A Publication of
Genetics Based Treatment Page 9
Providing Our Kids with Healthier Snacks Page 10
War Against
Mom’s Dilemma Work or Stay at Home
DIABETES
Page 22
Page 18
New Mental Health Section 2 February 201
MIND, BODY S O& U L
A Publication of
the Jewish Press Supplement to ion Periodical Publicat
lth Magazine A Mental Hea
February 2012 SEE INSIDE
SPECIAL Subscription Offer
Margaret Tietz NURSING & REHABILITATION CENTER
See Page Page 31 See
See Page 21
ADVERTISING BY: HOOPLA! 718-677-7710
2
Your Homecare Options Shouldn’t Be a Mystery to You.
FREE No Obligation Consultation
Having trouble navigating today’s complex world of Home Health Care? Confused about your options and unsure how to make the best decisions? You need a different kind of Home Health Care provider. You need someone that will make the entire process easy to understand, answer all your questions and guide you through every step in a simple and clear manner that leaves you with a feeling of confidence and peace of mind. You need Edison Home Health Care.
f f f f f f
Personalized home care for the elderly and disabled Skilled, compassionate professionals Medical, nursing, therapeutic and social support Private Pay and Long Term Care Insurance specialists Low introductory rates H OM E C A R E P L A N N I NG FREE Medicaid planning Provided by: SOLU T I O N S
718.705.5800
EDISON H O M E H E A LT H C A R E
946 McDonald Avenue Brooklyn, NY 11218 T. (718) 705-5800 F. (718) 682-0055 info@edisonhhc.com www.edisonhhc.com
¯ ¬
THIS WINTER SEASON, INFLUENZA STANDS NO CHANCE. ABBREVIATE YOUR COLD. Take Zahler® Abreve™ at the first sign of cold or flu symptoms. Zahler® Abreve™ advanced Cold & Flu formula is a powerful blend of herbs and nutrients that stops oncoming colds in their tracks. Plus, it contains nearly 1000mg of elderberry extract, which boosts the overall immune system and has been proven even more effective than Tamiflu® in reducing the severity and length of the flu.
BE PROTECTED FROM VIRAL AND BACTERIAL INFECTIONS ALL WINTER LONG
Includes 985mg of Elderberry Extract
3
Ask Zahler® ®
Every vitamin developed by Zahler goes through rigorous testing and is manufactured and bottled in a state-of-the-art GMP, NNFA & NSF® certified facility.
Have Questions? The signature Zahler® advice is available free of charge via the Ask Zahler® nutrition line:
1-877-ASK-ZAHLER® (NYC: 1-212-444-9936)
4
FEBRUARY 2012
W
elcome to the new, expanded version of Health & Living. In its updated format, we can now provide you with new features covering a broader range of topics, including men’s and women’s health, diet and exercise guidance, technology-related issues, a product showcase, a community profile and much more. Count on Health & Living to continue bringing you articles with information that will help you and the members of your family to live a healthier and more enjoyable life. In addition, we are pleased to present our expanded mental health section, Mind, Body and Soul. Here are some of the more compelling topics covered in this issue of Health & Living. We offer potentially lifesaving information about one of the fastest growing health problems of our times, the epidemic of diabetes. We explore the moral issues confronting end of life choices, and the proper role of our doctors and rabbis in helping us to make the right decisions. We offer parents practical advice about guarding the health of their children by putting sensible limits on the snacks they eat. We also give tips to parents on finding ways to bolster the self esteem of all of their children, while recognizing that each of them is unique, and ways to bring more happiness (simcha) into their homes. For seniors, we provide an introduction to the newest and most popular gadgets of our day, the smartphone and the tablet computer, and explain the various ways they can make their lives easier and more convenient. We also offer medical science’s latest advice on warding off the onset of Alzheimer’s disease. We examine the secrets to long life known as the ‘Okinawa Diet and Lifestyle,’ which has been modeled after the residents of the Japanese island of Okinawa. We take a look at the latest in lifesaving devices, the portable defibrillator, as well as ways to preserve our hearing from the din of digital devices which are becoming so ubiquitous. Finally, in our Doctor’s Desk column, we examine the topic of how we as patients can understand and minimize the risk of life-threatening medical errors. All of these new features and sections are designed to provide you with more of the information you want and need. Please send us your feedback and opinions about the new Health & Living, and topics which you would like us to cover in future issues.
Health & Living Digest . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Issues End of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Genetic Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Raising Our Children Kids Snack Attack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Twins Multiplying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
MIND, BODY & SOUL
It has become the ‘in’ practice in medicine today for patients and their families to consider end of life choices when treatment has become too daunting. Medical journals cite that more doctors are encouraging this practice since they opt out of medical intervention themselves. As Jews though, we must consider the Torah and our Rabbi’s input as our ultimate medical authority.
8
Snack is under attack in America. Mayor Bloomberg and even First Lady Michelle Obama are on a mission to eliminate unhealthy snacks from our schools’ lunches, vending machines and even grocery lists. American kids snack three times a day on chips, candy and other junk foods which now account for more than 27 percent of children's daily caloric intake, according to a recent study. Sunshine Vitamin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Kids’ Self-Esteem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
5
10 Diabetes: The Silent Killer
Exercise and Academia. . . . . . . . . . . . . . . . . . . . . . . . . 15 Redefining Autism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Unvaccinated Children . . . . . . . . . . . . . . . . . . . . . . . . . 17
Women’s Health Working Moms vs. Stay at Home Moms . . . . . . . . 18 New Clues Found in Lupus . . . . . . . . . . . . . . . . . . . . . 19 Fighting Breast Cancer with Cholesterol Drug . . 20
In Collaboration With:
A Mental Health Magazine
End of Life
Kids Snack Attack
February 2012 A Publication of
H&L BRIEFS
■ Contents ■
From the Editors
Komen Controversy with Planned Parenthood . 20
Diabetes is a phenomenon of modern living. It is largely the result of eating an unhealthy diet combined with a sedentary lifestyle. As a result, diabetes is nearly four times as common today as all types of cancer combined, and it causes more deaths each year than breast and prostate cancer combined. More than 25 million Americans already have diabetes, and more than double that number have blood sugar numbers high enough to classify them as suffering from pre-diabetes. That means that they are likely to develop the full blown Type 2 diabetes in the near future if they do not make the necessary changes in their diet and lifestyles to prevent it.
Golden Years Diabetes: The Silent Killer. . . . . . . . . . . . . . . . . . . . . . . 22 Cataracts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Parkinson’s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Antioxidants and Longevity . . . . . . . . . . . . . . . . . . . . 28 Seniors and Technology. . . . . . . . . . . . . . . . . . . . . . . . 29
see center of publication
Preventing Alzheimer’s. . . . . . . . . . . . . . . . . . . . . . . . . 30
22
H&L BRIEFS
FEBRUARY 2012
■ Contents ■ Is published by the Jewish Press Publishing since 1960
Healthy Living
Okinawa Lifestyle While many of us are searching for the secret to the fountain of youth, the residents of Okinawa, in Japan, have all the answers. Their lifestyle now called “The Okinawan Diet” shows that their longevity is the product of a healthful diet, coupled with exercise and a productive social atmosphere.
Okinawa Lifestyle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Truth about Juice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Supplement Publisher Moshe Klass
Trim and Fit – A Workout for All. . . . . . . . . . . . . . . . . 34
Senior Editor
Flavorful Dishes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Yaakov Kornreich
Natural Healing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Associate Editor
Controlling Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Tzivia Emmer
Copy Editor Ita Yankovich
Features Editor Leah Rothstein
Children Editor Dana Ledereich
Sales Director Heshy Korenblit
Advertising Sales
32
Arthur Klass David Hoppenwasser Raw Food Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
6
Hair Replacement
Advertising Coordinator Shaindy Urman
Majority of men experience some form of hair loss by the time they are 50. Years ago, men had few viable options for disguising hair loss, but today thanks to technological advancement, men have the option of being proactive beyond applying Rogaine and can consider options such as: hair restoration surgery, scalp flap, and scalp reduction.
Health & Living Tech Hair Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Demystifying Defibrillators . . . . . . . . . . . . . . . . . . . . . 39
Michael Kurov
Health & Living, in its sole discretion, reserves the right to decline any submitted advertisement or to discontinue publication of any advertisement previously accepted. The acceptance of advertising by Health & Living does not constitute endorsement of the services, products, or information advertised.
38
From the Doctor’s Desk
For subscription requests, advertising rates, general inquiries, calendar information and schedules contact Health & Living at 718-330-1100 ext. 352. You may also write to: Health & Living c/o The Jewish Press, 4915 16th Avenue, Brooklyn, NY 112041115 or e-mail magazine@jewishpress.com.
A Medical director of a Pediatric ER explains how medical errors occur in hospitals and what patients and relatives can do to minimize their occurrence. Protecting Your Hearing. . . . . . . . . . . . . . . . . . . . . . . . 40 Health & Living Showcase . . . . . . . . . . . . . . . . . . . 42-43
Profile Organizational Profile . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Medical Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Community Profile Bulletin. . . . . . . . . . . . . . . . . . . . . 46 Community Calendar . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Service Directory. . . . . . . . . . . . . . . . . . . . . . . 48-49
50
Design
Picking the Right Pharmacy & Pharmacy Directory . . . . . . . . . . . . . . . . . . . . . . . . . . 48
From the Doctor’s Desk. . . . . . . . . . . . . . . . . . 50
SUBMISSION INFORMATION Health & Living invites readers to submit Letters to the Editor. Letters will be selected for publication at the sole discretion of the editor, and may be edited for size and content. Submissions become the property of The Jewish Press. Please e-mail your Letter to the Editor to HYPERLINK "mailto:magazine@jewishpress.com" magazine@jewishpress.com.
FEBRUARY 2012
H&L BRIEFS
Digest Congress Unites in Farewell to Giffords
The House bade a tearful farewell to Arizona Representative Gabrielle Giffords on Jan. 25th as she submitted her resignation papers. She was praised by members of both parties as an inspiring symbol of courage in the aftermath of an assassination attempt against her last year.
Expiring Drug Patents Mean Big Consumer Prescription Savings In 2011 and 2012, the patents on many of the most expensive brand name drugs are expiring, which means that consumers can look forward to major savings on some of their prescriptions. Once
the patent on a drug expires, rival drug companies are free to market its chemical equivalent (generic) version, usually at a fraction of the retail price of the brand name version. Even consumers whose
health insurance includes prescription drug coverage will usually save a significant amount on their co-pays by choosing the generic rather than the brand name version of these drugs.
Brand Name
2010 Sales
Patent Expiration
Manufacturer
Medical Use
Concerta
$1.3 billion
2011
Johnson & Johnson
ADHD/ADD
Levaquin
$1.4 billion
2011
Johnson & Johnson
antibiotics
Lipitor
$7.2 billion
2011
PďŹ zer
cholesterol
Zyprexa
$3 billion
2011
Eli Lily
anti-psychotic
Seroquel
$4.4 billion
February 2012
Astrazeneca
anti-psychotic
Plavix
$6.1 billion
May 2012
Bristol Meyers Squibb
anti-platelet
Tricor
$1 billion
July 2012
Abbot Laboratories
cholesterol
Actos
$3.6 billion
August 2012
Takeda
Type 2 diabetes
Singulair
$4.1 billion
August 2012
Merck
asthma
Diovan
$1.5 billion
September 2012
Novartis
blood pressure
On Doctor Shortage What happens if the country doesn't train more primary care doctors? Health costs probably continue to rise. Decades of research have confirmed that more specialists leads to more specialty care, which leads to a more expensive system. A study last month found that physician visits that result in a referral to a specialist jumped from 41 million in 1999 to 105 million in 2009, an increase of 159 percent. As the above chart shows, primary care physicians have begun referring to specialists more — and specialists have become more likely to refer patients to other specialists. Source: Archives of Internal Medicine
7
FEBRUARY 2012
ISSUES
“End of Life” Choices: Reading Between the Lines By Barbara A. Olevitch
T
8
here is now a new popular literary genre - well-written, seeminglythoughtful essays encouraging patients and families with serious illnesses to choose less medical care. An example is the recent article called “How Doctors Die: It’s Not Like the Rest of Us, But It Should Be” by Dr. Ken Murray, posted on the Zocalo Public Square Blog. It suggests that most doctors are choosing not to have aggressive care at the end of their lives and that the rest of us should follow their example. In America right now, the role of the doctor is to offer medical care and the role of the patient is to decide whether or not to accept it. By arguing that we should all do as doctors do, Dr. Murray seems to be suggesting that the doctor can play both roles. Do doctors truly choose less care, and if they do, is there really any reason why we should imitate them? Dr. Murray’s article doesn’t really prove that doctors are choosing less care. He offers his impression, but no statistical evidence to back it up. I found some counterexamples in a book by another doctor, The Anatomy of Hope by Jerome Groopman. Dr. Groopman tells about an ill colleague, George Griffin, who was diagnosed with a usually fatal stomach cancer. In spite of the fact that his fellow doctors were against it, Griffin insisted on “combining high doses of chemotherapy with intensive radiation.” Then he had surgery and another round of chemotherapy and radiation, despite severe, painful side effects. After describing Griffin in a terribly weakened condition, Dr. Groopman surprises the reader with an amazing scene that occurred 13 years later. Griffin is still alive and Dr. Groopman meets with him to ask him about his decision to take all those treatments that weren’t expected to cure him. Griffin said that he knew everyone disagreed with his decision to take treatment. “I knew all the arguments made in cases like mine. Treatment would cause unnecessary suffering - for me and for my family. Add in that it throws away society’s money on a doomed person . . .I find these argu-
ments patronizing . . .I, of course, had a crystal-clear understanding of my chances. And it was my right to choose what I did. “Even if I didn’t prevail . . .I deeply wanted to live, so I had to fight. Then I could tell myself that I had tried, that I had done everything possible. There would be no regrets.” Dr. Groopman also tells the story of Richard Keyes, another doctor with
were painful and offered only a 2 percent chance of survival. When the usual cycles of chemotherapy failed to slow the cancer, she found a doctor who would bombard her with more.” Even if Dr. Murray is right in claiming that more doctors choose to avoid aggressive care, does this necessarily mean that we should emulate them? Could such a bias against aggressive treatment be a result not of the su-
In Judaism, we believe that every moment of life is precious and that it is meritorious to maintain hope. The doctor is our helper but not our ultimate authority who we must imitate. a serious tumor. He had surgery but resisted the idea of taking radiation therapy afterwards. Keyes eloquently expressed his skepticism, “I won’t be strung along... What - get dragged down to radiation every day, come back feeling sick as a dog? ...And when that’s over, everyone can say that they tried their best and then tuck me in my coffin with a clear conscience.” But his physician, Dr. Andrews, was not inhibited by the fact that Keyes was a medical expert. He offered him arguments to accept the treatment. He emphasized to him that although cure was not likely, it could occur. Keyes, despite his eloquently expressed skepticism, went through with the radiation therapy, and although it was difficult, it did work. He was cured. Another counterexample is particularly striking because it concerned a palliative care doctor. Anemona Hartocollis wrote in the New York Times on April 4, 2010 about Dr. Desiree Pardi. Hartocollis wrote, “While she and her colleagues had been trained to talk about accepting death, and making it as comfortable as possible, she wanted to try treatments even if they
perior knowledge they gained from their practice but, rather, of the pressures that they endure or of their overexposure to the stress of treatment? Must we accept Dr. Murray’s implication that doctors rejecting aggressive treatment for themselves are making rational decisions on the basis of their superior knowledge? Perhaps it would be more accurate to view them as ordinary human beings whose illness is even harder to bear because of their background. There is a popular saying, “Doctors make the worst patients.” There is much evidence that doctors do experience a high level of stress in their occupation. Dr. Pauline W. Chen wrote in the New York Times on October 7, 2010 that “for several decades now, studies have consistently shown that physicians have higher rates of suicide than the general population - 40 percent higher for male doctors and a staggering 130 percent higher for female doctors.” There are all sorts of theories that seek to explain the elevated rates of depression and suicide among medical students and doctors, but the most important point for our discussion
is how depression affects decisionmaking. When someone is depressed, even the ordinary pressures of life seem too much. A depressed patient may find it too much trouble to get dressed or comb his hair, much less undergo a difficult course of chemotherapy! It is a normal part of medicine to take note of a patient’s depression and to treat it if necessary. But when the patient is a doctor himself and he expresses his desire to quit, those around him may be too awed by his medical expertise and his dignified bearing to realize that he needs encouragement, and, that in fact he may, because of his experiences, need even more help than the average patient. The biggest trouble with Dr. Murray’s essay is that it implies that there is one right path and that it is always better to choose less care. This tends to minimize the real dilemma in making such decisions, namely the uncertainty of the outcome. In Judaism, we believe that every moment of life is precious and that it is meritorious to maintain hope. The doctor is our helper but not our utmost authority who we must imitate. We think that while the doctor can help the patient find out what care is available, it is the role of the Rabbi to help the patient decide which care should be accepted. Even in the case of a dying patient whose Rabbi has ruled that the patient is not obligated to accept a certain treatment because of its limited effect and the suffering involved, we still believe that it would be wrong to make the patient feel that he is being foolish or selfish if he chooses to continue fighting against his illness. There is no denying that in today’s American culture, it is the “in” thing to talk about discontinuing medical care. But as Jews, we have to maintain our own cultural atmosphere and talk to each other in ways that acknowledge the unpredictability of life and death, which are in Hashem’s hands. We must not discourage our ill loved ones or bias their important decision-making by allowing them to be drawn into the fashionable pessimism of the culture that surrounds us. Barbara A. Olevitch, Ph.D., is a clinical psychologist living in St. Louis, Missouri, and author of Life is a Treasure: The Jewish Way of Coping with Illness (Targum Press).
Medicine’s Newest Tool in Genetic Analysis By Yaakov Kornreich
L
ess than a decade after scientists first sequenced the first complete human genome — the DNA’s genetic instructions for making all the body's cells — the bioscience industry is working to offer doctors and hospitals the ability to analyze a person’s entire genome and to interpret its medical significance at a low enough cost to make it a routine medical diagnostic test. The DNA scanning technology has already been mastered, and the main challenge now is to develop software that can analyze a person’s complete DNA sequence quickly and identify which anomalies may be causing their medical condition. The problem is the huge amount of genetic information that needs to be processed. Each person's DNA chain, made up of the four different chemical bases of DNA, called A, C, G and T, contains 6 billion components, which can differ from "normal" at more than 3 million points. Doctors are still learning the full medical significance of most of those variations. That information could revolutionize the treatment of genetically-related diseases. Harold Varmus, director of the National Cancer Institute, said that genetic sequencing analysis is, “the biggest change I've ever seen in oncology. Doctors are taking genetic information they see in patients' tumors and changing therapy in dramatic ways." Biotechnology companies are now developing small, user-friendly DNA sequencers with software that doctors can use to diagnose and treat specific diseases. One of the new machines is the size of an I-pod and can be used to test patients for infections and drug responses. Martin Reese, the CEO of one of these companies, Omicia, described his goal. "We're taking a process, hand annotation of the genome, that can take up to six months to do, and automating it so that it takes just a half hour or an hour." At his office, Jay Flatley, the CEO of Illumina, demonstrated an Apple iPad loaded with an application that displayed his own genome. He quickly skipped from screen to screen filled with, text and color icons, stopping at one describing a gene that determines his body’s response to the blood-thinner warfarin. "I'm in the high-sensitivity category, so I should get a lower dose." The potential of the new technology was dramatically demonstrated by Joe Beery, an information technology expert working for Life Technologies Corp. With the help of his company’s DNA sequencers, researchers at Baylor were able to correctly diagnose his 12-year-old twins, Alexis and Noah, after standard diagnostic techniques had failed. The twins suffered from recurring vomiting, muscle weakness, seizures, and occasional breathing difficulties. They had been misdiagnosed at age 2 with cerebral palsy, but the stan-
dard treatments did not work. When they were 5 1/2 years old, their mother, Retta Beery, learned of a rare disorder of the nervous system called a "dystonia" caused by a deficiency in the chemical dopamine that seemed to fit. At first, the standard drug treatment for dystonia seemed to help, but the eventually some of the symptoms returned, especially for the daughter, Alexis. In 2009, after more diagnostic tests failed to reveal any more clues, the Beery’s turned to Joe’s company for help. It put the Beerys’ in touch with a team of doctors and scientists at Baylor College of Medicine's Human Genome Sequencing Center in Houston. They decoded the twins’ DNA sequence by hand, a process that took two months, with Joe’s company and Baylor research funds covering the cost. The analysis revealed that the children also had a second genetic condition that interfered with another chemical in the nervous system called serotonin. When the standard pharmacological substitute for serotonin was administered to the Beery twins, their symptoms disappeared completely. Recently, Life Technologies introduced a new $150,000 machine capable of sequencing an entire human genome in a day for about $1,000, less than the typical cost of a colonoscopy, and is marketing it to hospitals, clinics and testing laboratories as well as researchers. The Beerys said that while they had always prayed for guidance, they never dreamed that the answer to their children's health mystery would arise from his job. "Genome sequencing literally saved her life," Retta Beery said."The fact that I ended up where I ended up, you have to believe those prayers were answered," her husband added. But other obstacles still loom before this DNA diagnostic technology becomes generally available to patients who are not the subject of clinical research studies, or capable of paying for the sequencing and analysis out of pocket. Health insurers are already expressing reluctance to cover the cost of full genome sequencing and analysis, even if it is just $1,000. According to a spokesman for America's Health Insurance Plans, an industry umbrella group, insurers will first demand much more proof of its accuracy and utility in improving the outcome of medical treatment. Thus, once again, after medical science has given us a new and more effective tool to fight disease, patients will either need to wait, pay for it out of their own pockets, if they can, or wage another battle with the health insurance system to reap the same benefits that the Beery twin have gained from it. 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.
ISSUES
FEBRUARY 2012
9
RAISING OUR CHILDREN
FEBRUARY 2012
Kid Snack Attack! By Ita Yankovich
S
nack is under attack in America. Mayor Bloomberg and even First Lady Michelle Obama are on a mission to eliminate unhealthy snacks from our schools’ lunches, vending machines and even grocery lists. American kids snack three times a day on chips, candy and other junk foods which now account for more than 27 percent of children’s daily caloric intake, according to a recent study. Kids’ fast paced- lifestyle often make them prefer grazing on small snacks rather than consuming 3 solid meals.
10 10
Many Americans don’t appreciate politicians getting involved in their family’s eating patterns, but the fact remains that in the U.S alone at least 1 in 5 kids is overweight and the numbers continue to grow. Because most children do not purchase their own food, we have to look toward parents and caregivers as to why this epidemic exists. These days, many households do not have sit-down family dinners. That is because the parents are too busy working overtime trying to make ends meet, taking care of elderly parents, running errands after work, and shuffling children to afterschool activities to prepare proper meals for their families. To
satisfy their parental guilt, they often decide that the easiest way to remedy the problem is by allowing their children to eat convenient, high-calorie snacks to satisfy their cravings and eliminate complaints. Government surveys from the mid-2000’s show that the average American ate 2,375 calories a day, one third more than in the late 70’s. The biggest contributor to this increase has been the rise in the number of snacks people eat a day. Americans have gone from eating 3.8 snacks and meals a day to 4.9 on average. Many parents have also been confused by surprising reports which found that adolescents who ate more snacks were less overweight and had a higher energy level than those youth who ate fewer snacks. In a recent government survey of 5,800 teenagers, it was reported in the American Journal of Clinical Nutrition that the rates of obesity went down as the number of snacks the kids ate each day went up. Clearly the debate will continue, but in the mean time we have to be smart about how and what we allow our kids to snack upon. Kids are not going to eat healthy foods on their own; why should they choose trail mix and broccoli when they can eat an assortment of neon-colored, bubblegum-flavored snacks? So it is our job to help them make wiser decisions. When introducing a new healthy snack, studies recommend that just by telling your kids that the new food tastes good rather than “it is good for them” will improve the chances of success. Many children will reject a food without even tasting it if they see the word ‘healthy’ on the food packaging, because they assume it will taste bad. It is better to let kids be kids, and allow them to enjoy their favorite treats once in a while. Many parents are more relaxed about healthy food choices on Shabbos and Chagim for example, and let their kids eat their favorite nosh from the store or drink a little soda as a Shabbos treat, knowing that the more you make unhealthy food off-limits, the more kids will be tempted to eat them. Children are also more likely to eat foods they had a hand in preparing it. Experts suggest setting aside time on the weekend or evenings when parents and kids together can prepare snacks for the week ahead. This not only establishes quality time, but also creates a stock of healthy after-school snacks that will be readily accessible when they feel the urge to snack. By giving children a sense of ownership over the healthy snacks they have created, we also make them more likely to eat them. The Center for Science in the Public Interest has published a list of some of the nutritionally worst popular snacks on the market today. They are: Chips Ahoy!, Oreo cookies, Pepsi and Coca-Cola, artificial fruit juices, Hostess snack cakes, and Keebler Club & Cheddar Sandwich Crackers. The group also listed the nutritionally worst candy bars, citing Kit Kat Big Kat and Snickers, along with Starburst Fruit Chews. Below are some of the worst and best snacks.
Best and Worst Snacks Worst Snacks
Best Snacks
• Potato chips- The problem with most chips is that they are addictive. The old TV commercial was right -- usually you can’t just eat one. Most 1oz bags of chips have 225 calories and very little real nutrition. When eating chips, your child is just consuming fat, carbs and hydrogenated oils and salt. Potatoes in general are healthy and are loaded with potassium, but a much better way to get those benefits would be by eating a baked potato. • Cookies-Cookies and milk used to be a staple snack for kids coming home from school, but today we know that it is a bad choice since most cookies are loaded with sugar and little nutritional value, and the amount of butterfat in whole milk is unhealthy for all children over the age of 2. • Chicken nuggets- There is too little chicken in these treats and too much deep-fried bread, fat and sodium. • Cereal- Don’t be fooled by misleading claims of “whole grain” or “High in Fiber” or “Rich in Vitamin D” on your kids’ sweetened cereal boxes. ABC News reported that a shocking 44 children’s cereals contain more than 11 grams of sugar per serving. In fact, only a quarter of today’s cereals meet voluntary proposed guidelines of the federal Interagency Working Group on Food Marketed to Children which, recommends no more than 26 percent added sugar by weight. Good cereal choices are Cheerios, Cornflakes and Kix.
• Cut up Fruit/veggies-Kids often will reject this so make it interesting by cutting it in fun shapes and sizes and offering a side dip like hummus, guacamole or homemade salsa • Crackers- Whole wheat crackers are best especially when spread with peanut butter, ‘real’ cheese or hummus.
• Yogurt-Yogurt supplies lots of calcium--275 to 450 milligrams per 8-ounce container. Look for brands that do not contain NutraSweet or aspartame, choose those with “live and active cultures,” which are beneficial bacteria for your child’s intestines. • Nuts and Raisin Mix-Kids love small crunchy foods (think BBQ twists) so replace that with an assortment of seeds and nuts. Seeds are high in fat but they are ‘healthy unsaturated fats.’ Sunflower seeds are a good choice. The US Journal of Agricultural and Food Chemistry reports, sunflower seeds proved to be the best source of phytosterols — as well as being a good source of magnesium, iron, copper, manganese, and vitamin E. Add some raisins into the mix for some sweet flavor and you’ve just increased their potassium and iron intake for the day. • Popcorn - Popcorn is a good source of fiber, carbohydrates, and rich in antioxidants, plus your kids will love watching and hearing it pop! You can make it in the microwave or do it ‘old school’ in a non-stick sauce pan. When making or buying popcorn, keep it healthy by avoiding the addition of butter, oil or salt. One cup of air popped popcorn has only 30 calories. Ita Yankovich teaches English Literature and Writing at Kingsborugh and Touro College. She is also a freelance writer who has authored several articles in various publications. She can be reached at itayankovich@yahoo.com
Educating the next generation of health care professionals FOR MORE INFORMATION:
Explore our programs in:
1-866-TOURO4U OR VISIT TOURO.EDU/SHS CALL
NURSING Associate in Applied Science—Brooklyn* OCCUPATIONAL THERAPY BS/MS—Bay Shore, Manhattan OCCUPATIONAL THERAPY ASSISTANT Associate in Applied Science—Manhattan PHYSICAL THERAPY BS/DPT—Bay Shore, Manhattan PHYSICIAN ASSISTANT BS/MS—Bay Shore, Manhattan, Mineola SPEECH-LANGUAGE PATHOLOGY Master of Science—Brooklyn * A portion of this program must be taken in Manhattan.
Plus we offer baccalaureate degree programs in BIOLOGY and PSYCHOLOGY through the Undergraduate Studies Department in Bay Shore
INFORMATION SESSIONS FOR 2012-13 ACADEMIC YEAR
4DBO IFSF UP MFBSO NPSF
BAY SHORE CAMPUS
"ò PSEBCMF UVJUJPO t 'JOBODJBM BJE PQQPSUVOJUJFT GPS UIPTF XIP RVBMJGZ MANHATTAN CAMPUS
Programs represented include: Occupational Therapy, Physical Therapy, Physician Assistant-Long Island, Undergraduate Studies-Psychology, Biology
Programs represented include: Nursing, Occupational Therapy, Occupational Therapy Assistant, Physical Therapy, Physician Assistant-Manhattan, Speech-Language Pathology
.POEBZ .BSDI UI r 1700 Union Blvd., Bay Shore, NY 11706
5VFTEBZ .BSDI UI r 27 West 23rd St., 6th Floor, New York, NY 10010
INFORMATION SESSIONS WILL BE HELD FROM 6PM-7:30PM. SIGN-IN BEGINS AT 5:45PM, AND PRESENTATIONS BEGIN PROMPTLY AT 6:15 EACH NIGHT. Touro College is an Equal Opportunity Institution
RAISING OUR CHILDREN
FEBRUARY 2012
11
RAISING OUR CHILDREN
FEBRUARY 2012
Twins Are Multiplying By Amy A. Dubitsky aving twins used to be a novelty. Now, if you think that you are seeing double everywhere you go, it is not your imagination. The National Center for Health Statistics (NCHS), under the auspices of the Centers for Disease Control and Prevention (CDC), published a study last month noting the sharp increase in twin births over the past three decades. According to the study, the twin birth rate rose 76% from 1980 through 2009. In 1980, one in every fifty-three babies was a twin. In 2009, one in
own. The fertility treatments used often result in twin or higher multiple births. While ovulation stimulation medications, which are hormones taken by women to increase the chance that they will get pregnant, have no control over the number of embryos produced, Dr. Feinman is pleased that the medical field has been able to cut down on the number of triplet births caused by in vitro fertilization (IVF). When women use IVF, the doctor selects the number of embryos implanted. The method has been advanced to a level that, according to Feinman, “in a generally healthy women under the age of thirty-five, two embryos would be implanted on day three of their cycle or one embryo on day five
cal pregnancy rate,” which is when a heart beat is detected on an ultra-sound monitor. It doesn’t account for those patients that have miscarriages at 18 or 20 weeks gestation, which are more frequent with twins. The study by the CDC was done to evaluate the elevated health risks and accompanying greater health care costs due to twin births. Of the 865,000 twins born during the 1980-2009 study period, over 50% were low birth weight, and one in ten were very low birth weight. Dr. Feinman works closely with the Puah Institute, a non-profit organization that assists couples facing infertility, and guides them on how to pro-
every thirty babies was a twin. This study did not address births of higher multiple pregnancies. Dr. Michael Feinman, a fertility specialist at HRC Fertility in the Los Angeles area, says that the increase in twin births “is not a natural occurrence, but due to assisted reproductive technology and women giving birth at an older age.” Dr. Feinman explained that one reason for this is that after age 35, women naturally produce higher FSH levels, which is the hormone that is used in fertility treatments. The higher levels of this hormone increase the incidence of twin births. According to the CDC study, this only accounts for about one third of the rise in twinning over 30 years. Another reason for the increase in twinning is assisted reproductive treatments. Many eggs are no longer viable for pregnancy in women over age 35, and they are unsuccessful in getting pregnant on their
of their cycle. There is a growing body of evidence to prove that implanting more than one embryo in some scenarios does not increase the pregnancy rate.” Dr. Feinman doesn’t recommend planning a twin birth and his view is reinforced by the findings of the CDC. “Thinking that you are saving money on additional procedures by having twins is a fallacy. Other medical expenses usually accompany multiple births as well as other long-lasting problems. Fifty percent of the time, twins are born premature, and the incidence of cerebral palsy is eight times higher in twins than [in] single births, and forty times higher in triplets.” He also points out an increase in divorce rate in parents of multiples. When selecting a doctor for reproductive assistance, many patients ask for the doctor’s success rate. Dr. Feinman explains that doctors use the “clini-
ceed with treatments in accordance with Jewish law. He understands the emotions involved when couples are having difficulty getting pregnant, but makes the following recommendation: “Women under age thirty-eight who have not been successful in getting pregnant for six months should see a doctor, just for testing. If there is an obvious problem that can be corrected, there is no reason to wait longer. If there is no obvious problem, I recommend waiting a year before resorting to treatment. In women over 38 it would be [on] a case by case basis.” Couples facing infertility should consult with their personal physicians and Rabbis for guidance. And if twins are on the way- you should all be blessed with good health and an easy delivery.
H
12
Amy Dubitsky is a freelance writer and marketing professional in Phoenix, AZ.
RAISING OUR CHILDREN
FEBRUARY 2012
The Sunshine Vitamin By Dana Ledereich
V
itamin D is critical for healthy bone development and for a healthy immune system. Vitamin D enables the body to absorb calcium and thereby fosters bone growth and strength. Insufficient vitamin D can cause anemia and increased susceptibility to a variety of illnesses. Vitamin D is naturally available in certain foods including beef liver, egg yolks and fatty fish such as salmon and sardines. It is also available in vitamin D-fortified foods including certain milks and cereals. Vitamin D is produced by the body when the skin absorbs ultraviolet rays from the sun, which is why Vitamin D is known as the “sunshine vitamin.” Sunshine is the body’s main source of vitamin D. It can produce all of the Vitamin D it needs with just ten minutes outdoors, with exposed skin on the face and arms, three times a week, between 11-2 PM. Vitamin D deficiency is a byproduct of the industrial age, when people went from spending most of their day outdoors working in the fields or on farms to largely working indoors in stores, offices and factories. The use of sunscreen has made it more difficult to get vitamin D from spending time outdoors. An SPF of 8 has been found to reduce vitamin D production by up to 95 percent! While the critical importance of sunscreen as a protection against skin cancer cannot be overstated, it does have a negative impact on vitamin D production. The body’s vitamin D production typically falls during wintertime as well. That is because much less time is spent outdoors, and when we do go outside, more of our skin is covered to protect against the cold, and not exposed to the sun’s ultraviolet rays that it needs to produce vitamin D. It is important for parents to provide their children with alternate forms of vitamin D during this time. Meals should include foods that are natural sources of vitamin D or that are fortified with vitamin D. Also, the time spent outdoors in the spring, summer and fall months does enable the body to develop a reserve of vitamin D to support the body through the winter. People who cover their skin for modesty or cultural purposes are also at a greater risk for vitamin D deficien-
cy. They should make sure they ingest enough vitamin D through natural and fortified food sources to make up the difference. Even babies in-utero need vitamin D. The growing fetus draws the vitamin D from its mother. If a pregnant woman does not have enough vitamin D, it places the fetus at risk for vitamin D deficiency. Pregnant woman should be vigilant in their vitamin D consumption to ensure better health of their growing baby. Breastfed babies are also at risk for vitamin D deficiency. As baby skin is sensitive and delicate, it is not safe for a baby to spend time outdoors with exposed skin. If breast milk is the sole source of a baby’s nutrition, consult a pediatrician about vitamin D supplementation. Most infant formula is fortified with enough vitamin D to meet a baby’s needs. Vitamin D deficiency causes rickets, which is a softening and weakening of the bones in children. Doctors have known for years about the importance of vitamin D for bone growth and bone density and its importance in preventing fractures. More recently, they have discovered the importance of vitamin D to immune system health. Vitamin D is crucial for people of all ages – from fetuses in-utero to older adults. Deficiencies in adults have been linked to osteoporosis, certain cancers, heart disease and diabetes. In children, in addition to rickets, vitamin D deficiencies have been linked to stunted growth, muscle weakness, anemia and increased susceptibility to infections such as pneumonia. While the cold winter weather lasts, make sure to consume foods with higher amounts of vitamin D. Before you know it spring will be here. Then you can go outside, get some fresh air and make your own Vitamin D! Dana Ledereich, MA, OT/L is a pediatric occupational therapist who works in Yeshiva of Flatbush and also maintains a private practice. She evaluates and treats children age birth-13 years with sensory processing issues, poor handwriting, developmental concerns and neurological issues. She has lectured to both parents and professionals on various topics in sensory processing and handwriting development. She is available for lectures as well as to mentor new therapists. She can be reached at 718-252-2939.
13
718.629.1000 5350 KINGS HIGHWAY BROOKLYN, NY 11203 WWW.REVIVALHHC.ORG
RAISING OUR CHILDREN
FEBRUARY 2012
Helping Children with Health Challenges Develop Healthy Self-Esteem By Melanie Kwestel
T
here’s no doubt that a diagnosis of serious medical illness complicates both a child’s emotional development and the family’s dynamics. But even the most serious illness or disability is not a barrier to developing the healthy sense of self that children require to reach their potential. Clinical psychologist Rabbi Dr. Jerry Lob addressed the challenges faced by families of chronically ill children at Chai Lifeline’s LH Financial Services Annual Winter Family Retreat. The event, held in January, brought more than 350 parents, patients, professionals, and volunteers together to share outlooks and strategies. Dr. Lob outlined what he called the “three ‘S’s of parenting and family growth,” which is an appropriate strategy for all families.
14
rewards and consequences. Parents should be unified and confident in the decisions they make for their families. Children feel safer when they understand the limits in which they and their families function. Strong and close relationships with each child are critically important. While it is natural for parents to spend more time caring for their sick child whose condition requires it, mothers and fathers need to be aware and responsive to the needs of their other children as well. “The amount of time you spend
healthy self images in their children: Give real compliments. Compliments that reward children for real accomplishments encourage children to reach for the next level. Look for behaviors and achievements to compliment, and be generous with praise. When it comes to criticism, choose your battles. Dr. Lob recalled a conversation he had with Rabbi Yechiel Michal Twerski. He asked how Rabbi Twerski’s parents had managed to raise children who had achieved so much in their lives. “Our parents were half-blind,” Rabbi Twerski replied. “They didn’t no-
with each child won’t be the same,” Dr. Lob cautioned, “but both mothers and fathers should make time for each child and engage him or her in the most appropriate way for that child. For some, it may be learning together; for others, it could be having a catch outside.” Strong parents make demands of their children based on realistic assessments of their children’s abilities. Children do not have to be perfect, but they do need to feel that they can and will live up to their parents’ expectations for them. “Treating a child who is ill or who has any kind of special need as being less than capable in the areas where they can succeed is a disservice. Reaching for a goal will help a child develop self-esteem.” Dr. Lob emphasized that self-esteem is directly related to strong parenting. “Strong parents,” he said, “help build self esteem.” He outlined three strategies parents can use to promote
tice every silly thing we did. When they critiqued, it was constructive.” “Have less of an ayin ra and more of an ayin tov,” said Dr. Lob. “Catch your children doing good.” Set realistic, achievable goals, but don’t sell your children short. Children develop self-esteem when they go beyond what they thought they could do. Feeling good about themselves comes from liking what they see when they look in the mirror. While parents should not have unrealistic expectations of any of their children, they need to be particularly in tune to children who have physical, emotional, or academic challenges and help them meet their goals. Don’t let children off the hook. It can create resentment among siblings, and in the final analysis, will lower the child’s self esteem.
Safety In addition to physical safety (knowing and feeling that their parents are providing for their needs), children feel safer when they are confident that they can express their feeling and concerns to their parents. “Children need to feel that their opinions matter,” Dr. Lob stated. “They don’t need a vote (in how the household is run), but they do need a voice. They need to feel that they will be heard.” Taking the time to listen and accept the feelings of all the children in a family is important as well. Dr. Lob related the story of a sibling of a child with special needs who was never allowed to express negative feelings. “At first I thought he was exaggerating when he told me that he was not allowed to be negative. But when I spoke to the mother, she confirmed his statements. She felt that her healthy son’s life could never be as ‘bad’ as that of her special needs child. Therefore he could never express sadness or anger about his situation.” The child’s anger eventually led him off the derech and into dangerous behavior. For all intents and purposes, the young man was lost to his family.
Strength Children need strong parents who set appropriate boundaries with both
Simcha Create an environment of Simcha within your home. Look for ways to
spend time together as a family, for example, by reserving some Shabbos meals that will be “family only” time. Understand and respond to your children’s unique abilities and personalities. Dr. Lob recalled a rabbi who has two autistic children. Every day he comes home, turns on music, and dances with these two children, bringing simcha to their lives, and to his own. Parents also need to find time for themselves and to strengthen their marriage. Children feel more simchakdik when parents really care about each other. Each parent must do something that she or he enjoys, and couples need to find ways to have fun with each other. There’s no question that it is more challenging to find time for oneself and one’s spouse when parenting a child who is ill or disabled. But children are happier when they can see that their parents get along and are happy together. One of the ways that we as Jews create simcha in our lives and our homes is through our belief in Hashem. Remind your children and yourself that Hashem loves us and remains with us throughout our travails. Dr. Lob illustrated the concept with a d’var Torah from Harav Chaim Shmulevitz. When our forefather Yosef was sold into slavery by his brothers, he was transported in the caravan of a spice dealer. Rashi stated that the caravan usually carried foul-smelling goods, and that the presence of besamim comforted Yosef. Though his life had taken a disastrous turn, and he was worried about his father and the future of klal Yisrael, the sweet, familiar odor was a comfort to him. Harav Matisyahu Solomon added that Yosef took their presence as a sign that Hashem was still with him. The message to us is not to be oblivious to the positive signs that Hashem sends us. Though it is often a struggle for parents to raise children with the self-esteem necessary to succeed in life, our mission is to see the signs that Hashem has not forsaken us and to smell the besamim in our lives. Melanie Shimoff Kwestel is the director of communications for Chai Lifeline. Chai Lifeline provides emotional, social, and financial support that enables families of seriously ill children to cope with crises and daily challenges of pediatric illness.
RAISING OUR CHILDREN
FEBRUARY 2012
Exercise and Academic Performance By Dana Ledereich
R
ecent studies have confirmed what occupational therapists have been saying for years: Physical exercise has a positive effect on academic performance. The amount of time allotted to physical education during the school day has declined over the years. Decreasing school budgets and increased pressure from standardized tests have forced many schools to cut down or even eliminate physical education class from the curriculum in favor of more class time. However, studies show that this policy does not result in better academic performance. In some cases, more time in physical education class has led to improved grades overall and improved test scores on standardized exams. In controlled studies, children who increased their physical activity through physical education class or other school-based physical activity either maintained or improved their scores on standardized tests even though they received less classroom instruction than children in the control group. More and more American children are classified as obese. Some would even argue that childhood obesity has reached epidemic proportions. While some of the blame can be placed on processed food and on larger food portions, decreased physical activity plays a strong role as well. Children spend more time in front of a computer screen or texting on a cell phone than they do playing organized sports or just playing on the playground. There have been initiatives designed to encourage schools to serve healthy food in more appropriate portion sizes, but many of these same schools have cut back on physical education classes and thus deprive their students of regular physical exercise. The exact relationship between physical activity and academic performance is not fully understood, but physically fit and active children tend to demonstrate better academic achievement. It has been suggested that exercise increases the flow of blood and oxygen to the brain. Exercise has also been found to lead to
increased levels of norepinephrine and endorphins, substances that are important for reducing stress. Regular, intermittent breaks for physical exercise can also have a positive effect on overall behavior and concentration. This exercise can be in the form of jumping jacks near the students’ desks, wall push-ups, or simply walking around the desk a few times. Rather than creating a chaotic environment, the physical exercise stimulates better attention. For children more challenged by a decreased attention span, occupational therapists often recommend an air-filled seat cushion or a ball chair -- Both these options provide opportunity for movement to enhance the student’s ability to attend to the lesson. Incorporating physical exercise into the school day is especially challenging during the winter. During recess, the cold weather forces students to remain indoors in their classrooms. Although they may be allowed to stand or eat a snack during this 10-15 minute break, there is no opportunity for physical exercise. Teachers would be best advised to keep some jump ropes and Chinese jump ropes in the classroom for these times. Balloons also come in handy as a safe alternative to balls and are a fun way to provide physical exercise within the confines of the classroom. In this era of increased emphasis on standardized test scores, schools would find it advantageous to increase the emphasis on physical education and exercise during the school day. Moreover, if teachers provide opportunities for physical exercise within the confines of their classroom, they can expect improved classroom behavior and performance. Dana Ledereich, MA, OT/L is a pediatric occupational therapist who works in Yeshiva of Flatbush and also maintains a private practice. She evaluates and treats children age birth-13 years with sensory processing issues, poor handwriting, developmental concerns and neurological issues. She has lectured to both parents and professionals on various topics in sensory processing and handwriting development. She is available for lectures as well as to mentor new therapists. She can be reached at 718-252-2939.
365 days a year 24 hours a day, through good days and sad times, Chai Lifeline makes living with pediatric illness easier.
Last year, Chai Lifeline brought joy and hope to
4,297 lives impacted by pediatric illness.
45,621
Meals to hospitals and homes
20,938
Visits to sick children by trained volunteers
22,981 Rides to hospitals and medical centers 36,229 Opportunities for fun and support 1,961
Hours of professional tutoring
1,267
Hours of counseling
3,873
Trained, compassionate volunteers
263
Family days, holiday parties, recreation events and retreats
204
Crisis intervention workshops in schools, camps, and communities following tragedies
8
Become a partner.
Weeks in Camp Simcha and Camp Simcha Special, “the happiest place on earth” for children with cancer or chronic illnesses.
See how much more we all can do this year.
Helping the child, the family, and the community
151 West 30th Street, New York, NY 10001
(877) CHAI-LIFE (212) 465-1300 www.chailifeline.org
Regional Offices California | Florida | Illinois | New Jersey | Canada | England | Antwerp | Israel Chai Family Centers Brooklyn | Long Island | New York City | Monsey | Chicago | N. Miami Beach Chai House Philadelphia Goldman River Retreat Mahwah
15
RAISING OUR CHILDREN
FEBRUARY 2012
Advocates Fear a Proposed Redefinition of Autism By Yaakov Kornreich
T
16
he American Psychiatric Association (APA) has come up with a controversial new definition for autism, which is scheduled to be published by the end of this year in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders. Widely known as the DSM, it is the medical establishment’s "bible" for all psychiatric diagnoses. While the new definition has not yet been finalized, its outlines have already taken shape. Those familiar with work of the APA’s working committee of autism experts say that they have reached a broad consensus on doing away with the three distinct subtypes which were defined in the fourth edition of the DSM, published in 1994, as autism, Asperger Syndrome, and Pervasive Developmental DisorderNot Otherwise Specified, widely known as PDD-NOS.
In the fifth edition, already known as DSM-5, there will be only one recognized diagnostic category -- autism spectrum disorder -- that would replace the three current subtypes that, taken together, are already widely referred to as the autism spectrum. This will not just be a change in terminology. The committee is also changing the criteria that is currently being used by mental health practitioners to diagnose children with one of the three currently recognized subtypes, in an effort to give an autism diagnosis greater precision. The estimated rate of autism for children in the United States has skyrocketed since the definition was changed in the DSM-IV. Using the diagnostic criteria established in 1994, the rate of autism has been measured to be as high as one in every 110 children, many times the rate observed before those criteria were set. Some experts say that the sharp increase in the number of autism cases now being
*UDFLRXV 5HWLUHPHQW /LYLQJ RQ WKH $WODQWLF %HDFK %RDUGZDON
2FHDQ %RXOHYDUG $WODQWLF %HDFK 1<
diagnosed is authentic, and a cause for serious concern. Others contend that it is the result of the subjective nature of the diagnostic guidelines in the DSMIV, which encourages mental health professionals to label more borderline cases to be one of the three autism spectrum subtypes than they would have under the pre-1994 guidelines. There are also the autism skeptics who suggest that mental health practitioners are diagnosing more cases today because autism is in the headlines. As a result, more parents are bringing in their children for screening at a much younger age, when the symptoms of autism are much more ambiguous and difficult to interpret. According to Geraldine Dawson, the chief science officer for Autism Speaks, and a professor of psychiatry at the University of North Carolina, "This is not an academic exercise. These changes in the diagnostic criteria will have a real impact on people's ability to obtain services." According to Dawson, at least two studies of the new definition being proposed for DSM-5 show that it would sharply decrease the number of people who would be diagnosed with autism in the future, and who would therefore become eligible for health, educational and social services from the government. According to a presentation at a recent meeting of the Icelandic Medical Association, less than half the children who were diagnosed with autism in a 1993 study would qualify under the new proposed new DSM-5 criteria. For example, under the DSM-IV criteria, a mental health professional would have to identify impairment in only three of eight categories to confirm an Aspergerâ&#x20AC;&#x2122;s diagnosis, while under the proposed DSM-5 definition, an impairment in five of seven categories would be necessary. Dawson says that under the new definition, far fewer higher functioning individuals, including many now diagnosed with Asperger syndrome, would meet the autism spectrum disorder criteria. She agrees that the DSM-IV criteria do need updating because there is no clear differences between the three currently recognized subtypes as to their likely causes or recommended treatments. But she adds, "We have to keep in mind the real-world implications. In particular, we have to be very
careful that through this process that we're not excluding people from receiving services that they need and deserve."
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, is the ultimate mental health reference for professionals in the field, providing the definitive diagnostic criteria for all mental disorders. The DSM-IV was published in 1994, and is now being updated. The fifth edition, DSM-5, is due to be published in early 2013.
In addition to making it harder to diagnose new cases, parents of children already diagnosed with disorders on the autism spectrum and receiving treatment for it, worry that the DSM-5 definition might cause them to lose that designation, and the insurance and government benefits that go with it. Members of the APA's autism working group say that they are confident that their new definition and diagnostic criteria will not disqualify those who are truly autistic, but the research they say they have to back up that claim is still unpublished, and is thus not yet subject to scrutiny and verification by others in the field. Autism advocates say that the lives of too many people will be affected by a redefinition of autism to simply allow a committee of experts to do it by fiat. They are calling on the APA to put the proposed new definition to the test, and to release the results of that test well before the December 31st deadline for finalizing the DSM-5. That way, any fears and doubts about the new autism definition can be put to rest in advance, and there will be enough time to revise it, if necessary, before it goes into effect.
19 Unvaccinated Arizona Children Quarantined By Joel Mandel
A
case of the mumps diagnosed in a fourth-grader attending a public school in Gilbert, Arizona, a suburb of Phoenix, has led to the removal of 19 other students who have not been vaccinated against the disease, and who may have been exposed to the infected child on or before February 2. They will not be allowed to return to the Higley Elementary and Middle School until the end of the quarantine period, which in this case is February 28, as long as no additional mumps cases are reported before then. While the 19 children are kept at home, their school, with the help of county officials, will provide them with their daily homework. The move was a public health precaution against the unvaccinated children spreading the mumps to others. Bob England, the director of the Maricopa County Department of Health, said that, “we don’t do this unless we think we really need to. In order to cut it off before it has a chance to turn into a bigger outbreak, we have to make sure we’ve got herd immunity around that first case, meaning everybody around that first case immunized. … Hopefully, with this one, we can nip
it right in the bud and there won’t be any more cases.” "We hate to kick kids out of school," England added. "But every time a parent signs an exemption and chooses not to vaccinate their child, they've got to know this is possible." Arizona is one of the states which permits parents to opt out of the usual requirement for all children to receive their scheduled vaccinations in order to be admitted into class at the start of each school year. In Arizona, parents can request an exemption on personal or religious grounds, including fears that some vaccines could be harmful to their child’s health. The requirements in other states vary. Mumps is caused by a highly contagious virus. It used to be a common childhood disease, but outbreaks in the US have become relatively rare since vaccination became widespread in the late 1960's. Mumps is not serious, and leaves no lasting ill effects in children. Its symptoms include fever, headache, and a painful swelling of the salivary glands. Most children in the US are routinely vaccinated against the disease between the ages of 12 months and 15 months as part of the MMR shot (measles, mumps and rubella) and receive a second dose between 4 and 6 years old. The vaccine is about 80% effective.
Older adults are likely immune to the mumps because it was so prevalent when they were young, but children and younger adults who have not been fully vaccinated may be at risk. The safety of the MMR vaccine has been questioned. In 1998, Dr. Andrew Wakefield. published a paper in the British medical journal Lancet which claimed there may be an association between the MMR vaccine and onset of autism. This contention led many parents in the UK and around the world to resist the mandatory vaccination of their children. In 2004, evidence was uncovered that Wakefield had falsified his research. In 2010 Lancet retracted his paper, and Wakefield was reprimanded by his peers. Nevertheless, some parents still question the safety of vaccines, even though the consensus of the medical community is that the risks that they pose are small, and that universal vaccination is essential to public health. For example, in the summer of 2009, there was an outbreak of measles in several New York religious communities. It was started by an unvaccinated child who contracted the measles virus in Great Britain, and then spread it while attending a summer camp in the Catskills.
RAISING OUR CHILDREN
FEBRUARY 2012
17
WOMEN'S HEALTH
FEBRUARY 2012
Are Working Mothers Happier and Healthier Than Stay-at-Home Mothers? By Ita Yankovich
M
18
rs. Green is rushing off to work. She brushes away a strand of hair from her baby’s eyes, kisses her pudgy cheeks goodbye, while giving the babysitter last minute instructions for the day, all while adjusting her sheital, fumbling for her keys, and answering a ringing cell phone. In another household, Mrs. Abrams is keeping her eye on lunch sizzling on the fryer while folding laundry and singing ‘Twinkle Twinkle’ to her giggling infant in the bouncer. Her toddler is whining that he’s bored and demands that she play Lego with him, so she lowers the heat on the stovetop, puts the laundry aside and uses her left leg to move the bouncer all the while. The old debate over who has it ‘harder,’ stayat-home mothers or working mothers, has never been clearly resolved. Some studies claim that stay-at-home mothers are more satisfied while working mothers are plagued with guilt, while other studies suggest the opposite. To date, much of the research on maternal employment has been inconsistent and focused on how it affects the children’s upbringing, rather than how it affects the woman. Some studies have shown that the more a
HANDMAKER Serving Tucson, Arizona since 1963 Assisted Living Post Hospital Rehab Skilled Nursing Adult Day Programs Long Term Memory Care
520.322.7035 www.handmaker.org
mother works, the better off her children are, while other studies suggest the contrary. Finally, there are studies that haven’t even discerned a clear correlation. A recent report published in The American Psychological Association’s Journal of Family Psychology, claims that working mothers tend to be happier and even healthier than stay-at-home moms. That study found that mothers who are employed part-time reported better overall health and fewer symptoms of depression than stay-athome moms, and that there were no reported differences in general health or depressive symptoms between moms who were employed part time and those who worked full time. Mothers employed part time were just as involved in their child’s school as stay-at-home moms, and more involved than moms who worked full time. In addition, mothers working part time appeared more sensitive with their pre-school children and provided more learning opportunities for toddlers than stay-at-home moms and moms working full time. Mothers who participated in the study were from 10 locations across the U.S. The number of mothers employed part time remained at about 25 percent of the total during the study, although some of the mothers moved into and out of parttime work. Researchers then examined the data collected by a 10-year study by the National Institute for Child Health and Human Development, which tracked 1,364 mothers beginning in 1991 when their babies were 6 months old, and interviewing them seven times, and culminating when their children were fifth-graders. They compared stay-at-home moms to those who worked part-time or full-time (more than 32 hours a week) and concluded that in many areas, there was no difference in emotional well-being between the full- and part-timers. In general, part-time working moms reported less work-family conflict than full-time working moms, but the rates of depression and overall health levels were about the same for the two groups. The most significant differences arose when comparing stay-at-home moms to those who worked part-time. The part-timers were less depressed, had better health, were more sensitive to their children and were better able to provide them with learning opportunities. That may be a function of employment, which improves people’s social skills and increases awareness of what’s going on in the community. For example, part-time moms said they were as active in their kids’ schools as moms who didn’t work and, not surprisingly, were able to devote more time than moms who worked full-time. Tzivy Reiter, LCSW, and author of the soon to be released book, Briefcase & Baby Bottles: The Working Mother’s Guide to Nurturing Jewish Home, interviewed over 20 working mothers to gain insight into their daily lives. She believes that there is no one size fits all approach to the issue; whether or not a woman works is a very individual choice that
is based on a myriad of personal variables. “A woman’s happiness with her choice will depend in large part on the support she is given by her family and community, as well as the strength of the connection she has with her family,” Reiter explains. The financial-management website, Mint, published an estimate of how much a homemaker would earn if she were paid market prices for her work. The result was nearly $100,000 a year. Data like this vindicates stay-at-home moms who feel their work is undervalued. The salary was calculated by adding the daily cost of a chef, cleaning lady, babysitter, a personal driver, and a professional laundry service. Shira Offer, a Professor of sociology at Bar Ilan University in Israel, authored a study where she reported that working women today feel overburdened by their multitasking and lack of spousal domestic support compared to stay-at-home mothers. While today’s generation of fathers is expected to be involved in housework and child care, Offer still finds that most women feel that it is their primary role. “We expect mothers to be good workers who are highly committed to their work, but they are also the ones held accountable for how their children do and how their households are run,” says Offer. Socially, we are conflicted on how we feel about working moms vs. stay–at-home moms. In an online blog survey, when asked who has it harder, 39% polled believed that the answer is working mothers while 26% reported that all parenting is difficult, and 18% said it depends on the circumstance. “We live in a society that sends us mixed messages-extolling the virtues of the stay at home mom, yet denigrating her lack of career achievement,” says Reiter. This leads mothers to doubt their choices-whether that choice is to stay at home or work. This is why Reiter believes that being part-time working mothers allows them to have the best of both worlds-investment in a career, yet still affording them the flexibility to spend meaningful time with their children. Whether a woman chooses to stay at home or work it is imperative, as Reiter claims, that, “she feel supported in those decisions and comfortable that it can still yield a happy and positive outcome for their families”. Personally, as someone who has delved into both options, I can honestly say that I didn’t find one to be easier or more rewarding than the other. I think we all are just trying to be good “Yiddishe Mamas” in a modern, fast-paced world. Those who work feel the financial pressure to contribute and often feel conflicted when at home and at the office, while those who are at home all day can feel overwhelmed and isolated. The main take away point from this study is that we mothers have to take care of ourselves if we want to take care of our families. If it takes a village to raise a child, then shouldn’t it take at least for us, as women, to be plugged into our own mental health in order to take care of ourselves?
New Clues Found To Explain the Course of Lupus By Joel Mandel
L
upus is an autoimmune disease which affects an estimated 1.5 million Americans, striking mostly women of child-bearing age (15-44) 9 times more often than men. It can be difficult to diagnose because its symptoms tend to mimic those of other ailments. The most distinctive sign of lupus, which occurs in many but not all cases, is a facial rash that resembles the wings of a butterfly unfolding across both cheeks. Nobody knows why lupus causes the bodyâ&#x20AC;&#x2122;s immune system to attack healthy tissue in the kidney, blood vessels in the lungs, coronary arteries and the brain. However, a paper by Italian researchers, published in the Annals of Rheumatic Diseases identified a DNA sequence in people with a particularly intense form of lupus which appears to accelerate the progression of the disease.
These DNA "enhancers" in a sequence called HS1.2 accelerate the activation of neighboring genes responsible for the most severe form of the disease, which results in joint pain, fever, skin rashes, hair loss and anemia.
No two cases of lupus are exactly alike. Its symptoms may come on suddenly or gradually. The disease can flare up, becoming severe, and then, inexplicably start to improve or disappear completely. Scientists already knew that some people are born with a tendency toward developing lupus, which may be then triggered by infections, certain drugs or even exposure to sunlight. In addition, no two cases of lupus are exactly alike. Its symptoms may come on suddenly or gradually. The disease can flare up, becoming severe, and then, inexplicably start to improve or disappear completely over time. This is
We Are Here to Help. That is why we have a team of experts especially for you. Our Heritage Program has patient navigators that serve as liasons with physicians and medical staff to guide patients and families during their hospital stay. Call us anytime.
Richard Friedman, MD, FACS Director and Physician Liason (917) 710-4896
Joseph Deutsch Patient Navigator (917) 509-4441
why scientists have been eager to find more clues to accurately predict the course of the disease in each patient. The Italian researchers may have found part of the answer. They believe that the HS1.2 accelerator, which is
Dov Jacob Patient Navigator (917) 886-3865
found in over 30% of lupus patients, activates "transcription factor NF-KB," a molecule that turns on the genes which boost the production of the immune system antibodies that attack the healthy tissues of the body, which is the fundamental way in which lupus works. The HS1.2 genetic sequence also plays a role in other autoimmune diseases such as rheumatoid arthritis, and its presence in an individual may
indicate a greater susceptibility to all kinds of autoimmune diseases. Current treatments for lupus include cortisone, a powerful and dangerous steroid, as well as a variety of anti-malarial drugs and immune system suppressants. The discovery of the accelerator sequence could lead to new treatments for lupus based upon medicines specifically designed to "turn off" the accelerator effect. According to the head researcher for the study, Gianfranco Ferraccioli of the Catholic University of Sacred Heart in Rome, â&#x20AC;&#x153;new drugs that turn off the enhancer HS1.2, or inhibit its effect on NF-KB, may stop the disease without the need for immunosuppressive drugs or other therapies which have many dangerous side effects." The discovery could lead to a new diagnostic test for lupus sufferers, in which the presence or absence of the enhancer DNA sequence helps doctors to come up with a more precise prognosis for each patient, and more personalized care."
WOMEN'S HEALTH
FEBRUARY 2012
19
WOMEN'S HEALTH
FEBRUARY 2012
20
Breast Cancer Screening Caught in Controversy Over Planned Parenthood Once again, the bitter running controversy between right-to-life and pro-choice factions in this country has spilled over to impact the cause of promoting women’s health by damaging the credibility of the largest organization in this country fighting breast cancer, the Susan G. Komen for the Cure foundation. Komen was plunged into partisan political controversy on January 31 when it announced a cut off in its ongoing funding for breast cancer screening conducted by the Planned Parenthood organization. The foundation had been giving Planned Parenthood about $700,000 a year to provide the screening to all women seeking its family planning services. According to Planned Parenthood, over the past five years, the Komen grants paid for 170,000 breast cancer screenings at Planned Parenthood’s health centers across the country. The total amount of money involved, about $700,000 a year, represents a tiny fraction of the nearly $2 billion that Komen has spent fighting breast cancer since its inception in 1982. The Komen foundation has always been relatively conservative in its outlook. Its founder, Nancy Brinker, is a major Republican donor; who was appointed the US ambassador to Hungary by President George W. Bush. However, until now, her personal po-
litical orientation never intruded on the Komen foundation’s activities. However, the group’s previous grants to Planned Parenthood had drawn criticism from some pro-life advocates. They argued that giving Planned Parenthood money, even for a worthwhile purpose freed up other funds in its budget to pay for more of its abortion and other family planning services which pro-life advocates believe are immoral.
cized by Democrats in Congress and women’s health advocates for bowing to the pressure from the pro-life faction, and allowing the fight against breast cancer to be politicized. It quickly became a public relations disaster for Komen foundation, which is the largest, most widely known, and best-funded breast cancer organization in the United States. Planned Parenthood actually wound up reaping a fund-raising bo-
"Over the past five years, the Komen grants paid for 170,000 breast cancer screenings at Planned Parenthood’s health centers across the country." Komen foundation officials were careful not to tie the funding cutoff to the right to life issue. Instead they cited a rule Komen instituted last year which requires it to withdraw its funding to any group under any federal, state of local investigation. They then noted that Planned Parenthood is under investigation by Republicans in the House into whether it was violating the Hyde Amendment, which prohibits any federal health funding to be used to provide abortion services. The ruse fooled nobody. The leadership of Komen was severely criti-
nanza from the cutoff. Within three days of the announcement, a total of $3 million from over 10,000 donors around the country, including a $250,000 matching grant from New York City’s billionaire mayor, Michael Bloomberg. The intense criticism in the media forced the leadership of Komen to go into damage control mode, and search for a face-saving way out. Instead of simply admitting that they had blundered, they decided to change the rule which they had used as an excuse for the cutoff in the first place.
On February 3rd, the Komen board issued a statement to "apologize to the American public for recent decisions that cast doubt upon our commitment to our mission of saving women's lives." It also said that Komen "will continue to fund existing grants, including those of Planned Parenthood, and preserve their eligibility to apply for future grants." It also announced that the rule would be changed to "make clear that disqualifying investigations must be criminal and conclusive in nature and not political. That is what is right and fair." The announcement stopped short of committing the foundation to provide new funding for Planned Parenthood, and merely stated its eligibility to ask for it. Planned Parenthood then issued a statement saying, "We are enormously grateful that the Komen Foundation has clarified its grant-making criteria, and we look forward to continuing our partnership with Komen partners, leaders and volunteers." Then it was the turn of pro-life groups to express their disappointment that Komen had backed away from the cutoff, but by then it had become clear to everyone that the biggest loser from the episode was the effort by Komen to mobilize unified and bi-partisan public support for the war against breast cancer.
Cholesterol Drug May Fight Breast Cancer By Rachel Wizenfeld
A
new study published found possible benefits of using statins, a drug commonly used to lower cholestrol, to treat certain types of breast cancer patients, researchers and doctors say. The new research was published in the Jan. 20 issue of the journal Cell, and a Health Day News article said the study author, Dr. Carol Prives who is chair of the department of biological sciences at Columbia University in New York City, is cautious in her enthusiasm about the results and their implications. The study looked at a specific cell mutation called p53, which is found in roughly 20-40% of breast cancer tumors, according to Dr. Homayoon Sanati, oncologist and director of the MemorialCare Breast Center at Orange Coast Memorial Medical Center in Fountain Valley, CA. Cells with this p53 mutation have elevated levels of genes in a certain pathway called the mevalonate pathway, which is also involved in cholestrol synthesis. Stains are used to block this pathway to lower cholesterol, and
concurrently, when p53 breast cancer cells were exposed to statins in a laboratory, their growth rate went down. “Basically, that’s a signal in lab findings that statins can be useful in breast cancer patients that have this gene,” said Dr. Hanati. “It might be a mechanism to block their growth.” He cautioned that these findings are very preliminary, and additional research may be difficult since most of the statins drugs are becoming generic, the drug companies are not going to invest money in research. Thus government-sponsored cooperatives and other groups are needed to fund a study that will identify patients with this p53 mutation, give them statins, and see if it makes an impact on their breast cancer. Oftentimes it may take five to ten years to get a concept from a lab to actual clinical practice, Dr. Hanati said. Another study reported in 2005 also noted a link between breast cancer and statins. The observational study, reported at an American Society in Clinical Oncology meeting in Orlando looked at 40,000 patients in the VA system and
identified 500 who had breast cancer. Of those 500, patients who were taking statins versus those who were not had a reduced breast cancer risk of 50%. The problem with observational studies is that researchers don’t have complete information about the patients, including family history and what additional hormones they may be taking, Dr. Sanati said, but studies like these are possible in the VA system because of their excellent health records. Statins are also commonly used to treat heart disease, which is currently the most prevalent cause of death among women. Although another recent study has found increased risks of diabetes for statins-users, doctors agree that the benefits of statins far outweigh the risks. “Statins changed the landscape of coronary artery disease and for that reason many women should be on it,” said Dr. Sanati. Rachel Wizenfeld is a frequent contributor to publications like The Jewish Press, The Jewish Journal and the New York Blueprint. She lives in Los Angeles.
21
GOLDEN YEARS
FEBRUARY 2012
22
Diabetes The Silent Killer By Yaakov Kornreich
The world-wide diabetes epidemic and its related precursor, obesity, are the fastest growing public health menaces of the 21st century.
"Medical expenses for people with diabetes are more than two times higher than for people without diabetes." Source: National Diabetes Fact Sheet, 2011 - published by the Centers for Disease Control and Prevention
D
iabetes mellitus is a chronic condition resulting from the body’s inability to properly control blood sugar (glucose). Normally, the body controls the glucose level with a hormone produced in the pancreas called insulin. Those who have diabetes have either lost the ability to produce enough insulin, or the cells in their body no longer respond properly to the insulin that is being produced. More than 90% of diabetes cases in the US today are Type 2, and less than 10% are Type1. Diabetes was well known to the ancients, but the current epidemic of Type 2 diabetes is a phenomenon of modern living. It is largely the result of eating an unhealthy diet combined with a sedentary lifestyle. As a result, diabetes is nearly four times as common today as all types of cancer combined, and it causes more deaths each year than breast and prostate cancer combined. More than 25 million Americans already have diabetes, and more than double that number have blood sugar numbers high enough to classify them as suffering from pre-diabetes. That means that they are likely to develop the full blown Type 2 diabetes in the near future if they do not make the necessary changes in their diet and lifestyles to prevent it. Type 1 and Type 2 diabetes have many of the same symptoms and potentially deadly consequences, but different causes. Type 1 diabetes is also known as “juvenile diabetes” because in most cases it appears in childhood, in contrast with Type 2, which used to occur only in adults, which is why it was formerly known as adult-onset diabetes. Type 1 is an autoimmune disease, like Rheumatoid Arthritis and Lupus, in which something triggers the body’s own immune system to attack the insulin-producing beta cells in the part of the pancreas known as the islets of Langerhans. Type 1 cannot be cured, but it can be effectively managed. Proper insulin therapy, combined with regular monitoring of blood sugar levels, can allow people with Type 1 diabetes to lead a normal and healthy life. One of the most insidious aspects of Type 2 diabetes is that by the time people are diagnosed
AT A GLANCE - DIABETES
with it, they may have already developed a serious long term complication of the condition. Type 2 doubles the risk of cardiovascular disease, which ultimately kills 52% of people with diabetes. People diagnosed with Type 2 also have double the risk of suffering a stroke within 5 years. Almost one in three will eventually develop kidney disease, and diabetes is one of the leading causes of adult blindness. Diabetes is also associated with circulation problems in the lower extremities. This can result in the slow healing or infection of wounds on the feet and legs. This is further complicated by the fact that high blood sugar due to diabetes can cause damage to the nerves that sense pain. This means that diabetes patients may not realize that they have a wound on their leg or foot until after it has become dangerously infected. This can ultimately lead to the need for amputation. Type 2 diabetes is also a condition related to aging. Approximately 20% of the population over 60 have the condition, and an equal number have its precursor. It is no longer called “juvenile” diabetes because of the shocking relatively recent result of the obesity epidemic, the discovery of Type 2 diabetes, for the first time, in grossly overweight teenagers and young adults. Type 2 is typically treated with oral medications such as metformin, and it, too, requires the monitoring of blood sugar levels. The good news is that pre-diabetes or mild cases of Type 2 can also be controlled through appropriate changes in diet and lifestyle and weight loss. These are more effective, but require a lot more work and discipline, than taking pills. In fact, there is evidence that Type 2 diabetes can actually be reversed, in at least some cases, with sufficiently aggressive and strictly observed diet and lifestyle changes and weight loss. There are other types of diabetes, the most common being gestational diabetes, a temporary condition which affects 2-5% of pregnant women and generally subsides after the baby is born. The symptoms are similar to those of Type 2 diabetes, and women who have had gestational diabetes are at higher risk of developing Type 2 diabetes later in life.
Diagnostic Criterion (Type 1 and Type 2)
(Also known as: Diabetes Mellitus)
Definition: A metabolic condition in which the body suffers from excessively high blood sugar (glucose) levels. Estimated number of cases worldwide: Over 300 million
Hemoglobin A1c test: Pre-diabetes: 5.7% - 6.4% Diabetes: 6.5% or higher Fasting blood glucose level: Pre-diabetes: 100-125 mg/dL Diabetes: 126 mg/dL or higher
RESOURCES Friends With Diabetes www.friendswithdiabetes.org A Rockland County-based support group for religious Jews with diabetes. Distributes diabetessafe recipes, sponsors meetings (separated by gender and age), and presentations by renowned rabbonim. Publications, edited by Rabbi Hirsch Meisels, in English, Hebrew and Yiddish, address halachic, social and health challenges facing frum Jews living with diabetes.
GOLDEN YEARS
FEBRUARY 2012
Jewish Diabetes Association http://jewishdiabetes.com An organization devoted to diabetes education and advocacy offering its website, magazine and contact persons in both Hebrew and English.
Living With Diabetes www.mendosa.com Informational website
American Diabetes Organization http://www.diabetes.org An organization dedicated to preventing and curing diabetes and improving the lives of all people affected by the disease.
Women with gestational diabetes must be treated and closely monitored, because of the potential danger from the diabetes to the health of both the mother and the fetus. Gestational diabetes in the mother puts the baby at greater risk for high birth weight, cardiac and central nervous system problems, respiratory distress and skeletal muscle malformations. The damage done to blood vessels could impair the function of the placenta, causing fetal distress requiring early delivery through the induction of labor or cesarean section. Metabolic syndrome is the name for an increasingly common cluster of symptoms exhibited together in the same patient which are likely due to common factors. People with metabolic syndrome are at increased risk for coronary artery disease, stroke, and type 2 diabetes. The greatest risk factor for metabolic syndrome is obesity in which most of the extra weight, in the form of fat, is found in the chest and abdomen, giving the body an “apple” shape. It is also commonly associated with the phenomenon of insulin resistance,
Symptoms (all types): • Increased thirst • Increased urination • Blurry eyesight • Fatigue • Weight loss despite increased appetite • Numbness or tingling in the extremities (Type 1 & Type 2) • Nausea and vomiting (Type 1 & Gestational)
Continued on page 24
Major Complications (Type 1 & Type 2): • Damage to eyesight, leading to blindness • Cardiovascular disease leading to heart attack or stroke • Kidney damage leading to end stage renal failure • Nerve damage leading to loss of feeling • Circulatory problems in the legs and feet leading to infections and amputation
23
GOLDEN YEARS
FEBRUARY 2012
24
Continued from page 23
in which the body is unable to use insulin properly to control blood sugar and fat levels, leading to pre-diabetes. Other risk factors for metabolic syndrome include age, lack of exercise, and genetic factors. While not yet proven, scientists have a theory about how excess fat, especially in the abdomen, leads to Type 2 diabetes. Dr. Naveed Sattar, professor of metabolic medicine at the University of Glasgow, in Scotland, believes that if too much fat is stored in the abdomen, it can interfere with the way the pancreas produces insulin, and the way that the liver uses it to control blood sugar and fat levels in the body. Glucose is one of the main fuels for the cells of the body. It is released into the bloodstream by the digestion of the carbohydrates in our food. Insulin is used by the body to help maintain a constant level of glucose in the bloodstream by stimulating the liver and muscle cells to store excess glucose in the form of glycogen. When there is too much glycogen to be conveniently stored, the body turns it into fat which is stored in fat cells. According to Dr. Sattar, Type 2 diabetes may be the result of the body being unable “to make and store fat safely. Some people can store fat subcutaneously (under the skin). With others, it goes straight to the liver and pancreas. That's the classic big waist, pot belly shape; the fat isn't distributed around the body." According to the theory, at some point that excess fat interferes with the proper functioning of the liver and pancreas. The classic symptoms of uncontrolled diabetes include increased frequency of urination accompanied by increased thirst, and increased hunger. The symptoms develop more rapidly (over a few weeks or months) in type 1 diabetes while in type 2 diabetes they usually develop much more gradually and may therefore be more difficult to notice. Another symptom of uncontrolled diabetes is blurred vision, because of changes caused by high blood glucose levels in the shape of the lens of the eye.
Many of the long term complications from diabetes are the result of its accumulated damage to blood vessels throughout the body, including the coronary arteries, the veins in the legs, and the tiny blood vessels found in the retina of the eye and in the kidneys. How does one get diabetes? Scientists are not sure, but for Type 1, heredity plays only a minor role. Less than 10% of people with Type 1 have a family history of the condition. Scientists believe that even those with a genetic predisposition still must be exposed to an unknown triggering mechanism for the autoimmune reaction which destroys the body’s ability to produce insulin. Type 2 has a much stronger hereditary component, particularly when both parents have the condition. But even those who have those genetic factors can lower their risk by maintaining a proper weight and exercising regularly. While there is no cure for Type 1 diabetes, there
has been encouraging progress in its treatment. A new generation of miniaturized insulin infusion pumps is being developed which includes a continuous blood glucose monitoring system. Once perfected, the system would be implanted under the skin to function like an artificial pancreas. There are also ongoing experiments with transplants of pancreatic cells or stem cells to start producing insulin in the body again. But for now, most people with the condition still must rely on daily insulin injections. However, for people with Type 2 diabetes, there are viable alternatives to lifelong dependence on medications. In a recent study, more than 70% of subjects with Type 2 who underwent bariatric (gastric bypass or lap band) surgery, and who lost more than 30 pounds of body weight, appeared to be free of the condition. Similar benefits can be obtained by following a very low-carbohydrate diet, combined with regular exercise, which is intended not only to eliminate body weight, but also to slash the amount of fat around the liver and pancreas. According to Dr. Joel Goodman, the head of the Department of Endocrinology and Metabolism at Brookdale University Hospital and Medical Center, in Brooklyn, NY, a low-carb diet is most appropriate for people treating their Type 2 diabetes. Jews appreciate good food, and perversely, diabetes actually increases the body’s cravings for food, making it more difficult to curb one’s appetite. Yet today, religious Jews with diabetes can, within certain limitations, eat the traditional foods they love on Shabbos, Yom Tov and even Passover without endangering their health. Readily available resources provide diabetes-safe recipes for Jewish delicacies, halachic guidance, support and counseling. The obesity epidemic and the climbing diabetes statistics amount to a nationwide public health emergency. Yet, thanks to modern medical science, we have a much better understanding of this silent killer. Jews with diabetes, in particular, are no longer faced with the dilemma of being forced to choose between following our traditions and beliefs or protecting our health.
AT A GLANCE - DIABETES - THREE COMMON VARIATIONS: Type 1 (formerly known as Juvenile Diabetes) Prevalence: Less than 10% of all cases Cause: An autoimmune reaction destroying the body’s ability to make insulin Triggering Mechanism: Unknown Duration: Chronic Onset: Sudden Diagnosed population: Children or young adults Family History Risk Factor: Minor, less than 10% of cases have a family history Other Risk Factors: Unknown Treatment: Daily insulin injections with close monitoring of blood sugar levels
Type 2 (formerly known as Adult Onset Diabetes) Prevalence: More than 90% of all cases, growing quickly Cause: Improper body reaction to insulin (insulin resistance) Triggering Mechanism: Suspected interference of fat with pancreas and liver function Duration: Chronic Onset: Gradual, often marked by rising blood sugar levels (pre-diabetes) Diagnosed population: Older adults and others who are morbidly obese and sedentary Family History Risk Factor: Significant, especially in certain ethnic populations Other Risk Factors: Obesity and a sedentary life style (Metabolic Syndrome) Treatment: Oral medication, combined with change of diet and regular exercise
Gestational Diabetes Prevalence: 2-5% of all pregnant women Cause: Similar to Type 2 Triggering Mechanism: Interactions with pregnancy hormones Severity: Generally mild Onset: Midway through pregnancy Duration: Temporary - symptoms disappear after delivery Family History Risk Factor: Yes Other Risk Factors: Overweight, high blood pressure, age Treatment: Adjust diet to maintain safe blood sugar levels Complications: Babies tend to be larger than normal Mother at increased risk of Type 2 diabetes later in life
GOLDEN YEARS
FEBRUARY 2012
Diabetes Facts w cases of diagnosed Estimated number diabetes of new cases of diagnosed diabetes among people aged 20 years or older, by age group, United States, 2010
Estimated number of new cases of diagnosed diabetes among people aged 20 years or older, by age group, United States, 2010
d and undiagnosed diabetes Estimated percentage of people aged 20 years or older with diabetes, by age tage of people aged 20 years or older with diagnosed and undiag group, United States, 2005–2008 by age group, United States, 2005–2008
26.9%
About 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010.
1,052,000
13.7% 465,000 390,000
3.7%
20–44
20–44
45–64
45–64 Age Group
Age Group Source: 2007–2009 National Health Interview Survey estimates projected to the year 2010
Source: 2005–2008 National Health and Nutrition Examination Survey
Diabetes among people aged 20 years or older, United States, 2010 25
Group
Number or percentage who have diabetes
Age ≥20 years
25.6 million or 11.3% of all people in this age group
Age ≥65 years
10.9 million or 26.9% of all people in this age group
Men
13.0 million or 11.8% of all men aged 20 years or older
Women
12.6 million or 10.8% of all women aged 20 years or older
Percentage of adults with diagnosed diabetes receiving treatment with insulin or oral medication, United States, 2007–2009 16%
12% 14% Insulin only
58%
Insulin and oral medication
FAST FACTS ON DIABETES Diabetes affects 25.8 million people 8.3% of the U.S. population
Oral medication only No medication
DIAGNOSED 18.8 million people
Source: 2007–2009 National Health Interview Survey
Among adults with diagnosed diabetes (type 1 or type 2), 12% take insulin only, 14% take both insulin and oral medication, 58% take oral medication only, and 16% do not take either insulin or oral medication.
UNDIAGNOSED 7.0 million people All ages, 2010
Source: National Diabetes Fact Sheet, 2011 - published by the Centers for Disease Control and Prevention
GOLDEN YEARS
FEBRUARY 2012
By Dr. Morris Shamah
26
our doctor just told you that you have a cataract. He explained to you in a few words what a cataract is, and asked when you want to schedule surgery. You are stunned. What? A cataract? A film in my eye? Am I going blind? The doctor briefly reassures you, but, a little confused, you say you want to go home and discuss it with your family. He gives you a look, and with a shrug of his shoulders, he agrees, but you really do not understand what’s going on. What is a cataract. What has to be done? What is the overall picture of your future vision? We are all born with a lens in our eye. The lens is just behind the pupil, or behind the iris. It is, in an adult, about the size of two large lentils, side by side. The purpose of this lens is to focus an image of what we see on our retina, the optical sensor at the back of our eye. When we are born the lens is crystal
Understanding Cataracts
Y
clear. As we age, it gets cloudy, dark, filled with little vacuoles, much like a dirty window. After a long while, the lens becomes really opaque and the image that is transmitted to the retina becomes just a blur of light.
we call it an “egg white” and not an “egg clear.” What is happening when we heat the egg white is that we are changing the nature of a clear pro-
Why does this happen? In a minority of cases, it is due to certain diseases, to exposure to certain toxins or to radiation. But in most cases, it is a normal consequence of aging. Perhaps sunlight, chemicals in our diets, poor living and other factors add to the insult to the lens to make it cloudy. We know that diabetics get cataracts at a somewhat earlier age than non-diabetics. And we do know that some diabetics do get a particular type of cataract. But, in most people, a cataract is just a result of normal aging.
Why? Think of an egg white. As you crack a fresh egg, the white is nearly clear, transparent. But as you heat it, beat it, or shake it, it becomes cloudier and cloudier, until it is finally opaque and white. That why
tein and altering it so that it is no longer transparent. The same thing happens over time with the lens in our eyes. It is first a clear crystalline protein, but, with exposure over time, that protein becomes cloudy. This cloudiness usually does not happen suddenly, but rather gradually. The cloudiness can develop in different sections of the lens – in the front, middle, back, or throughout. The amount of opacity and its location is what determines if and how it affects your vision. For example, early on you could just have a bit of yellowing in the middle of the lens. This would cause almost no noticeable symptoms. Your doctor would tell you that you have an early cataract. At this stage, the cataract really needs no care. After a bit more time, this type cataract might cause slight darkening of your vision and a small change in your eyeglass prescription. A year or two later, you may find that things just do not appear as clear as they once were, that colors are changing (warm colors, like yellow, are more intense, cool colors, like blue, are less intense). Now your doctor would then check your glasses prescription, to see how much your vision can be improved, and discuss other symptoms from your cataract. If he and you together decide that vision will not improve enough with a change in the prescription of your glasses, he would then present you with the option of undergoing cataract surgery, to remove the cloudy lens inside your eye and replace it with a clear one. We will discuss the nature of this operation in the second part of this ar-
ticle, but first, we will discuss the various kinds of cataract development. Cataracts that develop on the very back of the lens – known as “posterior sub capsular” -- often cause a great deal of glare, even in the early stages. The glare from such cataracts can make night driving and walking in the sun terribly uncomfortable. And yet, in medium lighting, one might still see very well with such a cataract. These types of cataracts tend to develop in younger people and often progress rapidly. The decision as to whether or not to operate on this type of cataract would depend on the level of disability that it causes. For example, someone who drives at night would be a more likely candidate for surgery. There are various types of cataracts, including cataracts which affect newborns, that must be taken care of early. But in most cases, the decision on when surgery is necessary is a judgment call that the doctor and patient must make together after a glasses exam (refraction) is done. The decision is usually based on the level of patient disability and discomfort. If it is not necessary to remove the cataract immediately, an appointment is made for another visit to check on it in several months. It should here be said that there are some physicians who, for reasons that will go unmentioned, will surgically remove just about any opacity. It also should be noted that optometrists cannot, not by training and not by law, perform any eye surgery. So, in some cases an optometrist might try to nurse a patient with a cataract along by selling them new glasses when what they really require is a referral to an eye MD, an ophthalmologist, for surgical removal of the cataract. We will explain what that entails in part two of this article. Dr. Morris Shamah is an ophthalmologist, with a sub-specialty of glaucoma. He has headed the division of glaucoma for over 20 years at Brookdale Hospital. He is currently involved in full time clinical practice. Dr. Shamah is a founding member of the Ophthalmic Laser Surgical Society and is founder and chairman of the Brooklyn Glaucoma Society. He prides himself in resisting the trend of factory type medicine and runs a ‘super modern‘ but old fashioned type personal medical practice.
New Insights into Parkinson's By Sandy Eller
W
hile more than 50,000 new cases of Parkinsonâ&#x20AC;&#x2122;s Disease are diagnosed annually in the United States, sources as early as an ancient Egyptian papyrus describe symptoms that resemble those of this degenerative neurological disease. The first formal study of the disease was an 1817 write-up by British apothecary James Parkinson entitled â&#x20AC;&#x153;An Essay on the Shaking Palsy.â&#x20AC;? Today scientists are attempting to discover both the cause of and a still elusive cure for Parkinsons, and new treatments for the disease continue to evolve. Parkinsonâ&#x20AC;&#x2122;s is a brain disease that creates problems with movement. Its four main symptoms -- tremors, stiffness of the limbs and trunk, slowness of movement and impaired balance -- develop gradually and worsen over time. It is more prevalent in men and tends to develop at around age 60. High profile Americans who suffer from Parkinsonâ&#x20AC;&#x2122;s include former boxer Muhammad Ali, former attorney general Janet Reno and actor Michael J. Fox, whose Michael J. Fox Foundation for Parkinsonâ&#x20AC;&#x2122;s Research aims at finding a cure for the disease by funding Parkinsonâ&#x20AC;&#x2122;s research. While medications and surgical options exist to treat Parkinsonâ&#x20AC;&#x2122;s, none actually reverse the effects of the disease but merely alleviate its symptoms. Medications to treat Parkinsonâ&#x20AC;&#x2122;s include levadopa, developed in the 1960s and still the most effective treatment available; dopamine agonists, which trick the brain into thinking it is receiving dopamine; anitcholinergics, which help control tremors; and MAO-B and COMT inhibitors, which help prolong the effects of levadopa. For many years Parkinsonâ&#x20AC;&#x2122;s was thought to involve a lack of the neurotransmitter dopamine, caused by the death of dopamine-releasing cells in a particular area of the brain. But scientists now have reason to believe that the onset of Parkinsonâ&#x20AC;&#x2122;s actually begins in other parts of the brain. According to Dr. Edward Fon, chair of the Scientific Advisory Board of Parkinsonâ&#x20AC;&#x2122;s Society Canada, many Parkinsonâ&#x20AC;&#x2122;s patients have a medical history of loss of smell, abnormal REM (rapid eye movement) sleep, excessive sleepiness and chronic constipation, among other conditions. Dr. Fon hopes that by being aware of these non-motor manifestations of the
disease, Parkinsonâ&#x20AC;&#x2122;s patients can be identified long before crucial dopamine producing brain cells begin to die out. The discovery in 1997 of an abnormal gene that appeared to be responsible for early onset Parkinsonâ&#x20AC;&#x2122;s, which accounts for a small percentage of Parkinsonâ&#x20AC;&#x2122;s patients, was a significant breakthrough, as Parkinsonâ&#x20AC;&#x2122;s had long been thought not to have a genetic component. Since that time, researchers have identified mutations in seven genes that are directly linked to developing Parkinsonâ&#x20AC;&#x2122;s. While this accounts only for a minority of Parkinsonâ&#x20AC;&#x2122;s cases, it has opened up new doors in the research of this disease. Deep Brain Stimulation (DBS) is an existing surgical option that was approved by the Food and Drug Administration for Parkinsonâ&#x20AC;&#x2122;s treatment in 2002. In a small group of patients it has dramatically relieved their symptoms for as long as five years. A recent study on DBS effectiveness indicates that it may hold the key to significant improvements for Parkinsonâ&#x20AC;&#x2122;s patients. â&#x20AC;&#x153;This study validates the use of mild electrical currents delivered to specific brain structures in order to improve Parkinsonâ&#x20AC;&#x2122;s disease in select patients with advanced symptoms and additionally it explored a new stimulation paradigm,â&#x20AC;? said Dr. Michael S. Okun, administrative director of the University of Florida College of Medicineâ&#x20AC;&#x2122;s Center for Movement Disorders and Neurorestoration. â&#x20AC;&#x153;Future improvements in devices and the delivery systems for DBS will hopefully provide exciting new opportunities for Parkinsonâ&#x20AC;&#x2122;s sufferers.â&#x20AC;? Recent research also suggests that an abnormal protein in the brain called alpha-synuclein may be one of the causes of the cellular damage that plagues Parkinsonâ&#x20AC;&#x2122;s patients. If this is true, then developing drugs that could either stop or slow the spread of this protein could have significant bearing on the disease. â&#x20AC;&#x153;It is an exciting time to work on Parkinsonâ&#x20AC;&#x2122;s Disease,â&#x20AC;? Dr. Fon told Dimensions, a publication of the National Research Institute Canada, Canadaâ&#x20AC;&#x2122;s premier organization for research and development. Sandy Eller is a freelance writer who has written for various websites, newspapers, magazines and private clients in addition to having written song lyrics and scripts for several full scale productions. She can be contacted at sandyeller1@gmail.com.
Our aids are specially trained for your KOSHER needs.
GOLDEN YEARS
FEBRUARY 2012
A company of the GEFEN Senior Care Group
Our Services Include: R5 /,-#(!5 /* ,0#-#)( ( 5 %#&& 5 /,-#(!5 ,0# -
R5 ")**#(!5 ( 5 , ( R5 )'* (35.)5 " /& 5 **)#(.' (.-
R5 ,-)( &5 ,))'#(!5 ( 5 --#-. ( 51#."5 .#0#.# -5 R5 .35 /* ,0#-#)( ) 5 #&35 #0#(! R5 #!".5 )/- % *#(!I R5 &5 , * , .#)(
/( ,3 (includes accomodating chronically ill, diabetic, and R5 )'* (#)(-"#* KOSHER needs)
27
Our Homecare Locations Include: MAIN OFFICES 113-15 76th Road, Forest Hills, NY 11375 Tel: (718) 575-9090 Fax: (718) 575-9099
RECRUITING OFFICES 3099 Coney Island Avenue, Brooklyn, NY 11235 Tel: (347) 462-2900 Fax: (347) 462-2899
111 Beaver Dam Road, Brookhaven, NY 11719 Tel: (631) 286-4786 Fax: (631) 286-5229
372 E. 204th Street, Suite A, Bronx, NY 10467 Tel: (347) 945-2040 Fax: (347) 945-2041
Services are available 24 hours a day, 7 days a week. For more information about our home care services, please call us:
1-877-55-GEFEN (718) 575-9090
(1-877-554-3336)
www.gefenseniorcare.com
GOLDEN YEARS
FEBRUARY 2012
Effect of Antioxidants on Longevity Irina Lenkovskiy, MS, RD, CDN
T
28
he most common medical condition currently affecting the elderly in the United States is coronary heart disease, followed by stroke. Most seniors are plagued with some sort of ailments usually related to heart conditions, dementia, and osteoporosis, diabetes, and Parkinson’s disease, cancer and/or eye problems. We are so focused on drugs to manage these illnesses, that we neglect to consider how nutrition and a person’s diet play a very large role in keeping a person healthy and controlling some of these conditions, often preventing many of these diseases from even surfacing. Antioxidants in the blood are vital to overall health. Antioxidants is the collective name for the vitamins, minerals, carotenoids, and polyphenols that protect the body from harmful free radicals, which are the molecules produced when the body breaks down food, or by environmental exposures like tobacco smoke and radiation. Free radicals can damage cells, and may play a role in heart disease, cancer and other diseases. Low levels of antioxidants, or inhibition of the antioxidant enzymes, cause a chemical imbalance and may damage or kill cells. Antioxidants come from a variety of food sources, including fruits, vegetables, whole grain cereals, nuts and some other surprising sources such as coffee, chocolate, and red wine. Antioxidant substances are found in beta-carotene (found in large concentration in carrots), lutein (found in green, leafy vegetables), lycopene (absorbed from cooked tomatoes products), selenium (found in rice and wheat), vitamin A, vitamin C, and vitamin E. Vitamin E destroys free radicals in cell membranes and protects unsaturated fatty acids from lipid peroxidation. Vitamin E can block hydrogen peroxide production and the resulting cytotoxicity. Thus vitamin E may slow the progression of Alzheimer’s disease. According to recent studies, vitamin E concentration in the blood was lower among demented patients as compared with non-demented ones. Thus, a lower level of vitamin E may relate to developing Alzheimer’s disease.
The recent studies indicate that people who consume the highest amounts of vitamin C experience a reduced risk of ischemic stroke. Antioxidants can also protect against inflammation, atherosclerosis, enhance immune defense, protects eyes against cataracts and macular degeneration. They can slow and
recommended that patients should increase their Vitamin D to 600800 milligrams a day, studies have shown that high, daily doses of over 2,000 can put patients at risk for upper gastro-intestinal cancers such as pancreatic cancer. Another study suggested that smokers who took beta-carotene were at an increased
patients in their own home, employ dieticians which will be very beneficial to patients. An elderly person’s diet has a very strong effect on their aging process and medical condition. It is therefore beneficial for the elderly and their caregivers to seek the advice of a Registered Dietician.
possibly prevent the development of cancer. Antioxidants can have negative effects as well. High doses can be dangerous by working as prooxidants which promote rather than neutralize oxidation. In addition, not all free radicals are harmful. Some of them can attack harmful bacteria or cancer cells in the body and are therefore necessary. Thus, very high intake of antioxidants may destroy or slow the effect of the protective free radicals. Maintaining the proper level is very important; this is where professionals can step in. There is no simple approach to taking antioxidants. Many seniors are overly cautious and are not getting enough while others are taking too much for their medical conditions. Medical professionals warn that seniors can cause harm to themselves from overmedicating with antioxidants via supplements. For instance, when it was
risk for getting lung cancer, and the debate still rages over the benefits vs. the risks of cancer patients taking antioxidants. A dietician especially trained to work with the elderly population can discuss and emphasize the benefits of antioxidants, which can slow their aging process and prolong lives. A dietician can recommend healthy food options that contain antioxidants in a daily diet and explain the drawback of antioxidants when they are taken in the wrong amounts. Seniors cannot decide independently the level and quantities of their antioxidants; these specifications are determined by multiple factors such as: autoimmune disease, menopause, and cardiovascular issues. Seniors and their relatives may be surprised to know that the better home care agencies, such as Americare, an agency providing skilled and paraprofessional services to
Irina Lenkovskiy is a Registered Dietitian and Certified Dietitian Nutritionist. She has a masters of Science degree in nutrition and has been working with the elderly for the last seven years. She is currently employed by Americare CSS as a nutritionist providing direct counseling to the patients and continuing education/consultation to Americare’s nurses. Americare CSS is a Certified Home Health Agency. The Americare Companies, founded in 1982, provide high quality home care services in the N.Y. metro area, including the 5 boros, Long Island, and Westchester, Rockland, Orange, Dutchess, Putnam, Sullivan, and Ulster counties, in the Hudson Valley. Americare integrates compassionate patient care with family needs and is ready to serve 24/7 with registered nurses, home health aides, PT’s, OT’s, speech therapists, registered dieticians, and social workers. For further information call Penina Mezei at 917-992-5529, or e-mail pmezei@americareny.com for any questions regarding Americare or home care services.
Seniors and Technology Do Go Together By Shimon Lewin
W
ith so many new devices filling today’s technology market, picking one that fits your needs can be daunting and frustrating for someone who hasn’t used such devices before. Seniors, especially, may question if they actually need any of these gadgets. Many people think the new devices coming out are geared mostly for young people, but to their surprise, I have shown them how several of the devices can be of great use to them. The good news is that even though technology is getting more and more advanced, it is also getting easier to use. Besides for laptops, there are other types of devices that one can carry around with them and enjoy the many benefits that these machines have to offer. In this article, we will mention two: the smartphone and the tablet.
The Smartphone: A smartphone is a phone that does more than just make telephone calls. For instance, it can give
you the ability to see pictures and video of family members thousands of miles away. It can also help you keep track and schedule your daily tasks. The smartphone has four main operating systems in the U.S. This is the software that provides functionality to the phone. The companies that provide the operating systems are Apple (the iPhone), Blackberry, Google (Android devices) and Windows. The smartphone market was at first dominated by the Blackberry, but in recent years, Apple has pretty much taken over, while Google’s Android has been catching up. In last place are Windows-based phones.
The Tablet: A tablet is a device that can do most things that a computer can do but is lighter and more portable thereby providing greater ease of use. Picking out a tablet can be relatively easy if you are getting an Apple, as there is one basic line to choose from- the iPad series. If you decide to purchase a Google-based tablet, there is a little more research involved when choosing among the different options. I would recommend a screen that is 10.1 inches as opposed to the cheaper seven-inch screens. The bigger screens will allow you to see more and make the view clearer thereby enhancing your day to day usage. Other tablets are produced by companies like Barnes and Noble and Amazon, but that’s a topic for another discussion. These devices can greatly improve your way of living. Some of the apps (programs that can be purchased for the device) are briefly mentioned below, and will hopefully be discussed more in depth in future articles. Keeping track of medications. Remembering which medications to take and when can become a challenge when there are many pills to keep track of. There are apps designed to help you keep track of your meds, with the appropriate schedules. Planning a road trip? Visiting a friend who just moved out to a new neighborhood? Paying a visit to a new doctor? Google Maps will be able to assist you in getting to your destination in unfamiliar territory. You can actually see pictures of the streets (depending on the area) of where you need to go. You will Continued on page 31
GOLDEN YEARS
FEBRUARY 2012
29
GOLDEN YEARS
FEBRUARY 2012
Preventing Alzheimer’s Disease With Brain-Healthy Habits By Tzivia Emmer
A
A GLATT KOSHER Assisted & Independent living community
living at a NEW level
R. GROSSMAN 718.677.6757
30
s the first wave of baby-boomers hits their mid-60’s, the scientific community is paying close attention to the escalation of Alzheimer’s disease and other forms of dementia that affect an aging population. Alzheimer’s disease is becoming a global health crisis that is expected to exceed 100 million by 2050. So far, with clinical trials underway in a number of research centers, the only current medical treatment consists of drugs that can ease or delay symptoms in some patients. At the same time, a growing body of research indicates that lifestyle factors can effectively push back the ticking Alzheimer’s clock, allowing people to be free of symptoms well into old age, even past age 100. Senility was once thought to be a normal part of aging, but we now know that Alzheimer’s is a specific disease that causes structural and functional
changes in the brain. In 1906, the German neurologist and psychiatrist Alois Alzheimer applied chemical stains to slides of brain tissue obtained after the death of a patient with early-onset dementia. He saw deposits of abnormal waxy protein fragments and twisted fibers -- the “amyloid plaques” and “tau tangles” that currently define Alzheimer’s disease. Advances in imaging technology eventually showed that these protein deposits were present in nearly all older people if they lived long enough, and that they accumulated over a long period of time. “We now know that the pathology underlying AD is present years, if not decades, prior to development of symptoms,” said Jeffrey R. Petrella M.D., a leader of Alzheimer’s researcher at the Duke University School of Medicine in Durham N.C. In addressing a session of the yearly meeting of the Radiological Society of North America, Petrella gave an overview of how research using MRI, posi-
tron emission tomography (PET scans) and biomarkers such as cerebrospinal fluid have allowed scientists to observe what happens inside the brain of a living person. As a result of such research, the National Institutes on Aging and the Alzheimer’s Association have changed the definition of Alzheimer’s disease to recognize several stages, beginning with mild cognitive impairment (MCI). Previously, the only stage diagnosed was that of dementia, when significant cognitive decline has already occurred. Gary Small, M.D., who also spoke at the RSNA conference, emphasized the importance of lifestyle factors in forestalling the symptoms of Alzheimer’s disease. Small, the director of UCLA’s Longevity Center and author of the book, The Alzheimer’s Prevention Program, recommends a defensive arsenal of good habits to preserve brain health but he warns that “doing it for a few days isn’t going to help very much.” The point is to establish genuine habits, and to do so as early as possible. Small’s defensive strategy includes: • Diet, especially the Mediterranean diet, which emphasizes fruits and vegetables, healthy fats (such as olive oil), and fish (especially those with a high concentration of Omega-3 fatty acids). Those who dislike fish might want to explore and try different types of fish especially in light of MRI studies at the University of Pittsburgh Medical Center that suggest eating baked or broiled fish every week can reduce the risk of developing mild cognitive impairment and Alzheimer’s disease. Other dietary recommendations include antioxidant-containing foods, moderate caffeine intake, whole grain and high fiber foods, alcohol in moderation including red wine, and a number of spices, including turmeric. (Interestingly, the incidence of Alzheimer’s is relatively low in India, where curry is the national dish.) • Exercise. Couch potatoes take note: Sedentary people who begin a fitness program increase the size of their brains in the hippocampus
Courtesy NIH/NIA
Alzheimer’s disease spreads throughout the brain, ultimately affecting the areas of the cerebral cortex that control language, reasoning, sensory processing, and conscious thought
and frontal lobes, areas related to memory. Researchers at Harvard found that 90 minutes of brisk walking per week, or about 15 minutes a day, could delay cognitive decline. Any type of aerobic activity will serve the purpose: The goal is to get the heart pumping faster so that it delivers more oxygen and nutrients to the brain. • Brain training. Memory games and puzzles are becoming popular for improving brain function. But do they work? We now know that the brain can change and remodel itself in response to the right kind of stimulation. It can literally grow new neurons to improve information processing, memory, creative thinking and problem solving. Continued on page 31
Combining the warmth of home with resort ambiance Schedule a tour of our newly decorated Assisted Living Community PHOTO CREDITS: EMES STUDIOS
52 Madison Ave. Lakewood, NJ 08701 Ph: 732.905.2055 Fax: 732.905.4030 www.lakewoodcourtyard.com
Chanah Daina, CALA Director of Marketing
732.865.8130
TELL US YOUR FAMILIES STORIES ABOUT LIVING WITH ALZHEIMER'S, TO APPEAR IN OUR MAY 2012 ISSUE. EMAIL US AT MAGAZINE@JEWISHPRESS.COM
Margaret Tietz Nursing & Rehabilitation Center
IS ON THE MAP**
GOLDEN YEARS
FEBRUARY 2012
and our numbers have increased to match!
Providing
SPIRITual Sustenance as your body recovers!™
Brand new luxurious setting
Ronald Reagan, the 40th president of the U.S., was one of many prominent people afflicted with Alzheimer’s disease, including Aaron Copland, Norman Rockwell and Sugar Ray Robinson. Continued from page 30
In other words, mental exercise “builds brain muscle.” In addition, a recently released PET scan study at Washington University in St. Louis showed that people who are mentally active throughout their lives had lower levels of beta amyloid in their brains than those who were less mentally active. Since amyloid begins accumulating in the brain long before cognitive decline occurs, the best approach is to keep learning, reading, writing or engaging in intellectually stimulating activities throughout life. • De-stress. Among other studies, researchers in Sweden who followed a group of 1100 women for 35 years found that frequent stress in midlife led corresponded with a 65 percent higher risk of Alzheim-
featuring newly renovated rooms & upscale ambiance.
er’s disease. Defensive strategies against stress include getting enough sleep, not multi-tasking, meditation, physical activity, and meditative exercise such as yoga and tai chi. Although the National Institutes of Health (NIH) has yet to declare positively that lifestyle habits prevent mental decline, 80 million baby boomers entering the age of risk don’t have to wait around but can incorporate the strategies in the anti-Alzheimer’s arsenal into a healthy lifestyle. And meanwhile, as Dr. Petrella told the RSNA attendees, “the cure could be in someone’s test tube right now.”
New Director of Guest Relations –
Rebbetzin Lonni Oppenheimer,
Expansive Rehab Gym, well-stocked with the latest cutting edge equipment.
Tzivia Emmer is a freelance writer and partner with medical physicist Bruce Emmer, DABR, DABMP, in Emmer Communications, a copywriting and content team serving the radiology industry. They can be reached at info@emmercommunications.com.
Expanded Kosher Kitchen, with two dedicated & fabulous chefs. *We created our very own
Neighborhood Eruv Map & Guide,
dering or worrying about your property while you are on vacation. The list of things these tablets can do with the right apps installed on them is endless. It is important to keep in mind that technology can be of great use to people of all ages. Once you learn a little bit about the different devices out there, it’s really not as intimidating as it may seem at first. Shimon Lewin is IT director for The Jewish Press and the author of numerous articles on technology and software. He can be reached via email: electoday@jewishpress.com
a highly popular piece that’s now in its second printing!
adlibunlimited.com
never have to fumble with an outdated map, or rely on unclear or incorrect instructions from friends. It really is amazing to be able to see places you have never been to in such great detail and depth! Apps that connect you to devices to monitor your home while you are away. There are some great devices and apps out there that can help you see your home when you are thousands of miles away -- No more won-
31
Plans for
Seniors and Technology Do Go Together Continued from page 29
beloved Rebbetzin of Young Israel of Forest Hills, to make sure our Residents feel at home.
164-11 Chapin Parkway, Jamaica Hills, NY 11432 718-298-7800 • www.margarettietz.org Centrally located near the Queens communities of Kew Gardens Hills, Hillcrest & Jamaica Estates. Only 20 minutes from Brooklyn, Manhattan & the Five Towns.
HEALTHY LIVING
FEBRUARY 2012
The Okinawan Lifestyle: A Secret to Longevity? By Leah Lebel
F
32
or most people, celebrating at a friend’s or loved one’s one-hundredth birthday is considered a rarity. With an average world lifespan of just over 70, it’s quite likely that most of us will not have the privilege of celebrating our own centennial. In one segregated part of Japan, however, it’s rather common to meet someone who has celebrated this milestone. Okinawa, one of the Ryukyu Island group, boasts a community of people enjoying the longest life spans on earth. They seem to have access to some secret fountain of youth. In fact, not only are these people older than those in most other cultures, but they are also relatively more active, have fewer chronic health problems, lower rates of dementia, healthier bone densities and appear more youthful than those who are two decades younger. They have the lowest mortality rates from some of the most prevalent chronic diseases in the United States, including cancer, heart disease, and strokes. For years, people have been trying to uncover what became known as “The Okinawan Secret to Reaching Old Age.” While many had hoped to discover some mysterious herbal remedy, or perhaps a recipe for a youth potion, the reality is that there is no easy or quick way to achieve the staggeringly long lives that the Okinawans are fortunate to reach. Indeed, their longevity has a lot more to do with their lifestyle than with luck or a mysterious ritual. The Okinawans are living examples of just what far-reaching effects a healthful diet, coupled with a healthful lifestyle, can have. There’s nothing unfamiliar about what their diets contain. In fact, it’s mostly what’s been preached to us by public health officials for years. The problem is that behavior change is easier read about than accomplished. Moreover, many of the central characteristics of the Okinawan lifestyle are not readily adaptable to the fast-paced world we live in today. However, there are several noteworthy lifestyle adaptations that we can, to a limited extent, imitate and implement, with a little motivation and perhaps a powerful will to live longer. Here are some aspects of their healthy lifestyle that you can begin practicing right now: • The Okinawans do not overeat: When it comes to moderation, there are few who understand limits better than the Okinawans. This culture regularly practices calorie control by a simple cultural principle that they refer to as “hara hachi bu.” Odd pronunciation aside, this is essentially a method of eating whereby they stop when they are only eighty-percent full. Through Hara Hachi Bu, the Okinawans manage to maintain low BMIs (bodymass indexes), which is likely one of the secrets to their living long. • Their lower body weights: The average BMI of an Okinawan is twenty, significantly higher than the average in (surprise!) the United States. The new agenda for US public health is now addressing an overweight, rather than a healthy-weight, population. More than half of the American population
now has a BMI of over 25, making the majority of us overweight. A BMI above 25 puts one at increased risk for atherosclerosis and many chronic diseases. There are many benefits from achieving a healthier BMI that many of us can enjoy. Perhaps striving for a BMI that’ll decrease the risk of having a heart attack will increase the odds of extending our life spans. • Physical Activity: Even at extremely old ages, the Okinawans are anything but sedentary. They maintain high rates of physical activity every day, a recommendation that’s been made by the Academy of Nutrition and Dietetics (formerly known as American Dietetic Association) for many years. The Okinawans garden, dance, and practice martial arts (some members of the Okinawan community still participate in competitive sports past the age of one-hundred).
a non-pressurized and easygoing lifestyle, a strong sense of earthly purpose, and are optimistic. While many of us strive to slow down or squeeze in another hour of relaxation in our continuously busy schedules, the Okinawans take it easy and as a result, seem to have more time on their hands in the long run too. Although there is much evidence that the Okinawan practices correlate with longer life spans, there are still many people that are flummoxed and do not understand the staggering impact that merely leading healthful and non-stressful lifestyle can lead to. Truthfully, diet and lifestyle alone does not necessarily guarantee a longer lifespan, but it can offer a greater quality of life, if a longer life in itself is not attained. Another potential factor in the longevity of the Okinawan people, in addition to their healthy life-
• What they eat: The Okinawans eat a diet that’s naturally high in whole grains and contains a plethora of foods rich in antioxidants and phytochemicals. They consume extraordinarily high amounts of omega-3 fatty acids and monounsaturated fats from sources such as fatty fish. They also consume relatively low amounts of saturated and trans-fats. They eat diets quite rich in fruits and vegetables, which, like maintaining lower BMIs and achieving high physical activity rates, have been correlated with lower rates of mortality from many chronic diseases. • Other potential contributors: In addition to eating an ideal diet composition, the Okinawans maintain social networks and keep strong interpersonal bonds, which is yet another factor that has been associated with good health. Moreover, they have
style is their genetics. Science does not yet have a conclusive answer to the question of whether genetics or lifestyle has a larger impact on determining lifespan. Nonetheless, many are striving to emulate the ways of the Okinawans in the hope of extending their lives. Some consider this a futile quest, but others will not be surprised if the Okinawan emulators increase their chance to become fortunate enough to attend a very special hundredth birthday party— their own.
Leah Lebel is the former editor-in-chief of the Touro College newspaper. She graduated with honors and an award alongside her bachelor’s in biology and psychology and is now pursuing a Master’s degree in Nutrition at Brooklyn College.
Juice, the Whole Juice and Nothing but the Juice By Ita Yankovich
M
ost people turn to fruit juices as a healthy alternative to soda and coffee. Whether it’s apple, orange or grape, most of us enjoy at least one refreshing glass a day. Many are unaware; however, that drinking juice can be just as unhealthy as soda, harmful and damaging to one’s health and even deadly.
Medicine and Juice When taking medicine it is best to take it with plain water since many fruit juices do not interact well with drugs. Grapefruit juice specifically has been proven to counteract with many medications. The American Chemical Society recently conducted a study where they gave patients taking the allergy drug fexofenadine, either a glass of water or juice. When the drug was taken with grapefruit juice, for instance, only half of the dose was absorbed into the bloodstream, compared to taking it with water. Grapefruit also doesn’t mix with the popular drug Lipitor causing possible liver damage. Scientist have also found that grapefruit, orange and apple juices reduce absorption of the anticancer drug etoposide; certain beta blockers used to treat high blood pressure; cyclosporine, used to prevent rejection of transplanted organs; and certain antibiotics. European scientists have found high levels of antimony, a chemical linked to cancer, in a number of popular juice brands. In some cases, the levels were 10 times higher than that what is considered ‘safe' under EU guidelines. It is believed the substance is leached into fruit juices from the plastic bottles.
Children and Juice Many parents think they are doing the right thing by filling their kids’ bottles, Sippy cups and glasses with juice, but beware since many juices are not that much better than soda, due to their high sugar content. The American Academy of Pediatrics issued guidelines saying fruit juice should not be given to children younger than 6 months, and that there is no nutritional reason to give it to them before their first birthday. Children 1-6 years old should only have 4-6 ounces of juice a day and older children 8-12 ounces day. The problem with juices is that their high sugar and calorie count promote obesity in children and makes them lose their appetite for healthier options such as low-fat milk. In addition, by opting for the juice rather than the actual fruit, kids miss out on important fruit fibers. Fruit juices also promote tooth decay in children especially, when they are allowed to take a bottle or Sippy cup with juice to sleep with them. The prolonged contact allows the sugar in the juice to penetrate the enamel in the child’s teeth more deeply. Parents should make also sure that they are giving their kids only 100% pasteurized fruit juice, in which any harmful organisms that may be present have been killed by the pasteurization process. Arsenic found in apple juice has been getting a lot of attention since Dr. Oz, a prominent television talk show host, announced that apple juice contains potentially
dangerous levels of inorganic arsenic, a known carcinogen. The FDA at first discredited the report, but then Consumer Reports conducted its own apple juice tests, and found that 10 percent of juices tested contained high arsenic levels. That led the FDA to announce that it was considering tighter apple juice restrictions while it conducts its own research.
Diabetics and Juice When consuming juice, diabetics need to keep a close watch on their blood sugar levels since some juices (cranberry) are absorbed at a quicker rate and lead to a more rapid rise in blood sugar levels compared to unfiltered apple juice or vegetable juice with are absorbed at a slower pace. A limited amount of juice is allowed for diabetics, but they must consider how it fits in as part of a well-rounded diet in keeping within the recommendations of their physician. For diabetics who must take insulin, having a small container of juice readily available is highly recommended. Drinking the juice can serve as a quick antidote in cases of an insulin overdose, leading to the risk of passing out due to blood sugar levels falling too low. Interestingly, an Israeli study has found that pomegranate juice, although it contains sugars, does not worsen sugar levels in the blood, and in fact cut the risk of atherosclerosis.
Decoding the Juice Box This article is not intended to discourage juice drinking, but rather to be smarter about how and what kind of juice we drink. Fruit juices can be a vital part of a well-balanced diet, but consumers need to be educated and understand how to interpret the labels, so they are actually drinking juice and not a concoction of water, dye and sugar. Tropicana and Nestlé’s Juicy Juice were criticized by the FDA for printing misleading labels, which had consumers thinking they were purchasing a 100% blend of orange and tangerine juice, when in fact the product was mostly made up of flavored apple juice. The term used to describe the juice is important. In the USA, fruit juice can only legally be used to describe a product which is 100% fruit juice. A blend of fruit juice(s) with other ingredients is labeled “juice cocktail” or “juice drink.” Read the ingredient list. Make sure that you’re getting 100% juice. Often times, you think you are drinking cranberry juice, for example, buy you’re really drinking a mixture of apple, grape and cranberry juice, with added cranberry flavor, so don’t be fooled by the picture on the bottle. Check out how many grams of sugar are in the drink and if there are any artificial sweeteners and flavors. Just because the label claims to be sugar –free that doesn’t mean that the liquid is void of all sugars since the fruit contains natural sugars. Misleadingly labeled juice drinks can be dangerous for diabetics and bad for those trying to lose weight. Ita Yankovich teaches English Literature and Writing at Kingsborugh and Touro College. She is also a freelance writer who has authored several articles in various publications. She can be reached at itayankovich@yahoo.com
TAFKID
assists families whose children have been diagnosed with a variety of disabilities and special needs.
HEALTHY LIVING
FEBRUARY 2012
Services provided by TAFKID include:
D Family Support Services & Information D Educational Advocacy D Individual Case Consultation D Referrals to Doctors, Therapists, Schools and Government Programs
D Parent Matching D Family Recreation Programs D Parent Training and Meetings D Guest Lecturers D Community Sensitivity and Training D Informational Publications D Pediatric Equipment Lending Program D Tape/Video Lending
is a not-for-profit organization services are free of charge to all families. For more information call TAFKID at (718) 252-2236 or e-mail: tafkid@aol.com
33
HEALTHY LIVING
FEBRUARY 2012
Fit and Trim A Working Woman’s Health Routine By Tanya Rosen
M
34
edia conglomerate CEO Martha Stewart has a packed day, starting at 5 AM and ending at 12 AM. But no matter what her schedule demands, Martha makes time to do two workout routines - one complete fitness routine in the morning and a yoga session in the afternoon. The lesson is obvious - if Martha Stewart, at 69 years old, can make time for two fitness routines, all working women should consider adding a disciplined fitness routine into their daily or weekly schedules. For working women like me, juggling a family and a career, the key to a healthy - and moderately stress free life - is a schedule. Just like you have a weekly planner for all your tasks, buy a weekly fitness planner to track your fitness routine. And stick to it! By scheduling your fitness, you won’t miss a beat in your routine. Lunch time workouts are rising in popularity so
use that extra hour to your advantage. Research any gyms that are within a five minute of your workplace. Not interested in changing and feeling sweaty all day? Opt instead for an in-office workout utilizing chairs for tricep dips and stairs for a great cardio routine. No matter which option you select, make sure to focus on intensity. But most importantly - be sure to eat lunch at some point. You’ll need to refuel for the rest of the day. Take it from me - staying fit and eating healthy are important ingredients for a maintaining a healthy lifestyle in the workplace and in your home.
Fitting Fitness into a Busy Man’s Lifestyle By Isaac Hyman
W
hen it comes to staying healthy, many men elect to focus on healthy eating to maintain a healthy lifestyle. Without proper fitness and conditioning, however, you may miss out on a vital part of healthy living. Think of health and fitness as two business partners - steady, supportive, growth oriented, and unforgiving when you have one misstep. The problem lies in defining what proper fitness means to the busy working man who considers walking up a flight of stairs to be a strenuous exercise. We live in a world of speed and convenience, which means we’re more efficient workers but less healthy people. Still, we can do small things to modify our daily commute to and from work to improve fitness. Try getting off one stop earlier on your subway, or walk up the five flights of stairs instead of using the elevator. Instead of riding
the escalator, make double time by walking them also. These small steps will get you thinking fit in all aspects of your day. Posture issues from non-ergonomic seating, carpal tunnel syndrome, and cramping are all work-related health issues that affect body and mind. We’re not giving up computers, chairs, or cramped work spaces anytime soon, but a solid cardio and aerobic routine in the morning will leave you feeling refreshed and awake to start the day. And for those who just want to shake off the stresses and strains of sitting all day, hit the area gym before heading home. In business, time is money. If you value achieving something, then you’ll spend more than five minutes on it. And that goes for your fitness routine. A customized fitness routine is a better investment of your time than a 5 minute abs workout. A great fitness routine goes hand in hand with healthy eating habits. It’s important to remember to hydrate throughout the day with liquids other than coffee. Avoid snacking on chips and opt for a banana instead, a significantly filling and nutritious food. Stock your work fridge with yogurts or granola bars that you can grab and go. By eating healthy and keeping a steady fitness routine, you’ll have more fuel and energy to do more, achieve more, and keep your career moving as fast as you want.
TREADMILL TIPS & TRICKS Vary your workout. In other words, DO NOT do the same action every time you get on the treadmill. If you’ve been walking, run a little. If you always run, try power walking for a change. You can play around with the intensity, duration, and incline levels, all to change the type of workout. When you do the same thing, your body just gets used to it and stops reacting. So always change it up.
er to move, but it will work your muscles, and give you more of a challenging workout.
fat. That is because after interval training, your body continues to burn fat throughout the day.
Go climbing.
Don’t forget to warm up, cool down, and stretch.
On the treadmill that is. Raise the incline level on your treadmill. You can start with a 2.0 incline and work your way up to whatever feels comfortable (yet challenging). Again, this will slow you down but give you more of a challenge and vary your workout.
Add some weights.
Interval training is STILL the best.
Try putting on a pair of wrist weights, or ankle weights. This may slow you down, as it will be hard-
Interval training, mixing a warm up, jogs, runs and hill climbing, is considered the best way to burn
Your body is like a car; it is “cold” when not in operation, so give yourself a full five minutes of warm up before you start running or jogging. Walk at a moderate pace, and move your arms as well. When you are done, do NOT just jump off the treadmill with your heart rate so elevated. Slow it down gradually by decreasing the speed until you feel that your heart rate slowly went down (Around 5 minutes). Don’t forget to stretch when you are done.
Tanya Rosen is the co-owner of Shape Fitness, an all women’s fitness studio in Flatbush. Tanya is a certified nutritionist, personal trainer, and Aerobics Instructor, specializing in pre and post natal fitness. The first ever kosher workout DVD by Shape is now available in Judaica stores or online at www.shapefitnessgym.com, where personal training packages and class schedules can be viewed as well. To contact Tanya or Shape, please call (718) 338-8700
Isaac Hyman is a Certified Personal Trainer, pushing Jewish men and youth to stay fit, think fit, and act fit every day. He can be reached at 908.906.1857 or at MaccabiFitness@ gmail.com
Make Tonight’s Dinner Tomorrow’s Lunch! By Nina Safar
W
ant your resolution to eat healthy this year to last? Skip boring meals made out of bland ingredients and go for zesty dishes that are bursting with flavor. The more flavorful the meal, the more filling it will be! Cilantro, lime, honey, soy sauce, ginger and garlic should all be staples in your kitchen. Carefully blended, these can be used to make even the simplest recipes taste delicious. When shopping for ingredients, plan ahead to make enough dinner that there will be leftovers for tomorrow’s lunch! This way, you won’t be tempted to order in greasy takeout or munch on muffins, donuts and chips when in the office. * All of the recipes below can be served over brown rice, quinoa or steamed veggies for dinner; they also taste great in a whole wheat wrap with crisp lettuce and some avocado, or over a salad, for lunch.
Directions: Combine the olive oil, soy sauce, lime, honey, garlic, ginger and steak seasoning in a large zip lock bag. Place the chicken inside and marinate for several hours. Heat grill pan to medium high and grill chicken for approximately 6 minutes each side, or until juices run clear. Squeeze some fresh lime on top before serving.
HEALTHY LIVING
FEBRUARY 2012
Teriyaki Grilled Tofu: I love a good burger or a zesty chicken dish, however sometimes it’s nice to switch things up and keep the menu lighter with a vegetarian dinner. Going meatless doesn’t mean skimping on flavor! The glaze in this recipe is good enough to eat solo, but tastes even better drizzled over veggies and grilled tofu.
Baked Salmon with Lemon & Cilantro: My husband has never been a fan of salmon until we had it for dinner one night at our friends, Mira & Levi. I have to admit, at first I was jealous that she was able to get him to eat two servings of something that he would never finish at home. But then I gave myself a mental slap and realized it would be ridiculous for me to not ask her for the recipe. I’m glad I did, since I now make this for dinner at least once a week!
Honey Lime Grilled Chicken Some nights I crave carbs like pizza and pasta. Then there are the nights when all I want is a fresh garden salad topped with juicy slices of perfectly grilled chicken. This marinade blends together some of my favorite ingredients to create a sweetly glazed chicken that has just the right kick of lime.
35 • • • • • •
• • • • •
• • • • • • • •
Ingredients: 4 boneless, skinless chicken breasts 1/4 cup olive oil 1/4 cup soy sauce Juice of 1 lime 3 tablespoons honey 3 cloves of garlic, diced 1 tablespoon of ginger, diced 1 teaspoon Grill Mates® Montreal Steak Seasoning.
Ingredients: 2 tablespoons olive oil 2 tablespoons lemon juice 1/2 teaspoon Montreal Steak Seasoning Chopped cilantro 3 pieces of salmon
Directions: Combine the olive oil, lemon juice and steak seasoning and drizzle some over the fish, leaving half of the mixture on the side. Bake the salmon in a 500 degree oven for 20 minutes, uncovered. After you remove the salmon from the oven, place the chopped cilantro in the remaining olive oil and lemon juice mixture and pour over the freshly baked salmon.
Ingredients: 4 tablespoons soy sauce 2 tablespoon rice vinegar 1/4 cup honey 2 garlic cloves, minced 1 teaspoon peeled fresh ginger, minced 1 package of extra firm tofu
Directions: Remove tofu from package and pat dry with paper towels to remove moisture. Then, cut into triangles and grill the tofu on a grill pan over medium heat (do not heat with oil!). Meanwhile, combine the remaining ingredients on stovetop and stir until thickens. Once the tofu has been cooked, serve over steamed string beans and drizzle the sauce on top. When Nina Safar is not updating recipes on Kosher in the Kitch, she enjoys playing hostess. Never having too much time in the kitchen, she likes recipes that taste great and are easy to make. Kosher in the Kitch features recipes from experienced foodies as well as experimenting cooks. You don’t have to be a chef to cook a good meal! For more great menu ideas and tasty recipes, check out www.kosherinthekitch.com for your next favorite dish.
Crunchy Cravings: Low Cal Snacks! When you are craving something salty and crunchy, stay away from snacks loaded with empty calories such as potato chips, and reach for a healthier more filling (and still crispy!) snack instead.
- Apple slices with peanut butter - Carrot sticks with hummus - Almonds - Frozen Grapes - Roasted chickpeas
HEALTHY LIVING
FEBRUARY 2012
Sit Stronger to Control Back Pain By Dr. Steven Weiniger
I
f you have back pain, you probably already know your posture isn’t good. And if you sit for much of your waking day, you know you’re training your body to be slumped over into folded, or “weak” posture. However, even though you may never be per-
is an easy back and hip stretch you can do at your desk. You can use your office chair, or if you want to challenge yourself with an exercise taught by posture professionals, do the Sitting Leg Cross while sitting on a ball. A: Sit tall and strong on the front edge of chair or ball as you cross your left leg over the right knee. Pull your belly in to brace your core. As you
36
fectly straight, there are ways to relieve your pain by strengthening your posture. Low back pain from sitting results from mechanical stress on the body. This is called poor bio-mechanics, and when the body is not mechanically well aligned posture, and balance, is weak. The simple act of balancing when you stand up with weak posture will overwork some muscles and stress joints. The key to reducing this strain is to improve balance, and the ability to control HOW you balance, to retrain muscles and nerves for less pain and better function. Step one towards stronger posture is improving the symmetry of how your body moves on each side. In fact, just changing the position from which you move can help free up locked and stiff joints and become the first step to stronger posture and less pain. The SITTING LEG CROSS StrongPosture Stretch
exhale, keep your head and shoulders aligned as you pull your body forward. Take 2 or 3 breaths, and come up with your posture still strong. Repeat on other side. B: Repeat above, but this time cross your legs at the knee. Do this to help you become aware of and improve your lower body symmetry, and to start your own daily posture exercise program. Steven Weiniger literally wrote the book on posture exercise: Stand Taller~Live Longer-An Anti-Aging Strategy. He created the StrongPosture™ exercise programs taught by Certified Posture Exercise Professionals (CPEPs), chiropractors, PTs, massage therapists and other body professionals who promote the importance of posture with annual posture pictures and daily posture awareness. For more info see www.BodyZone.com.
New Approach in Natural Healing By Jenny Azar CMT
I
n an age of technical and at times, impersonal medicine, massage offers a drugfree, non-invasive and humanistic approach based on the body’s natural ability to heal itself. So what exactly are the benefits to receiving regular massage and/or bodywork treatments? • Increases circulation, allowing the body to pump more oxygen and nutrients into tissues and vital organs. • Stimulates the flow of lymph, the body’s natural defense system, against toxic invaders. For example, in breast cancer patients, massage has been shown to increase the cells that fight cancer. • Increased circulation of blood and lymph systems improves the condition of the body’s largest organ the skin. • Relaxes and softens injured and overused muscles. • Reduces muscle spasms and cramping. • Increases joint flexibility. • Reduces recovery time, helps prepare for strenuous workouts and eliminates subsequent pains of the athlete at any level. • Releases endorphins the body’s natural painkiller. Massage is now being widely used in chronic illness, injury and recovery from surgery to control and relieve pain. • Reduces post-surgery adhesions and edema, and can be used to reduce and realign scar tissue after healing has occurred. • Improves range-of-motion and decreases discomfort for patients with low back pain. • Relieves pain for migraine headache sufferers and decreases the need for medication. • Provides exercise and stretching for atrophied muscles and reduces shortening of the muscles for those with restricted range of motion. • Promotes shorter labors for women giving birth, as well as reducing the need for medication, relieving depression and anxiety, and shortening hospital stays. Jenny Azar is a Certified Massage Therapist specializing in pre/post natal massage at Bavia Health in Monmouth Medical Center. She is also a teachers assistant at The Institute for Therapeutic Massage. For more info call 732-936-911 or log onto http://www. massageprogram.com.
Raw Food Diet By Sheryl Mayer MS RD CDN
I
t seems like we will do anything to lose twenty pounds before Pesach (or any holiday), whether it entails getting rid of bad carbs, fats, sweets, caffeine or well, almost everything. Many of my patients are asking me about the raw food diet being popularized by celebrities in the media. This diet requires us to eliminate almost everything we are used to out of our diets, and replace it or just keep foods that are raw. Proponents of the diet believe that a diet made up of mainly uncooked and unprocessed plant foods leads to a thinner body, more radiant skin and hair, and more physical and mental energy. It also claims to prevent many chronic diseases that are rampant in our times. Because the diet consists of over 75% raw fruits and vegetables (preferably organic), the diet takes a lot of commitment and a lot of time. There is a lot of investment in the kitchen, chopping, blending, juicing and dehydrating. The staples
of the diet are fresh fruits and vegetables, nuts, seeds, beans, grains, legumes, dried fruits, seaweeds, sun-dried fruits, fresh fruit and vegetable juices, and purified water. People who are true “raw foodists” put a lot of effort into making yeast “cheeses”, cashew milk (from soaked cashews), and sprouted beans. Dairy and animal products are not allowed. Foods cannot be heated higher than 115 to 118 degrees. A dehydrator is a machine that uses heat of the aforementioned low temperature to dry out fruits and vegetables and can help devoted dieters prepare homemade cookies or fruit leathers. The principle behind this temperature restriction is that high heat deactivates enzymes naturally found in food and makes the body’s organs work harder to produce the enzymes needed for digestion. Also, heating foods at high temperature tends to produce carcinogens. I don’t believe that implementing this overly restrictive diet is beneficial long term. While it is definitely beneficial to eat an abundance of
raw produce, many are unaware that cooking some vegetables (such as tomatoes or carrots) actually boosts the bioavailability of the phytonutrients. So eating everything raw means that some nutrients won’t be as efficiently absorbed in the digestive tract. In the absence of dairy and meat, it can also be challenging to meet your needs for key vitamins and minerals including calcium, iron, zinc, B12, omega 3 fatty acids and protein. But that doesn’t mean the core concept of the raw food diet is for naught. Meal preparation, using minimal prep and the least processed ingredients, is usually the healthiest way to go. The best way to transform your diet into a healthy and energizing one is to aim to have two-thirds of your plate made up of healthy plant foods, like vegetables, fruits, whole grains and beans. Then have the remaining one-third made up of protein, preferably fish, lean poultry, and very limited amounts of red meat. To add flavor, use moderate amounts of healthy oils, herbs, spices, citrus and vinegars.
Mango avocado salad
HEALTHY LIVING
FEBRUARY 2012
• 2 Ripe Mangoes, peeled and chopped • 1 Ripe Avocado, peeled and chopped • 1 tbsp Lime Juice • 2 tsp Extra Virgin Olive Oil • 1 tbsp chopped basil • 1 tsp Black Sesame Seeds (optional) Mix all ingredients together, chill for a few hours and serve.
Sheryl Mayer MS RD CDN is a registered dietitian with an M.S. in Health and Nutrition. She is the owner of Nutritionista, a nutrition consulting service. Due to multiple requests, a weight loss group is forming for overweight teens. (Separate groups for boys and girls). Nutritional counseling and therapy in a group setting (in addition to regular private consultation) will be used to help teens learn how to lose weight and keep it off permanently. To inquire about this group, please call 347-850-3438 or email at SherylMayer@ Nutritionistainc.com. Please visit the website www.nutritionistainc.com
37
H&L TECH
FEBRUARY 2012
The Truth about Hair Replacement By Barry Katz
U
38
nless you are among the lucky 15 percent of males, you will experience some hair loss by the time you reach 50, according to statistics from the American Hair Loss Association. Men losing their hair are not the minority; in fact, by age 21, one in four men will have lost some of their hair. Years ago, men had few viable options for disguising hair loss. Aside from buying a larger yarmulke, one could wear a toupee, perhaps not the most natural look. Furthermore, there are halachic considerations with regard to donning tefillin atop a toupee. Some poskim hold that it is assur to do so, which would necessitate removing the fake hair -- thereby defeating its purpose. Rabbi Moshe Feinstein allows for one to place tefillin atop a toupee while in shul, as long as the wearer donned his phylacteries on his bare head at home beforehand. This hardly seems worth the trouble. A major change took place during the 1980s, when doctors prescribed a medication called minoxidil for patients suffering from high blood pressure. People soon discovered that one of its side effects was the thickening of hair. Thus, in 1988, Rogaine launched a product containing
minoxidil that promised to regrow hair. Thanks to a heavy dose of marketing, Rogaine was soon a household name. While their website boasts that 85 percent of men regrew their hair after four months, the company fails to mention a number of downsides. First, the product is costly. A three-month supply of their topical solution â&#x20AC;&#x201C; which may or may not work, as the numbers indicate â&#x20AC;&#x201C; sells for $49.95. This adds up to several hundred dollars a year, and thousands of dollars over oneâ&#x20AC;&#x2122;s lifetime. Second, the product needs to be applied twice a day. This is quite time consuming. Additionally, when one stops using the product the hair that had regrown, falls out, leaving the user back to the original situation. Finally, users have mentioned that although Rogaine is FDA approved, it may cause side effects such as dry scalp and itching. Longer-lasting solutions include hair restoration surgery. The idea is to implant hair into the scalp that will re-establish blood flow and allow the hair to grow normally. Various techniques are used to transplant hair. As with most technologies, hair grafting has come a long way since it was introduced about a half century ago. The first hair transplant surgery took place in 1959. Over the next 20 years, the method
was to implant about 12 hairs in a 3-4 millimeter round. In one session the surgeon would implant about 50 of these grafts. Patients with large bald spots often required multiple visits. This was both time consuming and expensive. Another issue was that the density of the grafts next to the spots without hairs led to a toothbrush-like effect. These surgeries were therefore unpopular. During the 1980s the grafts became smaller. These days, five hairs per graft and smaller rounds give the hair a more natural appearance. Technology also allows for inserting more grafts per visit. Nevertheless, upon close inspection a discerning eye can see the differences between one with a transplant and one with naturally full hair. Another disadvantage is it can take a long time for the hair to be fully restored; the transplanted hair might first fall out before new hair grows in, so anyone expecting quick results will be disappointed. Finally, as with all hair replacement methods, insurance will not reimburse these treatments, which range from $4,000 to $20,000. Another method is called a scalp flap. Hair from another part of the head is grown long and inserted into the scalp. While this method Continued on page 41
FEBRUARY 2012
By Jason Esses
I
f you’ve seen a defibrillator used in movies or television, you come away with an image that evokes heroism, speed, and technological success. A doctor or paramedic sees an individual in cardiac arrest and quickly grabs a defibrillator to shock the person back to life. You might think that all that’s needed is the opportunity to defibrillate and everything will be all right. If only it were that easy. Actually, it all depends on time. Even in a hospital setting, and I’ve seen many cardiac arrests in many hospitals, it could sometimes take more than ten minutes, an eternity, to defibrillate someone in cardiac arrest. Several types of defibrillators are available. The two general categories are external and internal. External defibrillators come in two varieties: the simple-to-use, automated external defibrillators or AEDs, and the ones typically seen in hospitals, which are the more sophisticated, manual or semi-automatic kind. The internal defibrillator is automatic and implantable, hence the name Automatic Implantable Cardio-defibrillator or AICD, and a little larger than a typical permanent pacemaker. Let’s first focus on the external kind. Just what do defibrillators do?
The heart has multiple, interconnected systems: the pumping system, i.e. the heart chambers; the plumbing system, i.e. the coronary arteries; and the electrical system, i.e. the specialized conduction tissue of the heart. Defibrillators target problems with the electrical system,
although not all problems. The electrical system may stop working partially or completely, or it could “short-circuit” -- both being potentially life-threatening situations.
H&L TECH
Demystifying Defibrillators Two examples of “short-circuiting,” or arrhythmias, are ventricular fibrillation (VF), or ventricular tachycardia (VT). During Ventricular Fibrillation or Ventricular Tachycardia, the heart functionally stops pumping, immediately endangering organs such as the brain. Within minutes, approximately three to five, neurons in the brain start to have irreversible damage. Although Cardio-Pulmonary Resuscitation (CPR) is thought to help, the only real treatment is effectively targeting the Ventricular Fibrillation or Ventricular Tachycardia by applying high electrical energy on the heart. This is what a defibrillator does. It does not correct a cessation of electrical activity, which only a pacemaker can treat. According to the American Heart Association, approximately 300,000 out-of-hospital cardiac arrests occur annually, many of them to people who appear healthy and have no known heart problems or risk factors. Eighty percent of these arrests happen at home, and a meager eight percent survive. Although not all causes of cardiac arrest are due to ventricular fibrillation or ventricular tachycardia, a significant percentage is. These occurrences are potentially treatable by defibrillation. Upon application, AEDs are designed to recognize one of these arrhythmias, Continued on page 41
39
FEBRUARY 2012
H&L TECH
Protect Your Hearing in the Digital Age By Rachel Wizenfeld overs of the iPod and iPhone may rave about their music collections, but their ears often tell a different story. Due to the increased prevalence of ear buds and personal listening devices (PDAs) throughout the world, at least one leading doctor estimates that hearing loss is going to hit people at younger and younger ages. “It’s going to shift the curve,” said Ronald Hoffman, MD, director of The Ear Institute at the NY Eye & Ear Infirmary. “If we would normally see hearing loss at say, 62, I think it’s going to go to 56. It’s going
found that a large percentage of young people who use PDAs are experiencing hearing loss. Indicators of hearing loss are very subtle, he said, but signs include difficulty hearing through background noise and being unable to hear phone beeps or the ticking of your wristwatch. Highpitched, high-frequency sounds are usually the first sounds to go, he warns. “When using a PDA, try to set the sound at the lowest level that you can comfortably hear what you need to hear,” said Dr. Hoffman. “If after using a PDA or noise exposure your ears feel clogged or stuffy and you hear ringing, that sound was too loud. If we tested your hearing at that moment, we would measure a hearing loss…that loss is re-
to shift the curve down – people are going to get in trouble earlier.” Any loud noise can damage hearing, he explains, but the real risks come with long-term exposure – whether it’s a noisy work environment, constant listening to earphones or frequent rock concerts or other loud music venues (shall we mention Jewish weddings?). He quoted a recent study out of Israel, which
versible, but if you repeatedly suffer these types of hearing loss, they eventually become permanent.” The Occupational Safety and Health Administration (OSHA) has recommended an upper limit of 80 decibels for PDAs, according to John Weigand, AUD, director of audiology at SUNY Downstate Medical Center. Dr. Weigand noted that many mp3 players and other music devices have limiting con-
L
40
trols, so parents can keep the sound output at desired levels for their children. “But if my own son said he’s going to listen to music at 79 decibels for 8 hours a day, which is lower than the OSHA limit, it’s still too loud,” he said. “It’s common sense: if you’re using earphones and someone else can hear the music, it’s too loud.” Dr. Weigand mentioned the three-foot rule: “If you and I are talking in an environment with background noise, music or traffic, and we’re three feet away from each other and we have to raise our voices, we’re in a place that could be hazardous to hearing over time.” And while there are steps that everyone can – and should – take to prevent hearing loss, it is still very individual, he said. He’s had patients who experienced hearing damage from just one loud event, and then seen people like a cabinet maker, who used power tools for 25 years, eight hours a day, whose hearing was barely affected. “People are predisposed to it,” he said. Certain health problems are associated with hearing loss, including diabetes, high blood pressure and smoking, “anything that affects blood flow can affect the way the inner ear is getting enough oxygen,” Dr. Weigand said. He advises people with these conditions to take extra precautions. He said that there’s no evidence that a child’s ear is more sensitive than an adult’s, but “it’s natural to take extra precautions – children have a longer way to go in life so they will need their hearing much longer.” Wearing disposable earplugs from the pharmacy is an easy way to protect hearing in noisy work environments, whether in a band or near a construction site. “Weddings of all faiths get loud,” Dr. Weigand reports, “and usually the band will not turn the music down. Most people attend an average of five weddings a year, and if that’s the loudest environment they’re in, it’s not such a problem. If you’re playing in the band five times a month or more, there may be problems.” Tips to Protect Hearing • Keep volume levels on PDAs, phones and music devices at the lowest level that you can comfortably hear. • Keep music levels below 80 decibels; if you have kids, implement controls on your children’s music devices so they can’t surpass this level. • Be conscious of feelings of ringing or stuffiness after listening to music – if you have these sensations, lower the volume or limit your listening time. • Wear properly-inserted earplugs, available at the drugstore, if frequently exposed to loud environments. Rachel Wizenfeld is a frequent contributor to publications like The Jewish Press, The Jewish Journal and the New York Blueprint. She lives in Los Angeles.
Demystifying Defibrillators Continued from page 39
and announce to bystanders if a shock is to be delivered. All the bystander has to do is press the shock button. The more sophisticated, semi-automatic or manual defibrillators found in hospitals require rhythm interpretation by a healthcare professional prior to defibrillation. Case in point: In November 2010, while announcing for a high school football game at Midwood High School in Brooklyn, Erasmus Hall athletic director Marshall Tames suffered a cardiac arrest. One of the coaches started CPR, and a local physician grabbed an AED and saved the man’s life. The entire event was broadcast over the public announcement system. The man recovered nicely after open-heart surgery, and equally important, he didn’t suffer any significant brain damage, because the AED was nearby. If the first responders had had to wait for the paramedics to supply the AED, he could have suffered permanently brain damage even if doctors could have subsequently treated his heart problem. The implantable defibrillator, or AICD, is offered to two categories of patients. Some patients who have had a prior cardiac arrest
need an AICD for prevention of a repeat event, i.e. secondary prevention. And some patients are at risk for cardiac arrest even if they have never had such an episode i.e. primary prevention. Risk factors for cardiac arrest include congestive heart failure, or a “weak and damaged” heart from prior heart attacks. In the last year, several studies have revealed that the AICD is under-utilized by the medical community, even though it is more effective at saving lives than most of the common medications that patients take to prevent heart attacks. We all should be asking the following questions: Does my local synagogue or community center have an AED? How about the catering hall or summer camp? If so, do we know where it is and how to use it? Would we even know to look for it? If not, then we need to do something about it. AEDs are relatively inexpensive. AEDs can save not just the body but also the quality of productive “life” as it was meant to be lived. For more information about defibrillators, see the American Heart Association online, www.heart.org. Jason Esses is an attending cardiologist practicing in Brooklyn, affiliated with Maimonides Medical Center.
The Truth about Hair Replacement Continued from page 38
produces instant results, the surgery is more complicated. Besides the health risks that accompany all medical procedures, this method will most likely produce uneven results unless it is performed by an expert surgeon. A third variation of hair replacement surgery is scalp reduction. It is exactly as it sounds: Excessive bald skin is removed, and the parts of the scalp with hair are stretched and sewn together. Often this is combined with one of the previous methods. Cutting open the scalp carries the risk of infection, scarring and swelling of surrounding areas, including the face.
When electing to undergo one of these surgeries, one must evaluate whether the potentially improved appearance is worth the possible side effects, the risk that the results will look unnatural, and the cost. If opting for surgery, however, experts advise using only recommended and known surgeons, even though the cost will be much higher. For those unwilling to pay the big bucks, there is always the bigger yarmulke. Barry Katz is a college administrator and adjunct professor who lives in Brooklyn, NY with his wife and three children. You can contact him at iambarrykatz@gmail.com.
In Our Next Issue of
H&L TECH
FEBRUARY 2012
Using Technology to Enhance the Shabbos Experience In our May 2012 issue, Health & Living will look at various ways in which new technologycan enhance our enjoyment of Shabbos and Yom Tov within the bounds of Jewish law.
If you have any novel implementations of technology to suggest for inclusion in this story, please email us at magazine@jewishpress.com 41
H&L SHOWCASE
FEBRUARY 2012
Compiled by Leah Rothstein
Showcase
Women’s Fitness - The Kosher Way Having a hard time making it out to the gym in the evenings? Unhappy py with your local fitness classes? Now you can get a workout in the privacy of your home without compromising your values. Shape Fitness, a gym in Flatbush, has produced a workout DVD specifically designed for the frum woman. Since it’s a tzniusdik production n with kosher music, you can feel comfortable playing it in your home. The fitness routines offered include Zumba, kickboxing, Pilates, and Boot Camp with easy-to-follow lessons given by experienced instrucuctors. Each workout is divided into short 20 minute segments, meant to fit into a working woman’s busy lifestyle. The Shape Fitness Kosher workout DVD is now available for only $19.99 in most Judaica stores, and online at www.shapefitnessgym.com (Shipping is available).
Skin and Hair Care: For Women in a Rush Smashbox Camera Ready Full Coverage Concealer
T
his concealer is extremely versatile since it is packed in a lipstick like tube form, so you can carry it around in your pocketbook without worrying (like with a liquid or a powder) that its contents will spill out. It is super easy to blend; all you have to do is dab it onto your face while you’re on the go. It’s thick enough to actually cover a blemish fully, and long lasting too. You can also put it under your eyes on those days when you’ve barely slept and need to hide those giant dark under-eye circles.
Protecting Digestive Wellness Through The Web
42
For those suffering from digestive illnesses like Crohn’s disease, ulcerative colitis, or celiac disease, the SCD (Specific Carbohydrate Die) has become increasingly popular in recent years. The diet restricts complex carbohydrates, allowing only monosaccharides which can be easily absorbed into the body’s digestive systems. SCD also bans all refined sugar, grains, and starch. Although it can have positive effects, the diet is not easy to stick to- the requirements are complicated and the food choices can be very limited. Digestivewellness.com sells products to make it easy for those who want to go on the diet. With basic cooking ingredients (such as coconut oil, $8.99; organic red lentils, $3.99), flavor extracts (pure vanilla, $3.99), and nut-based flours (hazelnut, $9.75; almond, $6.49; cashew, $10.25), your cooking needs are covered. There are condiments for purchase too, including honey-sweetened ketchup, $8,49; BBQ sauce, $9.75; mustard, $2.99. An SCD-compatible organic grape juice is available for your Shabbos table ($4.19).
Neutrogena Body Oil: Light Sesame Formula
Ready-made products include baked goods like muffins and brownies, as well as some packaged desserts (pure honey candy, $8.99; caramel crème, $9.79). A variety of cheese and yogurt makers are offered so you can make your own dairy products (for the dairy-eating version of the diet.) Eight different cookbooks for the SDC diet are also sold on the website.
Y
ou can overcome dry, itchy skin in winter weather with this product. Neutrogena Body oil is a lighter alternative to thick moisturizing creams. Applied after showering, it disappears into your skin and leaves it looking and feeling soft instead of dry, flaky or greasy.
Garnier Fructis Sleek & Shine: Anti-Frizz Serum
I
f your hair is curly, dry, frizzy, damaged and lifeless, rub this serum into your hair and it magically becomes slick, shiny, and easier to manage. Apply a handful to damp hair and keep it from frizzing once it dries. It also works really well if you apply it before straightening or blow drying your hair. One word of warning- it’s best not to use on dry hair, since for some hair types, it might leave your hair looking greasy.
OPI Nail Lacquer
SeniorMed: Helping Seniors Take Their Medications Safely Taking medicine can be complicating for seniors who often take a number of medications at once. SeniorMed Consulting can help so that serious errors are never made. The Medication Review Service has licensed pharmacists rmacists checking a patient’s medication for drug interactions, correct rrect dosage, and determining whether the medication should be continued. Customized Pill Cards are created from patient’s ient’s medication lists to make a schedule that explains when hen each medication should be taken. These can be ordered ered as cards or magnets. SeniorMed also sells an advanced version of a pillbox called the eMedtracker, which helps keep track off confusing pill regimens by lighting up or beeping to show which pill needs to be taken, and also contacts patients or caregiverss with reminders via text, phone, or email. More information is available at http://myseniormed.com/. rmed.com/.
I
f you want to treat yourself to a top-quality manicure but don’t have the time or budget to go to a nail salon, OPI nail polish is a salon-quality alternative, and though pricier than some other brands, is still a better deal than a manicure. Popular colors include pinks like “Italian Love Affair” and “That’s Berry Daring;” for a shade that’s a little different, try silvery “Coronation,”“Pale Teal”“Hey! Get in Lime!” or for a deeper shade try, “Purple with a Purpose.” OPI even has a fun Muppet- themed color collection, with colors such as “Kermit”“Gonzo” and “Miss Piggy.” OPI also has a great nail strengthener product, so if you have problem nails that are weak and brittle, try applying Nail Envy under your polish to harden and keep your nails tough.
Showcase Living Tree Community Foods Living Tree sells olive oils, dried fruits, nuts, and other products that are both organic and in sync with the raw foods movement. They cater to the kosher consumer, with a list available on their website http:// livingtreecommunity.com/store2/product-list.asp clearly labeling which of their products are kosher (certified by the Vaad Hakashrus of Northern California). The main categories of products sold on the website are: dried fruits/vegetables, edible seeds, wild rice/grains, coconut products, nut butters, tahini, pestos, olive oils, and honey. They also offer international produce, including some exotic products that can be hard to find (a good
H&L SHOWCASE
FEBRUARY 2012
opportunity to make the blessing of shehechiyanu), such as goji berries, agave nectar, and raw cacao beans. The products come directly from family farmers- the almonds and olives are grown in California’s Central Valley region. For the allergy-concerned, all of the nut butters sold are entirely peanutfree. As a special offer, nursing mothers and seniors get a free package of organic sundried raisins with their order. Don’t forget the chocolates, which are made entirely without sugar- honey is used as a sweetener instead. Tasty and organic gift packs are available for you to send as shalach manot.
Tokyo Hibachi: Kosher Asian Restaurant When you think of exotic restaurant destinations, the first place you think of is probably not Springfield, NJ. Yet Tokyo Hibachi is right there, serving Japanese-style glatt kosher hibachi grilled meat. They also have sushi meat, due to customer demand- but don’t worry, the meat isn’t raw. New Jersey Jewish News reports that the restaurant is owned by Amy and Tony Pan, from Indonesia and China respectively. The couple hopes to eventually add more items to the menu from their native cuisines, but it’s hard to find all the ingredients they need here in America, particularly since they need to find kosher versions. The restaurant is under the supervision of Vaad Harabbonim of MetroWest.
43
Is Your IPhone Pesachdik? Tired of shlepping around printed directories of Kosher for Passover products and fumbling through pages of listings when doing your Pesach shopping? Now there is a better way. The OU has released a free app for the iPhone, iPod Touch or IPad which allows you to search for the kind of OU certified product you are looking for on your smartphone while you are in the aisle of the supermarket. Products are listed by category and brand and specify what kind of kosher symbol should be printed on the package. Users have their choice of searching only for products that are Kosher for Passover or all OU certified kosher products for year round use. The app will also display current OU kosher alerts, listings of new certified products, and provide access to the OU kosher question hotline. The new app, which was released in January, is in addition to an app which was released last
year which searches only for OU Kosher for Passover foods either by name or by category. Both are available free for download from the Apple iTunes store.
DO YOU HAVE A PRODUCT OR SERVICE THAT YOU WOULD LIKE US TO FEATURE? EMAIL US AT - SALES@JEWISHPRESS.COM
COMMUNITY PROFILE
FEBRUARY 2012
Community Profile By: Sandy Eller
F 44
ounded just over four years ago, Kids of Courage is rapidly making a name for itself as the only year round program to provide free medically supervised trips for children with a wide range of illnesses and disabilities. In that short period of time, co-founders Ari Adlerstein, Dr. Stuart Ditchek and Howard Kafka have created an organization whose slogan “Conquering Illness Through Adventure” has given a new lease on life to both children who are coping with serious medical situations and their families. Kids of Courage serves over four hundred families and their list of patient diagnoses is staggering: familial dysautonomia, muscular dystrophy, nemaline myopathy, cancer, seizure disorder, neurofibtomatosis, cerebral palsy, quadriplegia, paraplegia, spina bifida, liver, kidney and heart transplant, Fanconi’s anemia, total brain injury, stroke, glycogen storage disease, Gaucher disease, multiple genetic disorders, and cystic fibrosis. While some children suffer from long term disabilities, others are dealing with life threatening illnesses. Kids of Courage selects campers based on medical need, targeting the most seriously ill children who are cognitively appropriate for their age group. It arranges events and trips with full medical supervision that allow these children and young adults to escape and have some good old fashioned fun despite their fragile medical conditions. The Kids of Courage annual ski weekend is the world’s largest adaptive ski event. This past year’s three day trip, which took place in early January at Vermont’s Mount Snow in conjunction with Ability PLUS, gave close to sixty children, including some on ventilators, the opportunity
to enjoy a day on the slopes using both regular and adaptive ski equipment. The most impressive Kids of Courage program is the annual summer
camp trip. One hundred and fifty children from twelve different states, Israel, England and Canada participated in the 2011 trip which featured an eight day visit to San Francisco. The itinerary included visits to Six Flags Discovery Kingdom, an Oakland A’s baseball game, the Golden Gate Bridge, Raging Waters, and tours of Alcatraz, the NASA center and the Jelly Belly factory. Putting together a trip of this magnitude is a Herculean effort. “The average cost per camper with accompanying staff is $5000, which includes air travel, medical equipment rentals, hotel, food, event admission and medications,” explained Dr. Ditchek. “All trips require a minimum of a one to one counselor/camper ratio for the least complicated campers and up to a three to one ratio for the most demanding patients, in addition to medical and logistics staff.” New for 2011 was the TD Bank Five Boro Bike Tour, a forty mile fundraising race that attracted one hundred and
sixty riders, including fifteen campers on adaptive cycles. The event raised over $180,000. Kids of Courage is hoping to attract two hundred riders to this year’s bike tour, which will take place on May 6th. Kids of Courage runs approximately six Shabbatons, two major trips and several smaller events sprinkled throughout the year. As a precaution, the trips are limited to locations that are near sophisticated medical facilities. In most cases, however, the full complement of volunteer medical staff that is an integral part of each
event is able to handle the emergencies that inevitably arise. “To date we have had one case that we weren’t able to handle on our own and required hospitalization,” said Dr. Ditchek. “We deal with medical situations on every flight and have never had to divert a plane due to medical emergency.” Kids of Courage relies exclusively on private donors and foundations and receives no government funding. The organization has one part time paid administrative employee and
a staff of 1400 volunteers from New York, New Jersey, Florida, Los Angeles, Toronto, Chicago, Detroit, Maryland, Denver, Washington DC, Israel and other locations.. For the dedicated volunteers who donate countless hours, it is an opportunity to give back to those who are less fortunate, and to gain valuable life lessons. “While I have spent the past four years donating much of my free time towards Kids of Courage, the time I have spent with these children has hardly been unidirectional,” offered volunteer Moishe Gamss. “These kids and their families maintain social normalcy in spite of their daily complications. Seeing this provides me with an obligation to view my comparably uneventful life in a new light. I realize how trivial some of my past discomforts have been and cherish everything I have so much more.” One of the main priorities for Kids of Courage is to provide a social structure and a network of friends to children whose medical conditions typically take them outside the normal realm of socialization. Many campers communicate through the Kids of Courage Facebook page, which features videos, pictures and an opportunity for social networking. “These kids are often homebound,” said Dr. Ditchek. “Facebook and Skype have presented many great opportunities to our kids. Our goal is to create new opportunities for our campers, providing year round friendship and medical support and to demonstrate to the world that having an illness doesn’t mean that you stop living or experiencing exciting things.” They can be visited at www.kidsoc. org and Facebook: www.facebook. com/kidsofcourage
BY THE NUMBERS Founded: 2008 Number of Families in Program: 400+ Number of Volunteers: 1400 Number of Paid Full Time Employees: 0 Number of Paid Part Time Employees: 1
Medical Profile
COMMUNITY PROFILE
FEBRUARY 2012
45
COMMUNITY PROFILE
FEBRUARY 2012
Community Provider Bulletin Brooklyn Hospital Offers Minimally Invasive Kidney Stone Treatment New York Methodist Hospital is now using an improved technology, known as the Sonolith i-move, for the dissolution of kidney stones. Extracorporeal shock-wave lithotripsy (ESWL) is a minimally invasive surgical procedure used to treat patients with kidney stones. Physicians in NYM’s Division of Urology, headed by Ivan Grunberger, M.D., make up the first
team in the United States to use the new lithotripsy device, which offers improved results. Kidney stones are solid masses of tiny crystals that can form in the kidneys and cause bleeding, kidney damage, or ongoing urinary tract infections. It is estimated that more than one million patients with ESWL are treated annually in the United States.
The new lithotripter can also monitor patient movements in real time with revolutionary infrared tracking: if the patient moves slightly during the procedure, the machine locates the kidney stone and completes treatment. The extended penetration depth of the shockwaves also allows for treatment of patients who are obese.
L-R: Angelish Kumar, M.D., Edward Zoltan, M.D., Ivan Colon, M.D., and Ivan Grunberger, M.D., chief of urology at NYM, with the Sonolith i-move machine.
NYM Adds Bariatric Gastric Bypass to Robotic-Assisted Surgery Program
46
Adding to its advanced robotic-assisted surgery program, New York Methodist Hospital now offers minimally invasive, robotic gastric bypass surgery to help obese patients achieve weight loss of up to 70 percent of body fat. Obesity is defined as having a body mass index, or ratio of height to weight, of greater than 35. NYM is one of only three hospitals in the Northeast to offer robotic gastric bypass surgery. “Weight loss surgery can greatly improve the quality of life of many patients,” said Steven J. Carryl, M.D., attending surgeon, Department of Surgery at NYM. “With better results, less post-operative symptoms and a shorter recovery time, minimally invasive bariatric surgery can be a good option for many obese
patients who need to lose a significant amount of weight.” Robotic gastric bypass surgery helps patients lose weight by permanently reducing the stomach size and rerouting the digestive track. Because of its decreased size, the patient’s stomach will only be able to hold small amounts of food. The robot, which is controlled by a surgeon, allows for increased precision and enhanced magnification for the surgeon, which results in less pain and a shorter recovery time for the patient, as the minimally invasive procedure means smaller incisions. The patient also experiences less blood loss and less scarring than a patient who undergoes traditional gastric bypass surgery.
Because it is irreversible, gastric bypass surgery should only performed when all other weight loss methods have failed. For patients who may only need to lose up to 45 percent of their body fat, NYM offers laparoscopic band surgery, a minimally invasive, reversible bariatric procedure that restricts the amount of food a patient can eat by placing an adjustable band around the stomach. New York Methodist Hospital also provides customized weight loss plans through its Comprehensive Weight Management Program for overweight or obese patients who do not need or want to undergo surgery. Program participants receive a medical evaluation and may meet
Steven J. Carryl, M.D., attending surgeon at NYM, poses with the da Vinci robot.
with a nutritionist, fitness expert and behavior modification specialist. Monthly follow-up visits with their weight loss “team” allow participants to monitor their progress. For more information about the Comprehensive Weight Management Program at NYM, call 718.246.8580. To speak with a Hospital staff member about gastric bypass or laparoscopic band surgeries, call 718.780.5293.
Newly Transformed Tietz Center a Must-See Following the culmination of a $16 million renovation project, the community is invited to see the brand new Margaret Tietz Nursing and Rehabilitation Center. Centrally located in the heart of Queens, this 200 bed skilled nursing facility boasts state-of-the-art sub-acute and long-term care in an upscale and luxurious ambiance. The Tietz Center’s newest AMENities™ for the body and soul include a thoroughly remodeled rehab gym that doubled in size, as well as a new décor that pervades the entire facility. The Center caters to the specific needs of the Jewish com-
munity offering daily minyan prayers, which take place in its very own synagogue with their own on-site Rabbi who also leads Torah study groups. A beautifully furnished Shabbos apartment is conveniently available for the comfort of visiting family members, and residents enjoy delicious and healthy glatt kosher cuisine certified by the Vaad Harabonim of Queens. The 140 private and 30 semiprivate rooms, are well appointed and provide patients and residents with a haven of wall-to-wall comfort. The Tietz Center offers the ideal environment for recovery following
surgery or a debilitative illness and specializes in quick recovery for orthopedic conditions. Physical, Occupational and Speech Therapies are provided utilizing the most innovative techniques and technologically advanced equipment. In addition to Short Term Rehabilitation, the Tietz Center provides Long Term Care, In Patient Hospice/Palliative Care and Adult Day Care. Medicare, Medicaid, and most HMOs are accepted; a Medicaid Coordinator is available to assist with Medicaid applications. For more information call Stephanie Zim, Director of Admissions at (718) 298-7800 ext. 2264.
Rehabilitating in the state-of-theart Rehab room at Margaret Tietz Nursing and Rehabilitation Center is enhanced by the presence of Rabbi Zavel Pearlman and visiting students from nearby Chofetz Chaim Yeshiva.
Community Provider Bulletin
COMMUNITY PROFILE
FEBRUARY 2012
Specialty Care Group & Health Services Centers now in Boro Park Boro Park Center, located at 4915-10th Avenue is one of Centers for Specialty Care Group’s newest NYC nursing home and rehabilitation centers. The home specializes in long and short term rehab, bariatric recovery, and hip and knee rehabilitation, among other specialty treatments. "Centers for Specialty Care Group prides itself on servicing the community. At the Boro Park Center, we understand what that involves, and therefore make it our goal to be there for the community," said Kenneth Rozenberg, CEO of CFSCG. Since Boro Park Center has joined the group, the management has made many positive changes to reflect that mission. Recently, the facility celebrated the opening of
a magnificent shul. The shul was the brainchild of Jeremy B. Strauss, Executive Director and Kenneth Rozenberg, CEO. The Shul at Boro Park Center is for the convenience of residents and their families,” said Strauss. It is brand new, beautifully decorated and fully stocked with seforim. It is especially comforting for residents to have the shul conveniently located on premises. BPC has full time Resident Ambassadors on site to make certain that all residents’ needs are being met. These ambassadors facilitate the comfort of each individual, ensuring that every resident feels at home at Boro Park Center. Boro Park Center now has a free courtesy shuttle for the convenience of all members of the community. Schedule for the shuttle can be obtained
through a Resident Ambassador. A brand new, lavish Bikur Cholim Room is available to all guests. The room is stocked with food, drink and other amenities. Centers for Specialty Care Group is a comprehensive and well-respected health services group based in New York City. The group operates an extensive network of health care centers throughout the boroughs in New York City and upstate New York as well as facilities throughout South Jersey. CFSCG facilities have full time on-site physicians, nurses, and many other health care professionals dedicated to providing caring treatment. With many locations throughout New York State, a Centers for Specialty Care facility is never far from you. Now,with Boro Park Center as a member, it is closer than ever.
Community Calendar 47 MARCH
1
Weight Loss Surgery Support Group
Where: Hekemian Auditorium 30 Prospect Ave. Hackensack, NJ. Hours: 6:30-7:30 PM Free support group run by registered nurses and nurse practioners providing on-going peer support and education to the post-operative bariatric surgery patient. For more information call (201) 966-2193.
4
North Shore HospitalWomen's Pavilion Tour
Where: 125 Community Drive Great Neck, NY. For more information call 516-465-2552.
MARCH CONTINUED
20-23
Medical Ethics Conference
Where: 3700 Henry Hudson Pkwy, 2nd Fl. Riverdale, NY Yeshivat Chovevei Torah Rabbinical School of Medical ethics conference will be a three day conference with a community event on the night of March 20. For more information call (212) 666-0036.
21
Save Your Vision - Crescent Tower Community
Where: 23-22 39th Astoria, NY: 11:3 AM. Speaker: Dr. Chad Haller
MAY
1
Flatbush Satmar Bikur Cholim Annual Spring Tea Where: Ateres Chynka
6
Hatzolah of Flatbush Annual Gala Auction Where: Cong. Shaarei Zion
19
Hatzolah of Boro Park Annual Melaveh Malkah (for men) Where: Ateres Golda
20
APRIL
Hatzolah of Boro Park Annual Gala Auction Event (for women)
Where: Ateres Golda
7
JASA Presents: The Annual Volunteer Ventures Expo for New Yorkers 50+
Where: UJA Federation of New York - 130 E. 59 St. New York, NY. Hours: 10AM-2PM. A conference and volunteer opportunities fair for adults 50+ Register in advance at jasa.org
12
Maimonides Birthing Tour Where: 4802 10th Ave. Brooklyn, NY. For more information call (718) 283-6000.
18
Elaine Kramer Child Development Workshops.
Where: UJA Federation 130 East 59St. between Lexington and Park Avenues NY, NY Using Music to Promote Emotional Expression and Build Social Skills Contact Roni Katz at rkatz@jbfcs.org or (212) 6907234. $30 per workshop
18-20
Young Child's Expo-9th Annual Conference Where: Hotel Pennsylvania
17
Partners for Life GalaOrganization: Gift of Life Bone Marrow Foundation
Where: Grand Hyatt- 109 E 42nd St New York, NY. 6pm-10pm Gift of Life will honor its marrow donors, transplant recipients, volunteers and financial supporters. This year actress Mayim Bialik will serve as the event's emcee. Cocktail hour 6PM Dinner 7PM. Contact: Barby A. Sloven Phone: 561-982-2914 or E-mail: gala@giftoflife.org
TO SUBMIT AN EVENT FOE THIS LISTING OR FOR THE WEEKLY JEWISH PRESS: EMAIL CALENDAR@JEWISHPRESS.COM
COMMUNITY PROFILE
FEBRUARY 2012
Community Service Directory How to Pick the Right Pharmacy
n Focus o ies c Pharma
48
Location/Convenience When you or your loved ones are sick, the last thing you need to be concerned about is getting in your car and driving miles to pick up their medication. You want to make sure that the pharmacy is close to where you live or work. It would also be helpful if they had a parking lot or curb-side pickup. You also want the pharmacy to be convenient with long hours and weekend hours. It would be nice to have a 24 hour operated pharmacy, but small (Shomer Shabbos) pharmacies cannot do that, so focus instead on finding a pharmacy open at least from 8am to 9pm. On the weekends,
hours are not as important, unless your doctor’s office is also open on Sunday to give you new prescriptions. Insurance You want a pharmacy that accepts a variety of insurance plans because there is a chance you may have to switch insurance companies due to work, age, medical or financial issues. If you are a Medicare recipient, you want to make sure that the pharmacy accepts ALL Medicare Part D plans. As a Medicare Part D patient, sometimes one plan becomes cheaper than another. You want to make sure that if you change plans you won’t have to change pharmacies. Friendly and Personal Service You want a pharmacy that takes the time to answer all your questions, that will work with your doctor on dosing and refill issues and that will deal with the insurance company. 7 Look for special perks that some pharmacies offer such as: blood sugar
or blood pressure testing and weight scale. Seek out pharmacies that offer private counseling or stock asthma inhalers or even crutches for injuries. Some pharmacies will mix flavored syrup into liquid medicines for children to make the taste more palatable. HIPAA Compliance The Health Insurance Portability and Accountability Act deals with patients’ rights. When choosing a pharmacy, make sure that they comply with the current HIPAA laws. Most pharmacies will have a sign posted about private consultations and a patient’s right to privacy. Online Pharmacy Many consumers are turning to the Internet to have their prescriptions filled. They do it for the convenience and for the potential of great discounts, but there are dangers involved if you choose the wrong on-
line pharmacy, so make sure that it follows these guidelines: • The pharmacy must require a prescription. • The pharmacy must ask for a medical and prescription history. Without this information, the online pharmacy has no way of checking for drug interactions or inappropriate prescribing. • The pharmacy does not advertise or offer to sell any narcotics or controlled substances. It is illegal for any Internet pharmacy to sell or ship these products. • The Pharmacy should be a fully licensed Internet pharmacy located in Canada, the U.S., Western Europe, Asia, Australia or New Zealand. You should be able to spot their licensing number on their website, and if you can’t then ask them for it, and verify it with the licensing organization.
Local Pharmacies AD Pharmacy 1310 48th Street Brooklyn NY (718) 972-5750
Dear Drugs 490 Avenue p Brooklyn, NY (718) 375-1282
Good Neighbor Pharmacy 1614 Ave. M Brooklyn, NY 11230 (718) 375-8900
J Drugs II Pharmacy 3402 Avenue N Brooklyn, NY (718) 258-5858
Modern Chemists 1630 Coney Island Ave. Brooklyn, NY (718) 258-4200
Apple Drugs 376 Kingston Avenue Brooklyn, NY (718) 467-6700
Eisenberg Pharmacy 203 Brighton Beach Ave. Brooklyn NY (718) 743-1200
Grand Central Pharmacy 420 Central Avenue Cedarhurst, NY (516) 295-8880
Just in Time Pharmacy 2126 Knapp St. Brooklyn, NY (718) 332-5474
Metro Drugs 5027 New Utrecht Ave Brooklyn, NY (718) 431-8000
Boardwalk RX 3100 Ocean Pkwy. Brooklyn, NY (718) 996-7600
Eliyahu’s Pharmacy 573 Kings Highway Brooklyn, NY (718) 627-0485
Hamilton Drugs Corp. 4514 Fort Hamilton Pkwy. Brooklyn, NY (718) 435-8800
Kings Bay Chemists 3610 Nostrand Avenue Brooklyn, NY (718) 891-3447
New Utrecht Pharmacy 4624 New Utrecht Ave Brooklyn, NY (718) 436-9300
Boro Park Pharmacy 4723 13th Ave. Brooklyn, NY (718) 437-0505
Ezra 604 Central Avenue Cedarhurst, NY (516) 569-7821
Haven Pharmacy 1211 Ave. U Brooklyn, NY (718) 382-9616
Klein’s Pharmacy 4818 13th Ave. Brooklyn, NY (718) 633-1548
New Age Pharmacy 2918 Ave. J Brooklyn, NY (718) 253-1700
Cropsey Pharmacy 2527 Cropsey Ave. Brooklyn, NY (718) 449-0434
Family Pharmacy 3692 Nostrand Ave. Brooklyn, NY (718) 769-9600
Island Pharmacy 1841 Coney Island Ave. Brooklyn, NY (718) 336-2800
Lane Pharmacy 4623 13th Ave. Brooklyn, NY
Navar Pharmacy 3002 Ave. M Brooklyn, NY (718) 677-5811
D-Best Pharmacy 490 Ave. P Brooklyn, NY (718) 336-7168
Get Well Pharmacy 5218 8th Ave. Brooklyn, NY (718) 686-0812
J Drugs Pharmacy 1205 Ave. J Brooklyn, NY (718) 258-6686
Lieb Pharmacy 4924 16th Ave. Brooklyn, NY (718) 633-5770
Noor Pharmacy 2036 Bedford Ave. Brooklyn, NY (718) 282-8982
Community Service Directory
COMMUNITY PROFILE
FEBRUARY 2012
Oceanna Pharmacy 6716 18th Ave. Brooklyn, NY (718) 232-2288 Park Pharmacy 3205 Quentin Rd. Brooklyn, NY (718) 645-3200 Quick Aid Pharmacy 3814 13th Ave. Brooklyn, NY (718) 854-7722 Shalom’s Pharmacy 1106 Ave. K. Brooklyn, NY (718) 253-4900 Shimon’s Pharmacy 115 Lee Ave. Brooklyn, NY (718) 384-0234 Sunshine Pharmacy 411 Kingston Ave Brooklyn, NY (718) 773-2020 Supreme RX Pharmacy 3011 Ave. N Brooklyn, NY (718) 677-6600
National Chains CVS Pharmacy Visit website for locations www.cvs.com Duane Reade Pharmacy Visit website for locations www.duanereade.com Rite Aid Visit website for locations www.RiteAid.com Walgreens Pharmacy Visit website for locations www.walgreens.com
49
COMMUNITY PROFILE
FEBRUARY 2012
From the Doctor's Desk by Dr. Robert Van Amerongen
Preventing Medical Errors
50
In 2001, the National Institutes of Health (NIH) published a groundbreaking report documenting for the first time one of the most serious new medical problems of our day, avoidable medical errors. According to the NIH, medical errors are responsible for between 40,00-100,000 deaths annually among patients in US hospitals, and up to 30% of them could be avoided. Sometimes the problem is simple human error. But in an increasing number of cases, the true culprit behind the medical error is the dizzying complexity of the modern health care system itself. After careful investigation, we often find that a medical error is the end result of a combination of failures in which the human mistake is just the last link in a long chain. As the head of the Pediatric Emergency Services department at New York Methodist Hospital in Brooklyn, I learned of one such chain of events which took place at another hospital. One day, two teenage girls came in at almost the same time complaining of similar symptoms, severe pain in the abdomen, leading the doctors on duty to suspect appendicitis. The two girls also, by chance, had very similar names, and were assigned to adjacent beds. Diagnostic blood tests were ordered on them both, and one quickly came back with a high white blood cell count, indicating an infection. Doctors placed an order into the hospital’s computer for the pharmacy to send up a dose of antibiotics for the girl with the high white cell count, and sent her to another department to get a CAT scan. Meanwhile, there was a shift change for the nurses on duty. The antibiotics arrived at the ward while the first girl was still away getting the CAT scan. One of the new nurses went to the computer to verify who should receive the medication, but the hospital’s computer system was temporarily down. The name on the antibiotic was close to that of the second girl, and she was the only one there at the time with the right set of symptoms, so the nurse gave her the antibiotic, unaware that it was intended for another patient she had never seen. This could easily have been a tragic mistake, especially if the second girl had suffered an allergic reaction to the medication. Fortunately, that did not happen, and when the first girl returned to the ward, the mistake was quickly discovered and rectified. No serious harm was done, but it could have easily turned out differently. A subsequent investigation would have blamed the nurse, but the error was actually caused by a “perfect storm” of unpredictable events which defeated the safeguards in place to prevent such mistakes. It was, in fact, a system error, an example of a modernized version of Murphy’s Law by former NASA official Charles P. Boyle who said, “Success can be insured only by devising a defense against failure of the contingency plan.” To explain how these errors happen, experts in the field compare a hospital’s medical safety systems to an onion with overlapping layers. In this case, one
layer of protection was the computerized system which the nurse should have been able to use to verify which patient should receive the antibiotics. But that layer failed because the computer was down. Another layer of the safety onion was the medical training of the nurse, but in this case, the medication was consistent with what she knew of the patient’s symptoms, so the error slipped through that layer as well.
"Dr. Van" taking care of the kids at Camp Simcha Special
Imagine that the errors are small peas being dropped on a constantly shifting stack of Swiss cheese slices, with each slice representing a medical safety system. In most cases, the pea will be stopped by the topmost slice, or it may fall through a hole in the top slice to be stopped by the slice below that. However, if you keep dropping peas long enough, eventually a hole in each of the shifting slices will line up exactly with the others, just for an instant, allowing the error to get all the way through the stack. Small medical errors of all kinds happen every day, but the built-in safeguards in the system catch the vast majority of them before they can do harm. For example, if a nurse or a patient reaches for one of several bottles of pills in a medicine cabinet, and accidently picks up the wrong one, they will usually be able to tell immediately by the unique size, shape and color of the pill that they made a mistake. The problem is that the great complexity in the practice of medicine today has created new ways that medical errors can evade detection. For example, doctors routinely check their patient’s medications to spot dangerous drug interactions, and the patient’s pharmacist is supposed to double check. However, if a patient is seeing several different specialists, one of them can easily be unaware of an incompatible medication that another doctor has prescribed. If that patient also shops around at different pharmacies to get the cheapest price on each drug, that layer of protection against drug interactions will fail as well. Chai Lifeline’s Camp Simcha Special is a program for children with very serious medical problems who
are usually taking multiple prescription medications and need various types of special treatment. To guard their health, the camp’s medical staff, under my direction, carefully checks and double checks every drug called for on each child’s medical record against the drugs which the child brings with them to camp. Then we have our supervising pharmacist check the drugs again for possible bad interactions, just to make sure. Today, American hospitals are being held more accountable to stop medical errors. Hospitals now have quality assurance officers on staff working to improve their safety systems, and their efforts have begun to bring down the number of medical errors being made. A major government-supported effort is now underway to computerize all US medical records to improve accuracy and facilitate sharing, in order to help doctors and nurses make the right treatment decisions. But if today’s war against medical errors is to be won, parents and the patients themselves must join in the fight. Parents must make sure that they are fully knowledgeable about every aspect of their child’s medical condition. They must serve as their child’s advocates, informing any doctor treating their child about every allergy, every medication their child is taking, and other relevant information, including their child’s accurate weight, which is crucial in determining proper dosages. The same holds true when looking after the medical needs of an elderly family member. If they are seeing several doctors, make sure that they are all aware of the total picture. Whenever a new prescription is issued, make sure that the drug name and dosage is clear, and get all the prescriptions filled through the same source, so that the pharmacist can catch any potential interactions that were overlooked. The rule of thumb for stopping medical errors is the same as for stopping terrorists: “If you see something, say something!” If you have a question, don’t be reluctant to ask it. If you suspect that a doctor or nurse is about to make a treatment mistake, speak up! Today, we truly live in an age of medical miracles. However, as parents and caring family members, we still need to be vigilant to make sure that those treating our loved ones have the complete and accurate information they need to deliver the proper medical care. Reference: For more information on the various causes of medical errors, read “How Doctors Think” by Dr. Jerome Groopman. Dr. Robert Van Amerongen is a graduate of Yeshiva University and the Albert Einstein School of Medicine. He completed a residency in pediatrics at North Shore University Hospital, and a fellowship in Pediatric Emergency Medicine at Bellevue Hospital/ NYU Medical Center. He is the director of the Pediatric Emergency Services at New York Methodist Hospital in Brooklyn. He has served as the Medical Director of Camp Simcha Special since 2008. Dr. Van Amerongen is a resident of the Five Towns and a Hatzalah volunteer. He is also the Medical Director of Priority Pediatrics, an urgent pediatric care facility located at 444 Merrick Road in Lynbrook, Long Island - (516) 599-5437.
51
52
FEBRUARY 2012
2 columns
53
FEBRUARY 2012
54
AD - FULL PAGE Size 8,625"x11,1875"
FEBRUARY 2012
AD - 1/2 PAGE Size 8,625"x5,5"
55
AD - 1/8 PAGE AD - 1/4 PAGE
Size 6,5"x2,67"
Size 6,5"x5,5"
AD - 1/8 PAGE Size 6,5"x
FEBRUARY 2012
AD - 1/2 PAGE Size 4,2"x11,1875"
56
FEBRUARY 2012
3 columns
57
FEBRUARY 2012
AD - 1/6 PAGE Size 2,75"x5,5"
AD - 1/3 PAGE Size 2,75"x11,1875" 58
These sizes only for 3 columns
AD - 1/6 PAGE Size 5,7"x2,67"