteintherapy.com.

In helping children cope with anxiety, parents may ﬁnd it useful to encourage children to postpone their worries to a designated time of the day in which they can all schedule a “worry period” and share their feelings. A “worry period” can give your child the opportunity to delay worrying until a later, scheduled time. This way, your child may be in a better position to function in the present. Most importantly, keep in mind that children are very attuned to their surroundings and aware of the conversations taking place around them. It is imperative that parents avoid feeding their children with material for their anxieties. By refraining from anxiety-provoking speech, parents can actively create a safe and positive environment, and thereby improve the quality of life for their children. Milcah Harari recently graduated from Wurzweiler School of Social Work and is currently working for the Boro Park office of the Jewish Board of Family and Children Services and Interborough Developmental and Consultation Center in Canarsie.

HEALTH LIVING

December 2010 | 25

Mind, Body & Soul continued

THE COUPLES’ QUANDARY By Dvorah Levy, LCSW

way for Chani to greet her hardworking husband?” Or perhaps you are thinking, “Sam should have called earlier to give her a heads-up.” Or are you wondering, “What’s the big deal? Why is this couple suddenly not talking?” Let’s look at this interchange from the perspective of emotional connection, recalling that at the bottom of most marital conflicts is the fear that our partner will not be there for us when we need them, or that we are not special to them. When Sam is not home on time, Chani feels hurt. Whether she is aware of her feelings or not, she is wondering, “Am I important to Sam?” When Sam comes home after a long, hard day, instead of being greeted with warmth and comfort from his wife, he hears only criticism from her. This causes him to wonder, “Am I valued by her?” When our loved one is unavailable or unresponsive to us, we are assailed by anger, sadness, hurt and, above all, fear. Our responses are primal. We react by either criticizing or attacking, with the hope that we will force our partner to notice us and recognize our need, or else we withdraw to protect ourselves, as if to say, “I won’t let you hurt me.” If Sam and Chani had understood each other’s needs and reactions on a deeper level, their dialogue would have gone like this: Sam walks in the door. Chani would have said, “I’m glad you are finally home. I was concerned that you were so late, and I was beginning to feel lonely. I made your favorite dinner, and I’m disappointed that it is cold now. I was also hurt that you didn’t remember to call me and tell me that you were going to be late, which made me start wondering if I was really important to you.” Sam would have said, “I was under so much pressure to finish my task at work today that I just want-

ed to get home as quickly as I could to be with you [latent message: you are important to me]. I’m sorry that I didn’t call. That was a mistake, and I will try to remember in the future. Thanks for making my favorite dinner. Don’t worry about it getting cold. I’m sure it will be great [expressed appreciation]. I’m starving!” This is how a couple can use a potentially negative incident to add

Dvorah Levy, LCSW is a psychotherapist in private practice working with individuals and couples. Her offices are in Flatbush and Hewlett. She specializes in marriage counseling and is trained in Emotionally Focused Couples Therapy. She can be reached at (516) 660-7157.

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When a bride and groom stand under the chuppah during the traditional wedding ceremony, we refer to the new couple as “Reim Ahuvim,” loving friends, and bless them that they should be truly happy. Couples join in marriage with ideals, blessings and joy, and then what happens? Too many times, joy turns into pain and conflict. The divorce rate in the Jewish community is now rising toward the level in the larger secular world. Many Jewish couples today are living with great stress, questioning the viability of their relationships and hurting deeply. Why are our relationships so often bringing us pain rather than comfort? We yearn to be in a close relationship, we aspire to the values of marriage and family, and yet so very often we find ourselves still lonely. Although we crave emotional safety, we find ourselves with exactly the opposite. Our partners often do not feel emotionally safe. This is the “couples’ quandary.” What can we do about it? At the root of many couples’ distress is emotional disconnection. Emotional connection is as vital to both men and women as air and water. Studies have shown the positive effects that being in a secure relationship has on one’s emotional and physical well-being. Conversely, tension and stress in a relationship have been clinically shown to lead to increased blood pressure, depression and anxiety. When we have doubts about whether our partner is there for us, we act out in subconscious ways, demanding answers to questions such as: “Can I count on you and depend on you?”“Will you respond when I need you?”“Do I matter to you?” “Am I valued and accepted by you?” Because we are so often unaware of what we need, which is reassurance, we tend to ask these questions in anger or indirectly, ways that could potentially push our partner away from us. If our partner could hear these cries for help that are driving our anger or withdrawal, their responses to us would be very different. But for this to happen, we need to be clearer and more aware. Let’s look at this scenario as an example: Sam comes home late from work. Chani, who had prepared his favorite dinner, was unable to reach him by phone. As soon as Sam walks in the door, Chani barks, “Where were you?” Sam responds, annoyed, “Where do you think I was? I had to finish up at work!”“Well, your dinner is now cold!” Chani snaps. Sam says, “Who needs dinner?” as he stalks into his study and slams the door. Does this interchange seem familiar to you? Are you thinking, “What a lousy

support and strength to their relationship on more than one level. Conversations between couples generally don’t go this well. This type of exchange requires not only a deep mutual awareness of one another’s needs, but also self-awareness regarding our own hurt feelings. We all enter our relationships with unique vulnerabilities and subconscious triggers. With experience, we can learn to recognize that our more hostile or confrontational responses to our partners often stem from our own attachment insecurities. The healing beneﬁts and positive effects of being in a healthy relationship with a secure attachment to our partner are huge, and well worth the eﬀort. By applying these insights and trying to look at these situations from our partner’s perspective, we can change our responses for the better, using our awareness to create closeness, and reclaiming the blessing of “Reim Ahuvim,” loving friends, always.

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26 | December 2010

HEALTH LIVING continued from page 1

Autoimmue Diseases: A Challenge to 21st Century Medicine spread, and how they could be prevented or cured. One by one, they were conquered – anthrax, tuberculosis, cholera, and in the mid-20th century, polio. Germ theory also led to an understanding of how to prevent deadly infections. The 1940’s saw another milestone with the introduction of the first antibiotic, penicillin. Once many of the most serious deadly diseases and infections were eliminated, life expectancies increased dramatically, and the attention of medical science turned to the fight against the diseases of middle age, including cancer, heart disease and stroke. While those battles were still being waged, medical science sought to uncover more fundamental secrets of health and the human body, as well as illnesses which have long defied all efforts to understand and treat them. Today we have actually mapped the human genetic code. We are exploring the inner workings of the brain in search of a solution for the mystery of Alzheimer’s disease. Another growing focus of research is revealing the causes and mechanism of the autoimmune diseases. This is a group comprised of at least 80 different conditions with a myriad of different symptoms, but which all are believed to originate from the same perplexing cause, a systematic attack on the human body by its own first line of defense against invasion by foreign bodies, the immune system. Autoimmune diseases are believed to be due to a baffling case of mistaken identity. For some reason, the various defense systems of the body designed to fight off the intrusion of hostile foreign bodies are launched against the body’s own organs with devastating results. Many of these autoimmune diseases were identified long ago by medi-

cal science, although their shared underlying cause was not suspected until relatively recently. These include Type I (juvenile) diabetes, rheumatoid arthritis and multiple sclerosis. Others were less well known and have only become the subject of intense research relatively recently. These include lupus, celiac disease and Crohn’s disease. More than 23.5 million Americans are believed to suffer from autoimmune diseases, and nearly 75% of them are women. A number of specific autoimmune diseases are known to primarily affect women. These include lupus (SLE), in which female sufferers outnumber males by a ratio of 9-1, Grave’s disease (7-1), multiple sclerosis (MS) (21), myasthenia graves (2-1) and rheumetoid arthritis (5-2). However, the number of men and women affected by Crohn’s disease is roughly the same. There is believed to be a genetic component to autoimmune diseases, making certain individuals more susceptible to them. Doctors practicing in Jerusalem over the past two decades have recognized an unusually high incidence of Crohn’s disease among Ashkenazi yeshiva students. Those who have a close relative, such as a parent, child or sibling who has been diagnosed with Crohn’s, are at higher risk of the disease (5-10%). Swedish researchers have identified a total of 71 genes associated with Crohn’s disease. Most of these genes are involved in the interactions between intestinal bacterial and immune cells in the mucosa of the intestines. There has also been other research into the mutation of a specific gene called NOD2 as a possible cause of Crohn’s. Other risk factors which have been identified as increasing the risk of developing Crohn’s include cigarette smoking and living in an urbanized area. In addition to hereditary and environmental factors, other theories have been proposed in the medical literature as possible causative factors for Crohn’s. One theory is that it is due to the overreaction of the immune system while trying to fight off a microbe that has invaded and inflamed the digestive track, causing a condition known as gastroenteritis. Some suggest that the microbe may be a um [or a strain of bacteria] known as mycobacterium avium subspecies paratuberculosis (MAP), which is commonly found in cows, sheep and goats. People with Crohn’s are seven times more likely to have traces of MAP in their blood compared to the rest of the population, but it is not clear whether this is a cause or

an effect of Crohn’s. Another theory suggests that it is due to an abnormal response by the body to one of the many different species of harmless or useful bacteria that normally live in the human intestine. Crohn’s disease is one of a family of conditions known as inflammatory bowel disease (IBD). The main culprit is an antibody known as tumor necrosis factor (TNF) generated by Crohn’s which kills all bacteria in the digestive tract regardless of whether it is useful or harmful. The TNF protein also causes inflammation of the lining of the digestive system, leading to abdominal pain, severe diarrhea and tissue damage. The most common site of lesions due to Crohn’s is the terminal ileum (lower part of the small intestine). The inflammation can lead to the development of ulcers throughout the intestinal track, which sometimes can break through the skin. In some cases, Crohn’s causes severe inflammation and arthritis in the joints. Other symptoms of Crohn’s may include blood in the stool, kidney stones and gallstones, fever, fatigue, eye inflammations and skin disorders, and, over time, osteoporosis, making the bones weak and brittle. Crohn’s often results in a sharply reduced appetite and a diminished ability to digest and absorb food, sometimes leading to severe weight loss and malnutrition. Because the symptoms of Crohn’s closely mimic other, more common conditions, such as irritable bowel syndrome, (IBS) diverticulitis and colon cancer, those causes must be ruled out before a firm diagnosis of Crohn’s can be made. That usually entails one or more of these procedures: blood tests, taking stool samples, imaging the bowel using colonoscopy, flexible sigmoidoscopy, X-ray, CT or MRI scans, or via a tiny camera in a capsule that is small enough to swallow (capsule endoscopy), as well as other tests. One of the major complications resulting from Crohn’s is an obstruction or complete blockage of the bowel, requiring surgery to remove the obstructed parts of intestines. Anyone suffering from long term inflammatory bowel disease is at a somewhat increased risk (less than 10%) of developing colon cancer. While there is no known medical cure for Crohns, drug therapies or a resection of the affected area of the bowel can sometimes lead to long term remissions. However, the symptoms of Crohn’s can return without warning.

The symptoms of Crohn’s disease usually first develop between the ages of 20 and 30. Sufferers often experience frequent relapses and temporary hospitalizations. There are many types of treatment, including medications, extreme diets cutting out whole classes of foods – like gluten – and the use of various herbs recommended by tradition Chinese medicine. The medications prescribed for Crohn’s fall into several categories. One is anti-inflammatory drugs, such as Asacol (mesalamine) as well as Azulfidine (sulfasalazine). If these don’t work, corticosteroids can be prescribed for short term use only, because of their numerous and often serious side effects. Immune-system suppressors are also used, such as Remicade (infliximab), which neutralizes the TNF protein, and has the fewest side effects in this class of drugs. Another drug used for Crohn’s and other forms of inflammatory bowel disease is Imuran (azathioprine). It can reduce the symptoms and promote healing, but it takes two to four months to begin showing results. Humira (adalimumab) is another drug that blocks the TNF protein, but it and four other immune system suppressors are only prescribed for those who do not respond to the other drugs in this class mentioned earlier. A number of other drugs being developed in this same class are currently undergoing clinical trials. Antibiotics such as Cipro are sometimes prescribed for Crohn’s patients to help in the healing of intestinal ulcers, abscesses and fistulas caused by the disease, as well as to reduce the levels of harmful bacteria within the intestine. Other commonly recommended non-prescription medications can be used to ease some of the more painful symptoms of Crohn’s disease. These include antidiarrheals such as Metamucil or Citrucel, iron supplements, laxatives, mild pain relievers such as Tylenol (but not NSAIDs like aspirin, ibuprofen or naproxen), vitamin B12 shots, and calcium and vitamin D. Some of these measures can provide temporary relief, but eventually the symptoms return. When all else fails to relieve the symptoms, doctors will recommend surgery to remove the damaged portion of the intestine and to repair other damaged tissues. The healthy sections of intestine are then reconnected, and the drug treatment is continued, but the relief from the procedure is usually temporary. Nearly three-quarters of patients who undergo surgery will eventually experience

HEALTH LIVING

December 2010 | 27

continued recurrence, usually near the spot where the healthy sections of intestine have been reconnected. About half of them undergo a second surgical procedure. When Crohn’s flares up, patients are urged to modify their diets to avoid those foods and eating patterns that can aggravate the symptoms. Recommendations include limiting the consumption of dairy products, foods that are high in fiber, and fatty foods. Crohn’s patients are told to eat five or six smaller meals a day rather than two or three larger ones, and to drink plenty of water, while avoiding any beverages containing alcohol or caffeine. They are also urged to consult with a dietitian to help plan meals since the variety of foods they can eat is so limited. Crohn’s patients are also urged to avoid or at least manage stress, because anxiety will have an impact on their digestive patterns, as it does for most otherwise-healthy people. Living with Crohn’s over the long term is so difficult and disruptive that it is comparable to going through a wartime experience or a natural disaster. A recent study of nearly 600 Swiss adults with Crohn’s found that 19% of them showed symptoms of post-traumatic stress disorder (PTSD). While Crohn’s can’t be cured, PTSD can, so doctors treating Crohn’s patients are being told to watch for signs of PTSD and refer them for the appropriate therapy. The pain and suffering of patients with Crohn’s and other types of inflammatory bowel disease can be so bad as to drive them to desperate measures. One 36-year-old California man with inflammatory bowel disease traveled to Thailand last year to visit a doctor who had him deliberately swallow the eggs of a human roundworm so that the worms could grow in his large intestine. The man said that he was following a procedure recommended by several researchers who published a paper recommending “worm therapy” for the relief of several conditions ranging from Crohn’s to asthma. According to a news report, the therapy seemed to have worked. Within a year of swallowing the roundworm eggs, the California man’s symptoms had all but disappeared. Scientists say that his body had produced a thick mucous inside his intestines in an effort to expel the worms, and that the mucous had soothed the ulcers caused by the inflammatory bowel disease in the lining of his colon. But despite that report, at this point, nobody else is recommending that Crohn’s patients try to manage their symptoms by swallowing worm eggs. For the time being, the available drug and diet therapies, and eventually surgery, are the best they can offer to their patients to get temporary relief from their symptoms and avoid

flare-ups. However, Crohn’s is now the target of intensive drug development efforts, and the recent development of an effective drug treatment for another autoimmune disease, lupus, offers hope that similar progress may soon be achieved for Crohn’s. After studying the results of extensive clinical trials, an FDA panel has declared that Benlyst, a drug developed by Human Genome Sciences and GlaxoSmithKline, substantially relieves pain and flare-ups caused by lupus. It is administered with a once-a-month infusion, and is the first effective new medication to be developed for lupus in five decades. Lupus is a potentially fatal ailment affecting around 1.5 million Americans, mostly women. It results in skin rashes, joint pain and inflammation of the kidneys and the fibrous tissue surrounding the heart. Until now, lupus has been treated with much the same arsenal of drugs used to treat Crohn’s. The decision of the FDA panel to endorse the drug was 13-2, and is subject to review by the entire FDA. Several of the panelists expressed concern about whether the benefits of the drug outweighs its potential risks of death, infection, and psychiatric effects, including suicide, and the fact that it seems to be less effective when used on African-American patients, who are three times more likely to suffer from lupus than Caucasians. A final decision by the FDA on whether to formally approve the use of Benlysta on lupus patients is expected in March. Despite the new drug’s apparent shortcomings, a majority of the FDA panelists appeared to have been swayed by the statements of 30 lupus patients, several of whom have been taking Benlysta, who urged its approval during a public comment session. They said the side effects of the other drugs they have taken for lupus, including steroids, are as bad as the symptoms of the disease itself. “Living with lupus is a daily fight simply to see another day, and often survival means letting go of things you love and wanted to do,” said Wendy Rogers, a spokeswoman for the Lupus Foundation of America. The same can be said of living with Crohn’s disease. It is a constant struggle, which affects a disproportionately large percentage of our finest yeshiva students. The intensive efforts by medical researchers to develop more effective medications and to uncover the nature of the genetic and environmental factors responsible for Crohn’s and the other autoimmune diseases which afflict more than 23 million Americans today is a source of hope for more effective and permanent relief of their suffering.

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Health Provider Bulletin Maimonides Unveils New Maternity Unit

Maimonides Medical Center in Brooklyn, NY, recently announced the opening of a newly renovated maternity unit. With 12 rooms, 24 beds and two centrally located nurseries, this modernized suite complements the existing maternity unit and brings all postpartum patients onto the same ﬂoor, along with nurseries. “There is no better testament to the success of our newly-opened postpartum unit than the reaction of the mothers who have enjoyed it since the suite opened on November 15th,” said Carol Kidney, RN, the Executive Director of Maternity Ser- Obstetrics nurses caring for newborns in one of the two new nurseries. vices. “The patients are delighted!” Ms. Kidney explained that new Now celebrating its Centennial, Maimonides Medmothers are impressed by the large, bright, spacious rooms, the cheerful nurseries and the cozy ical Center delivers more babies than any other hosfamily lounge. The unit provides a calm environ- pital in New York. Maimonides is a Regional Perinament for patients and families to bond with their tal Center with extraordinary obstetric and pediatric services. newest additions.

Mount Sinai Researchers Study Genetic Mutation Associated with Autism

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Researchers from Mount Sinai School of Medicine have found that when one copy of the SHANK3 gene in mice is missing, nerve cells do not effectively communicate and do not show cellular properties associated with normal learning. This discovery may explain how mutations affecting SHANK3 may lead to Autism Spectrum Disorders (ASDs). “We know that SHANK3 mutation plays a central, causative role in some forms of autism spectrum disorders, but wanted to learn more about how it does this,” said Joseph Buxbaum, PhD, Director of the Seaver Autism Center and Pro- Dr. Joseph Buxbaum fessor of Psychiatry, Neuroscience and Genetics and Genomic Sciences at Mount Sinai. “These data provide critical insight into the mechanism behind the development of the cognitive and social changes associated with autism.” Previous research has shown that gene mutation in SHANK3 is associated with delayed language abilities, learning disability, and ASDs. A team of researchers at the Seaver Autism Center and the Intramural Research Program of the National Institute of Mental Health studied the connection between the mutation and subsequent brain and behavior-

al diﬃculties. They examined mice genetically engineered to lack one copy of SHANK3, similar to patients who have the mutation, and compared their nerve cell activity with a control group that did not have the mutation. They also examined social behaviors in these mice. The team observed impaired communication between nerve cells in the mice with the mutation. Behavioral observations indicated reduced male-female social interactions in the mutant mice. The studies identify clear brain targets that can implicate drugs that can be therapeutic. “These results have helped us determine a pathological mechanism behind neurodevelopmental disorders like autism,” said Dr. Buxbaum. “Currently, the only therapeutic options for people with ASDs are to treat the symptoms of the disease, like anxiety or aggression. Armed with this breakthrough, we can begin testing drug compounds that treat the disease at its root cause, improving nerve cell communication. We hope and expect that, like other developmental disorders such as Fragile X Syndrome, the use of mouse models will lead directly to clinical trials that can beneﬁt patients.”

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Health Provider Bulletin Congressman Anthony Weiner Addresses Health Care Reform Bill at NY Methodist Hospital Lecture Congressman Anthony Weiner (D-NY) tackled the issues involved in health care reform at the seventh annual Joseph Silver, MD Memorial Lecture at New York Methodist Hospital (NYM), in Park Slope, Brooklyn on December 7, 2010. The lecture series was established in honor of Dr. Joseph Silver, former Chief of Orthopedic Surgery at NYM, who died in 2004. Dr. Silver was aﬃliated with New York Methodist for 40 years and had served as Chief of Orthopedic Surgery for 20 years. “The public has major misconceptions about what we did,” said Congressman Weiner, as he tried to dispel some of the misconceptions surrounding the Health Care Reform Bill. “People believe that we’ve completely transformed health care. In some ways, I wish that were true. For most Americans, there will be very little change in the way they receive health care.” Congressman Weiner continued. “But what is important is that about 40 million Americans, who were previously not insured, will now have coverage.” The Congressman also admitted that he would have preferred to have had the bill go even further. “I believe the idea of employer based health care is anachronistic and should be done away with. The only people who beneﬁt from the status quo are the health insurance companies.” He went on to suggest that a gradual expansion of the highly successful Medicare program might have been more cost effective and reduced bureaucracy.

(L-R) NYS Assembly Speaker Sheldon Silver, Rep. Anthony Weiner, and Mark J. Mundy, President and CEO of New York Methodist Hospital.

Still, the Congressman was clearly an advocate for the bill that was passed, and he noted that many of the public’s reservations about the bill were based on “an intentional eﬀort to make what was done seem complicated and sinister” by disseminating misinformation and fostering misunderstanding. The lecture was attended by over 100 NYM physicians and other health care professionals. Members of the Silver family, including Dr. Silver’s brother, Sheldon Silver, Speaker of the New York State Assembly, were also in attendance.

NY Eye and Ear Infirmary Awarded Federal Grant to Study Language in Children with Cochlear Implants examine vocabulary knowlThe New York Eye and Ear edge and processing in unInfirmary has been awardderstanding and speaking ed a five-year $2.5 million using state-of-the-art methgrant by the NIH- Nationods. al Institute on Deafness and Findings of the study other Communication Disshould help improve aporders to fund a study, Lanproaches by speech theraguage Processing in Children pists as they evaluate and with Cochlear Implants. The work with very young chilstudy will be led by Richard dren with cochlear implants, G. Schwartz, Ph.D., Director Elizabeth Ying, Supervisor of Hearing Habilitaof the Language and Hear- tion, works with children with cochlear implants. optimizing the way they learn speech and language. ing Research Laboratory at the Ear Institute at the NY Eye and Ear Infirmary and The study will use control groups consisting of norPresidential Professor of Speech-Language-Hearing mal hearing children (ages 5-11 years) and children Sciences at The Graduate Center of the City Univer- with cochlear implants (ages 7-11 years). Families interested in being part of this study should contact Dr. sity of New York. The research will investigate how children with Richard Schwartz at (646) 438-7838. The New York Eye and Ear Infirmary Ear Institute cochlear implants acquire language compared with their normal-hearing peers. Although cochlear im- is a comprehensive center focusing solely on diseasplantation as early as possible in children who are es of the ear and related structures. The Cochlear Imdeaf is successful in providing sufficient hearing to plant Center is one of the largest in the United States acquire oral language, little is known about the de- and implants children as young as six months and tailed language outcomes. This research project will adults into their 90s.

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HEALTH LIVING

At a Glance

Health & Living Checklists Winter Preparedness Checklist

continued from page 3 7. Cayenne – Oral use of cayenne can reduce the pain of indigestion. Studies have shown that it offered significant improvements in pain, bloating, and nausea. Dosage: 0.5 to 1.0 grams 3 times daily prior to meals. 8. Slippery Elm – The inner bark of the slippery elm tree neutralizes stomach acids and soothes the inflammation of ulcers in the stomach and intestines. Dosage: 4 to 10 grams daily, divided into 3 to 4 doses. 9. Chamomile – Chamomile is traditionally believed to reduce inflammation and quiet spasms in the gut. Dosage: 2-4 grams of dried chamomile daily or 1 cup of chamomile tea after meals. OVERTHECOUNTER REMEDIES: 1. Nexium (generic: Esomeprazole) – This medicine prevents formation of gastric acid in the stomach. 2. Zantac or Tritec (generic: Ranitidine) – It decreases the amount of acid made in the stomach, reducing resulting heartburn. 3. Carafate or Xactdose (generic: Sucralfate) – This medicine coats the stomach and promotes the healing of inflammation caused by acid or bile. 4. Imodium, Pepto-Bismol or Kaopectate (generic: Loperamide) – These medications are used to control diarrhea, a common symptom of indigestion, by increasing the amount of time food stays in the intestines. 5. Gas-X, Maalox or Rolaids (generic: Simethicone) – Used to treat the symptoms of gas including uncomfortable or painful pressure, fullness, and bloating. 6. Benefiber, Citrucel or Metamucil – Fiber supplements help food move through the digestive track at the correct speed. You can get fiber in pill or powder form. 7. Probiotics – Unlike harmful bacteria that can make you sick, probiotics help keep your digestive system running smoothly. They treat cramping, gas, and diarrhea. Probiotics are found naturally in foods like yogurt and miso, and are also available in dietary supplements in pill or powder form. Probiotics don’t produce the same effects in everyone, so it may take trial and error to find those that work best for you. 8. Coca Cola Syrup – Coke concentrate, or Coke syrup, is sold at some pharmacies in small quantities, as an over-the-counter remedy for nausea or mildly upset stomach. Natural remedies have been used for centuries to treat various illnesses, including indigestion. Herbs generally have fewer side effects and safety concerns about long-term use than drugs, but most have not undergone the rigorous scientific testing that pharmaceuticals must pass before being released to the general public. The side-effects and potentially dangerous drug interactions of prescription medications are well-documented. So each type of remedy has its own set of benefits and concerns. Whatever you decide, here’s to a speedy recovery!

• Have enough ice salt to last through two storms. If one storm closely follows another, stores will likely not have a chance to restock before the second storm hits, so you need to have enough salt on hand for both. • Invest in cheap weather stripping adhesive foam to put around doors and windows to eliminate drafts. • If you have sufficient warning before a storm, make sure that loose items on porches or decks are cleared so they won’t be blown away. • Keep gutters and rainspouts unclogged to prevent ice build-up. •Check your supply of boots, galoshes, gloves, hats and scarves before the first major storm hits so that if you need to purchase new ones, they’ll still be available in stores. • Keep a flashlight with extra batteries on hand in case a storm knocks out power. A battery-operated or hand-cranked radio will keep you informed of weather conditions even if the power does go out. • Keep several days’ worth of non-perishable foods and bottled water. In case a storm hits unexpectedly, or if the severity is worse than expected and you can’t make it to the supermarket, you should have enough food in your pantry to last at least three days. •Make sure that all entryways into your home have mats or throw rugs so that carpeting and flooring is not damaged by snow and water that is tracked in from outside. • Make sure your snow shovel is handy and in good repair. In the process of removing snow that

has turned to ice last year, its edges may have become dented, which makes the shovel less eﬃcient in picking up snow. • Once it snows, if possible clear snow as soon as it stops accumulating. The longer you wait, the more diﬃcult it will be to clear sidewalks and driveways. •If the snow is not very heavy, remove surface snow before it stops snowing so that there will be less to remove once the snow stops. You are less likely to exert yourself since there is less to shovel each time and the shovelfuls of snow won’t be so heavy. •After a storm, make sure you allow yourself additional travel time so that your haste does not create accidents. Give yourself enough extra time so that you won’t be tempted to speed on an icy road. When walking, make sure you leave yourself extra time to walk around patches of ice to get to where you have to go and back more safely.

Checklist for Preparing for a Doctor’s Appointment • Prepare a list in advance of everything you want to discuss with your doctor. Include all concerns and questions you want to ask. List symptoms and side effects to medications. • Be prepared with a list of all medications you are currently taking. Include prescriptions, over-thecounter drugs, vitamins and herbal supplements. Include dosage amounts. Some doctors recommend putting one dosage of each medicine in a bag and bringing that along. • Bring along copies of recent test results and medical records that are relevant to the appointment. Plan to tell your doctor about any changes you have noticed in your sleep patterns, energy level, and appetite. • If you are hard of hearing or have bad eyesight, make the medical staff aware of your situation. Explain, “I have difficulty hearing very well, so please explain everything slowly and clearly.”

• If you are not feeling very well or feel anxious about the visit, consider bringing along a family member or friend. Review with them the list of questions you want answered, too. • Make sure you bring along your insurance card and any necessary paperwork, such as referrals. • Know where the doctor’s office is located and leave sufficient travel time. If you are driving, make sure you know where to park and how much extra time it will take to walk to the office from the parking spot. If you are unfamiliar with the area, ask the doctor’s office staff for travel directions, or if they can recommend a local car service to pick you up from home and/or drive you back. • If you anticipate a long wait to be seen once you arrive at the doctor’s office, make sure to bring along with you a fully charged cell phone, some interesting reading material and a healthful snack in case you get hungry. • Before you leave, make sure to ask the doctor when to schedule a follow-up appointment. Schedule it while still at the doctor’s office so that you don’t forget once you return to your daily routine. • If your doctor has prescribed an expensive medication for you, don’t be ashamed to ask if he can prescribe a substitute or generic version which will cost you less. If you don’t have prescription drug insurance, or if your co-pay for a particular prescription drug is high, explain that to your doctor, and ask him if he has any free samples that he can give you to take home.

From the Doctor’s Desk:

HEALTH LIVING

December 2010 | 31

By Dr. Enrico Ascher

Vascular specialists diagnose and treat all conditions of the blood vessels outside of the heart and brain. They offer patients new and more effective techniques for salvaging limbs, wound treatment, stroke prevention and the repair of aneurysms. Aneurysms are balloonlike bulges in arteries which indicate a weakening in the wall of the blood vessel. They can rupture at any time, resulting in a life-threatening hemorrhage. Vascular specialists are a unique breed in the practice of medicine. Instead of practicing a single type of treatment, such as surgery, medicine, or intervention using a balloon or stent, a vascular specialist uses all of these tools, and can give each patient the optimum combination of all three for their specific vascular condition. I have spent 25 years working to minimize the magnitude of the vascular procedures we use, and at the same time make them more effective. We have been able to eliminate the need for some surgical procedures entirely, and to make others much less invasive, using the latest imaging technology, drugs and medical devices. For example, we have developed a new procedure for cleaning out the plaque which accumulates in the carotid artery in the neck, and which is a major cause of stroke. The prior treatment required major surgery, involving a long incision and an extended operation to find the blockage in the carotid artery and then remove it. The vast amount of cutting necessitated a long healing process. The new procedure, which has come into general use over the past 15 years, employs a 10step method which identifies the precise location of the blockage in the carotid artery before the surgery begins. As a result, the minimally invasive surgical procedure requires an incision in the neck only one inch long at the precise location, and the patient can go home the next day. We have also developed a subspecialty of interventional vascular ultrasound for use on patients who can’t walk due to blocked arteries, a condition known as Peripheral Artery Disease (PAD). Previously, the treatment of PAD called for extensive x-ray expo-

sure, and the injection of dyes which were dangerous for diabetics and kidney patients, followed by major surgery. Our new technique avoids those risks. It employs a duplex scan involving ultrasound, spectral analysis and Doppler imagery which gives us a color image of both the outside and the inside of the blood vessel. The duplex scan allows us to actually see the lesion, go in and treat it with a minimally invasive procedure using a balloon or stent over a wire, and we can actually see the results of the treatment in real time. Many of these innovations were pioneered at the Vascular Institute of New York at Maimonides Medical Center in Brooklyn, NY. Another specialty of the Vascular Institute is the intensive investigation and treatment of problem wounds and ulcers which would otherwise take months to heal. Vascular specialists work as silent partners with primary care physicians. Anyone over 65, or who shows symptoms of vascular disease, should have a vascular checkup, either through a referral from their primary care physician or by making an appointment directly with a vascular center. Symptoms of vascular disease include swollen legs, numbness or weakness in a limb, a sudden and unexplained inability to walk, a wound that does not heal within two weeks, and any history of stroke or aneurism. The checkup will give the patient a clear picture of their vascular health, telling them what to expect, and setting their mind at ease. They will be provided with prescriptions for any medication that may be indicated, and recommendations for exercise to maintain their vascular health. Vascular checkups are routinely covered by Medicare and most health insurance policies. The most exciting current developments in vascular medicine include a new generation of drugs, in addition to the statins now widely in use, for the treatment of arteriosclerosis (hardening of the arteries). The new drugs increase the amount of “good” HDL cholesterol in the bloodstream, reducing the risk of heart attack and strokes, and prolonging life expectancy. In addition, the development of new minimally invasive surgical techniques employing balloons, stents and catheters is expected to all but eliminate the need for open surgery for most vascular conditions within 5-10 years.

Dr. Enrico Ascher founded the Vascular Institute at Maimonides Medical Center in Brooklyn, NY, the first vascular center to be established in New York City. He is board certified in vascular surgery, and is a Professor of Surgery at Mount Sinai School of Medicine. A widely recognized expert in his field, Dr. Ascher was trained in the specialty at the Montefiore Medical Center/Albert Einstein College of Medicine. Dr. Ascher is the editor in chief of the gold standard medical reference book, Practice and Principles in Vascular Surgery, and is now preparing its 6th edition for publication.

New Insights Into the Mystery of Alzheimer’s

Celebrating for a Healthier Pesach Baby Boomers at 65 - What’s Next for Them? Young, Jewish, Frum and Divorced From Ballet to Karate - Getting Kids Interested in Exercise