Health Care in the Jewish Community
Supplement to Jewish News May 20, 2013
Dear Readers, Published 22 times a year by United Jewish Federation of Tidewater.
Health care is so much more than traditional medicine today. And, like everything, it all begins…well, in the beginning. Last month, the Maimonides and Business & Legal Societies of the United Jewish Federation of Tidewater had an opportunity to meet with Dr. Howard Jones, the man who pioneered in-vitro fertilization procedures in the United States right here in Tidewater. Jewish News took advantage of a chance to speak with him, and shares that conversation on page 36. Another article on life’s beginnings considers the ethics of knowing too much about an unborn’s genetic composition. Rabbis have
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plenty to say about this kind of information. It’s an interesting and informative read. In Boston, after the horrific bombings at the Marathon, the wounded were taken to hospitals where the doctors were prepared to deal with the challenges because they were trained by Israeli physicians who are all-to-familiar with treating victims of terror. Our article on page 35 is just one example of Israel’s willingness to help others save lives. On the brighter side, we offer an article about research out of Tel Aviv University that proclaims that feeling powerful does, in fact lead to happiness. Everything in moderation, though! Then there’s the piece about Jewish Family Service getting high marks from Medicare and Medicaid Services for its delivery of home health care, a need that in some way, touches almost everyone holding this paper.
Terri Denison, Editor Germaine Clair, Art Director Laine Mednick Rutherford, Associate Editor Hal Sacks, Book Review Editor Sandy Goldberg, Account Executive Sharon Freeman, Account Executive Mark Hecht, Account Executive Marilyn Cerase, Subscription Manager Reba Karp, Editor Emeritus Alvin Wall, President Stephanie Calliott, Secretary Harry Graber, Executive Vice-President
We are fortunate in this issue that two physicians, Dr. Holly Puritz and Dr. Steven Warsof, share personal stories with ultimately happy endings! They are certain to make you smile. There are other articles, too, about ways to stay healthy and fit and stress-free. We hope after you read this special section that like the article on “pushing your brain and your body” suggests, you’ll get moving
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and be healthy! © 2013 Jewish News. All rights reserved.
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34 | Jewish News | May 20, 2013 | Health Care | jewishnewsva.org
What Boston hospitals learned from Israel by Ben Sales
TEL AVIV (JTA)—Minutes after a terrorist attack killed three at the finish line of the Boston Marathon, doctors and nurses at the city’s hospitals faced a harrowing scene— severed limbs, burned bodies, shrapnel buried in skin. For Boston doctors, the challenge presented by last month’s bombing was unprecedented—but they were prepared. Many of the city’s hospitals have doctors with actual battlefield experience. Others have trauma experience from deployments on humanitarian missions, like the one that followed the Haitian earthquake, and have learned from presentations by veterans of other terror attacks like the one at a movie theater in Colorado. But they have benefited as well from the expertise developed by Israeli physicians over decades of treating victims of terrorist attacks—expertise that Israel has shared with scores of doctors and hospitals around the world. Eight years ago, four Israeli doctors and a staff of nurses spent two days at Massachusetts General Hospital teaching hospital staff the methods pioneered in Israel. According to the New Yorker magazine, every Boston patient who reached the hospital alive has survived. “We had periods where every week we had an attack,” says Dror Soffer, director of the trauma division at the Tel Aviv Medical Center, who participated in the delegation. “It becomes your routine.” Techniques that were “routine” in Israel by 2005, and helped save lives in Boston last week, began evolving in the 1990s, when Israel experienced a spate of bus bombings. Israeli doctors “rewrote the bible of blast trauma,” says Avi Rivkind, the director of surgery at Jerusalem’s Hadassah Medical
Center, where 60 percent of Israeli victims story with a happy ending. In 2002, Shiri medical professionals can usually be relied have been treated. Nagari was rushed to Hadassah after a bus on to arrive at their posts within minutes, Much of what Israel has learned about bombing. She appeared to have escaped sometimes even ahead of the ambulances treating attack victims was done on the fly. largely unharmed, but 45 minutes later she carrying the wounded. In 1996, a 19-year-old soldier arrived at the was dead. It was, Rivkind later wrote, the “Whenever there was an alarm, we Hadassah hospital following a bus bombing first time he ever cried after losing a patient. jumped, ran and called our homes, and with severe injuries to her chest and esoph“She seemed fine and talked with us,” he then got ready to absorb patients,” says agus. Doctors put chest drains on her lungs says. “You can be very injured inside, and Liora Utitz, the mass-casualty coordinator and performed endoscopies twice a day to outside you look completely pristine.” at Rambam Medical Center in Haifa. “I felt stop the bleeding. Both techniques are now Organizing the emergency room, very safe. The volunteerism of everyone gave regular practices. Rivkind says, is as important as treating me strength.” “We were sure she was going patients correctly. During the second intifaIsrael continues to export its trauma to die, and she survived,” da, Hadassah developed what he called the expertise. Rivkind has taught medicine Rivkind says. “accordion method,” a method of moving in Melbourne, Australia, and Southern A riskier move came patients through various stages of assess- California. Delegations of doctors from New five years later when ment with maximal efficiency. The process York and Los Angeles have visited him Adi Huja arrived has become standard in hospitals across in Jerusalem. Last week, he spoke with at Hadassah with Israel and around the world. Maryland Gov. Martin O’Malley, who was massive blood loss Some of what distinguishes Israeli visiting Israel, about strengthening connecfollowing an attack trauma doctors are qualities that are hard tions between Hadassah and hospitals in in dow ntow n to teach. Rivkind has said he keeps two Baltimore. Jerusalem. Rivkind beepers and a cell phone on him at all “We have tens of years of cumulative realized his team times, even in bed. Even when calls come trauma experience,” he says. “We’ve learned wasn’t controlling the in the middle of the night, a small army of not to give up.” bleeding, so he directed staff to administer a shot of NovoSeven—a staggeringly expensive coagulant typically used for hemophiliacs that was not approved for a trauma situation. THE RIGHT CHOICE FOR OPTIMAL OUTCOMES. But it worked and Huja survived. Rivkind is an internationally recognized expert in terror medicine and widely considered one of the great brains behind Israeli innovations that have been adopted around the world. Trained at Hebrew University, the Hadassah Medical Center and the Institute for Emergency Medical Services Systems(L-R) Nicholas (L-R) A. Midis, MD, FAAOS • Jordan, Kevin Bonner, FAAOS Louis C. Jordan, A. Midis,Nicholas MD, FAAOS • Kevin F. Bonner, MD, FAAOS • Louis C. MD,F.FAAOS • Jack L. MD, Siegel, MD, FAAOS •• James E. Dowd, MD, FAAOS •MD, SamuelFAAOS P. Robinson, MD, FAAOS Jack L. Siegel, MD, FAAOS • James E. Dowd, MD, FAAOS • Samuel P. Robinson, MD, FAAOS in Baltimore, he has contributed to several volumes on trauma surgery and post-attack care, (L-R) and Nicholas authored a number of seminal A. Midis, MD, FAAOS • Kevin F. Bonner, MD, FAAOS • Louis C. Jordan, MD, FAAOS • Jack L. Siegel, MD, FAAOS • James E. Dowd, MD, FAAOS • S 5716 Cleveland Street, Suite 200 • Virginia Beach, Virginia 23462 • (757) 490-4802 • www.jordan-younginstitute.com medical studies. Rivkind was the personal physician for the late Israeli President Ezer Weizman, helped care for Ariel Sharon when the prime minister fell into a coma following a stroke, 5716 Cleveland Street, Suite 200 • Virginia Beach, Virginia 23462 and has performed near-miraculous feats, 5716 Cleveland Street, Suite 200 • Virginia 23462 • (757) 490-4802 • www.jordan-younginstitute.com (757)Beach, 490-4802Virginia • www.jordan-younginstitute.com once reviving a soldier shot in the heart who had been pronounced dead in the field. But not everything Rivkind has learned about treating attack victims comes from a
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jewishnewsva.org | Health Care | May 20, 2013 | Jewish News | 35
Dr. Howard Jones on IVF, the Talmud, and the future by Laine Mednick Rutherford
P
roir to speaking in Norfolk before an audience of Jewish medical, legal and business professionals—and a slew of admirers—Howard Jones, Jr., MD, spent a few minutes sharing his thoughts and opinions with the Jewish News last month.
“Dr. Howard,” as he’s known at Eastern JN: In 2011, 35,000 IVF procedures were done Virginia Medical School, and to many around in Israel… the world, founded the Jones Institute for HJ: (Interjecting) How many children were Reproductive Medicine at EVMS with his born and what percent of newborns are late wife Dr. Georgeanna Seegar Jones from IVF? almost 35 years ago. The Jones Institute JN: Nearly 5 percent of children born are reported pioneered the first birth in to be from IVF. the United States of a baby HJ: Well that’s a very, conceived through in-viIVF procedures very high figure. In the tro fertilization, and since in Israel United States, it’s a little then reports 10,000 babies in 2011 over 1 percent. In the born through its reproducScandinavian countries, tive technology assistance, it’s a little over 3.5 per4,000 of which came from cent. Denmark is about IVF procedures. 5 percent, so Denmark Attentive, affable, and Israel, I think, are the and charming, Jones, at 102-years-old, remains inquisitive in nature leaders in children born from IVF. and generous in knowledge. We discussed IVF in Israel, the definition of personhood, JN: How do you feel about this being your and what the future holds for those strug- legacy from your research and your work? HJ: It’s not entirely from my legacy. Bob gling with infertility. Edwards, of course was the one who really got the thing started. I think Norfolk’s
35,000
Dr. Sam and Danielle Leibovici.
Dr. Reuben and Judy Rohn with Dr. Mark Lipton.
36 | Jewish News | May 20, 2013 | Health Care | jewishnewsva.org
contribution was making it available on a general basis, making it easier to do, easy enough for me to do it. And that technology was picked up and was widely used—and is still widely used, so that it’s a part of the evolution of the IVF procedure. JN: In Israel, at this point, IVF is virtually free for all women and you can have as many procedures as it takes for you to have at least two children. Statistics show it costs about $13,000 per procedure in the United States. Do you think that it should be free or covered by insurance in this country? HJ: I think that infertility certainly should be covered by insurance in the United States. There are some insurance policies that do, but in general, for IVF, it is the patient who has to pay. JN: When do you think life begins? HJ: Well, life began millions of years ago. (He grins.) So I think what you’re really talking about is, when is personhood acquired?
Dr. Howard Jones, 102, founder of the Jones Institute for Reproductive Medicine at Eastern Virginia Medical School.
JN: Yes HJ: Personhood being, defined as that status, the acquisition of which gives you protections by society. In the United States, the law is clear on this, and that’s the Roe v. Wade condition of the Supreme Court, which indicated about 28 weeks. I think the Supreme Court got it right on a biological basis, because when you discuss this matter with people who are interested in it—moral theologians for example—they say, ‘We need some major biological event that has occurred.’ When you think of the various things, I think that the ability to exist
Dr. Ed Karotkin, Sharon and Bill Nusbaum.
on your own—viability—is a pretty good thing. In the United States, they designated that as 28 weeks. To my understanding of the traditional Jewish view, it was the first breath, or at birth—I believe that that’s from the Talmud. If that is so, that’s not too different from the Supreme Court’s view, because the first breath concept can apply to premature infants. I think those two views are not too far apart. JN: I believe it depends on which rabbi you speak with. HJ: I’m sure that’s so. JN: When you were developing the IVF procedure in the United States—in Norfolk—did you have conversations with representatives of different faiths? HJ: We did. One of our strong supporters was [Rabbi] Larry Foreman—he spoke up for us, I think I got the Talmud expression from him. [Those conversations] were triggered by opposition to what we were doing. The right to life group protested vigorously, and as a result of that there was a hearing that began at 2 o’clock in the afternoon and lasted until 8 o’clock at night, and it was at that hearing that Rabbi Foreman spoke. We have had this problem of personhood from the very beginning. JN: How do you feel when you see children who were born as a result of in-vitro fertilization from the Jones Institute? HJ: I’m always really touched, and appreciate them very much. However, I must say that I am more impressed and concerned by those individuals who have tried to get pregnant and have not succeeded. We are not 100 percent successful yet, and
Dr. Richard Homan, EVMS president and provost, and dean of the School of Medicine, with Dr. Alan Wagner, Maimonides Society chair emeritus and EVMS faculty member.
that interests me and concerns me more than those who have already come. JN: How has research continued? HJ: The research continues to try to improve things. And I do think that in the future things are going to be better. Let me just give you one example. At the present time, when we fertilize two or three eggs and look at them under the microscope, we cannot tell which one of those has neonatal potential. You know—human reproduction is an inefficient procedure. Only about 20 percent of the time when the egg meets the sperm does that develop into a neonate; the others are aborted. What we need to do is to have some method of identifying, before transfer, that fertilized egg with neonatal potenDr. Howard Jones signs a copy of his newest book for Dr. Alison Ohana. tial, so that we can select that to transfer. That would immediately up prevent multiple pregnancies that some- it cheaper. So—we’ve got something to do. the pregnancy rate tremendously, it would times give difficulties, and it would make
Conversation with renowned doctor captivates audience of professionals by Carolyn Amacher
When did you become protected by law? Upon fertilization, heartbeat, quickening, fetal brain waves, or birth? Renowned for his involvement with the first in-vitro fertilization birth in the United States, the immortal HeLa cells of Henrietta Lacks, and sex reassignment surgery, 102-year-old Dr. Howard Jones is no stranger to ethical, moral, religious and legal questions such as these. Before an audience of 120 medical and legal professionals and guests at the Eastern Virginia Medical School Education and Research Building in Norfolk on April 29, Jones led a “Conversation Concerning Issues of Reproductive Technology, Bioethics, Religion and the Law.” The program was co-sponsored by the Maimonides and Business & Legal Societies of the United Jewish Federation of Tidewater, and facilitated by Dr. Alan Wagner, EVMS
faculty member and chair emeritus of the Maimonides Society. During the hour-long conversation, Jones discussed the roots of IVF and reproductive rights, his meetings with Vatican representatives during the EVMS Jones Institute’s early years, the policy surrounding personhood, and society’s ever-growing ethical questions. Much of the material covered is detailed in Jones’ newest book, Personhood Revisited: Reproductive Technology, Bioethics, Religion and the Law. Jones has a worldwide reputation for his groundbreaking work. He is professor emeritus of the Department of Obstetrics and Gynecology at EVMS and founder of the Howard and Georgeanna Jones Foundation. “Dr. Howard Jones gave a truly remarkable talk at EVMS, courtesy of the UJFT,” says community member Bill Nusbaum. “He is ‘only’ 102 years old, and just as lucid and detail-oriented as ever. The
pioneering research by him and his late wife Georgeanna (leading to the first IVF birth in the US), and their opening of the Jones Institute for Reproductive Medicine in Norfolk, are why Sharon and I are such lucky and proud parents of Leigh Nusbaum (Jones Institute IVF baby #588).” Following the discussion, Jones signed copies of his book, kindly greeted friends and fans, and briefly attended a reception in his honor. The Maimonides and the Business & Legal Societies of the UJFT serve to connect emerging and seasoned professionals in the fields of medicine, law and business to UJFT and its affiliate agencies, congregations and broader community. For more information on these societies, visit www.jewishva.org, or contact Carolyn Amacher at 757-3181 or email camacher@ ujft.org. To see more photos from this event, “Like” JewishNewsVA on Facebook.
jewishnewsva.org | Health Care | May 20, 2013 | Jewish News | 37
It’s true! Feeling powerful leads to happiness Powerful people feel freer to be their authentic selves, find Tel Aviv University researchers Tel Aviv—Television characters from mob boss Tony Soprano to 30 Rock’s Liz Lemon suggest that power is a gateway to loneliness, corruption, and unhappiness. But new findings from two Tel Aviv University researchers are challenging this perception. In a quest to discover whether power inevitably brings misery and emotional devastation, PhD candidate Yona Kifer and her supervisor Prof. Daniel Heller of TAU’s Department of Organizational Behavior at the Faculty of Management have shown that power can actually make people happier. In their study, published in the journal Psychological Science, the researchers found that a sense of power led to a heightened sense of well-being, and that one of the reasons for this effect is that power increases “authenticity”—the extent to which people feel they are being true to their deepest desires.
Overall, those who felt more powerful in their lives described themselves as 16 percent more content than those who did not. The effect was the most pronounced in the workplace, where those who reported having more power at work were 26 percent more satisfied at their workplace than lower-power colleagues. These findings reveal an interesting paradox, notes Kifer. While the pursuit of power has been found to reduce happiness, possessing power actually increases it.
Embracing your “true self” Despite the prevailing notion that power leads to misery and alienation from the self, the researchers hypothesized that in reality, those who are powerful have the ability to live their lives more authentically—appeasing their internal desires and
inclinations—and can therefore be happier. In a set of three studies, they surveyed 600 participants about the effect of power on feelings of authenticity and well-being, both generally and in specific contexts such as work and personal relationships. The results showed that the possession of power leads people to be more authentic and true to themselves, allowing their actions to reflect their own beliefs and desires. This effect was stronger in the context of the workplace than in a person’s personal relationships, Kifer adds. The researchers believe this may be due to the different nature of the social relationships in each environment. Whereas work relationships are typically formed within the hierarchical structure of the workplace, personal relationships—whether with a romantic partner or friend—are usually based on mutual
affection, meaning that power plays less of a defining role. These findings can be a valuable tool for managers who wish to boost employee morale. “In organizations, giving people a sense of power can dramatically improve job satisfaction, which is linked to improved performance,” Kifer advises. This can also have a positive impact on creativity. If an employee feels more authentic, they may be less guided by expectations and mainstream norms, and more willing to think outside the box.
Cross-cultural concepts of power The researchers hope to expand on the study by exploring the impact of power in other cultures. Of particular interest is the East Asian culture, where power has different connotations. Whereas Western cultures
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are individualistic and glorify independence and self-actualization, East Asians are typically more collectivistic, Kifer explains. The researchers hope to discover whether the happiness associated with power is more common in individualistic cultures. In addition, Kifer believes that it is important to look at whether the type of power a person exerts can make a difference
in terms of happiness. One question is whether people are happier if their power is exerted through positive means, such as charisma, rather than negative means, such as physical punishment. This work was done in collaboration with Prof. Wei Qi Elaine Perunovic of the University of New Brunswick, and Prof. Adam D. Galinsky of Columbia University.
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Jewish Family Service excels in providing home health care to patients by Jan Ganderson, director of nursing, JFS Home Health
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or more than a decade, the Center for Medicare and Medicaid Services (CMS) has required Medicarecertified home health agencies to collect and transmit Outcome and Assessment Information Set data for all adult home health patients receiving skilled home health care services. Skilled services are provided, based on a physician’s order, often following a surgery or hospitalization by registered nurses (RN’s), physical/ occupational/speech therapists, medical social workers, home health aides, and dietitians. This data has been used for multiple purposes by CMS, including payment calculations for an episode of care provided. CMS has also provided these reports to home health agencies to help guide quality/performance improvements efforts. Over the years, Jewish Family Service has implemented various initiatives to improve service to patients with a mission to provide the best care possible and to continue to “raise the bar” when the opportunity arises. The most recent outcome data provided by CMS in a report last month focused on two areas. The first report covered a 12-month period from March 2012 through February 2013 and tracked the number of hospitalizations that occurred for patients receiving home health care. Each month JFS was
impressively below the state and national percentage rate. This can only be contributed to JFS’ highly competent nurses and therapists who focus their teaching on disease and symptom management and preventative measures. The second report covered the same period of time and tracked the number of patients that improved in management of their oral medications. With the exception of March 2012, JFS was impressively greater in the state and national percentage rate of improvement. Again, this improvement is due to the nurses and therapists who provide ongoing teaching on the importance of medication management to their patients and their families/caregivers. The last recent outcome report received by JFS, covering the period from October 2012 through March 2013, measures the patients view or perspective of the quality of care they received from JFS. Of the 22 areas of care measured, JFS’s percentage of improvement was greater in all areas but one compared to the prior six-month period, and JFS scored higher than any other agency in the region and the entire data base surveyed by Press Ganey. JFS provides home health care with commitment and integrity, always striving for the highest standard of delivering this service. For more information about JFS Home Health Care, call 757-489-3111.
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jewishnewsva.org | Health Care | May 20, 2013 | Jewish News | 39
Prenatal whole genome sequencing technology raises Jewish ethical questions by Joel N. Shurkin
BALTIMORE ( JTA)—Expectant mothers long have faced the choice of finding out the gender of their child while still in the womb. But what if parents could get a list of all the genes and chromosomes of their unborn children, forecasting everything from possible autism and future genetic diseases to intelligence level and eye color? The technology to do just that—prenatal whole genome sequencing, which can detect all 20,000 to 25,000 genes in the genome from fetal blood present in the mother’s bloodstream—is already in laboratories. While not yet available in clinical settings because of the cost, once the price falls below $1,000 it is likely to become common, according to a report by the Hastings Center, a nonpartisan bioethics research institute. With it will come a host of Jewish ethical dilemmas.
“We need a serious set of conversations about the implications of this new technology,” says Peter Knobel, a Reform rabbi who teaches bioethics at the Spertus Center in Chicago and is the senior rabbi at the city’s Temple Sholom. How will parents react to a pregnancy destined to produce a child with an unwanted condition? What do parents do when genetic sequencing shows a predisposition for a deadly disease but not a certainty of it? What about diseases not curable now but which may be cured by the time the child reaches adulthood? When, if ever, is the right time to tell a child he or she has a genetic predisposition toward a particular disease? It likely will be the most contentious social issue of the next decade, predicts Arthur Caplan, director of the Division of Medical Ethics at NYU Langone Medical Center.
“Anyone who thinks that information that could lead to abortion isn’t going to be controversial has been asleep since Roe v. Wade,” Caplan says. According to Orthodox Judaism’s interpretations of Jewish law, abortion is permissible only when the mother’s health is at risk. The Conservative movement agrees, but its position includes other exceptions. “Our real concern will be massive increases in the number of abortions,” says Rabbi Moshe Tendler, professor of bioethics at Yeshiva University. “You have a young couple, 22, 23, 24 years old, and they don’t plan to have more than two or three children. Why take a defective child? I call it the perfect baby syndrome. The perfect baby does not exist.” Rabbi Avram Reisner, a bioethicist on the Conservative movement’s Committee of Law and Standards, says abortion by whim is clearly prohibited.
“Judaism is not pro-life,” says Reisner, the spiritual leader at Congregation Chevrei Tzedek in Baltimore. “Jewish law allows abortion. And it is not pro-choice. It is concerned with managing the health of the mother. It does not support abortion as a parental whim.” The Reform movement, though adamantly pro-choice, has a similar position. “Abortion should not take place for anything other than a serious reason,” says Knobel of the Spertus Institute, “hopefully in consultation with a religious or ethical adviser.” As far as Jewish ethics are concerned, prenatal whole genome sequencing has some elements in common with current genetic testing. Embryos of Ashkenazi Jews routinely are tested for such diseases as Tay-Sachs and the breast cancer genes BRCA—two illnesses disproportionately common among Ashkenazim.
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In haredi Orthodox communities where arranged marriages are common, matchmakers routinely consult databases that hold genetic information anonymously to see whether a match would face a genetic obstacle. That practice, and genetic testing during pregnancy, has practically eliminated Tay-Sachs disease in the American Ashkenazi community, according to Michael Broyde, professor at the Emory University law school and a member of the Beth Din of America, an Orthodox rabbinical court. The difference between prenatal sequencing and current genetic testing is the amount of information and its usefulness. Current tests look for specific genetic disorders. Prenatal sequencing is a fishing expedition, looking at everything. At present, the information is of limited use. No one knows what 90 percent of genes do, and it usually takes more than one gene to do anything. Furthermore, genes are not destiny: Just because one has the genes for certain diseases, such as coronary heart disease, does not mean one will get it. “All genetic stuff is probabilistic,” Caplan says.
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Some say that raises the question of whether Jews should be undergoing genome sequencing at all. “Just because you can get the whole genome, why do that?” asks Rabbi Elliot Dorff, chairman of the Conservative movement’s Committee on Law and Standards. “How much do you want to find out and how much do you want to share with the couple, and later with the child? Just because you can doesn’t mean you should.” The operative question, he notes, is whether it will cure or detect a serious disease. “With all questions of this type, the law doesn’t ask how something is being done; it asks what we are accomplishing,” Broyde says. “If sequencing makes people healthier, it’s a good thing. If it’s going to make people ill, it’s sinning.” Knobel says, “We need what I call an ethics of anticipation. We need a serious set of conversations about the implications of using the new technology, about how we can understand the values and ethics and come to grips with what it means in the long term.”
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jewishnewsva.org | Health Care | May 20, 2013 | Jewish News | 41
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CASE STUDY Maternal-Fetal Medicine Steven L. Warsof, MD
I
have been honored to meet some very special people in my career as a high risk Obstetrician over the past 30 years in the Tidewater area. Usually, Obstetrics is a happy field with good outcomes. I have always maintained that it is easy to be a great obstetrician when the outcome is good, but it is much more difficult to be an obstetrician when the outcome is tragic. Unfortunately 2–5% of all pregnancies have either a major birth defect or chromosomal abnormality. It has been my job to bring the frequently unexpected and often tragic news that a pregnancy has been affected in some untoward way. These problems range from lethal congenital anomalies, congenital heart disease, or chromosomal abnormalities such as Down’s Syndrome or worse. Perhaps one of my most memorable patients was the wife of a local minister whose fetus had anencepahaly, a birth defect that is uniformly lethal due to abnormal formation of the fetal skull and brain. After explaining the problem to the family, their decision, with my support, was to continue the pregnancy and to treat the fetus in a kind and respectful fashion. Frequently after a prenatal visit we prayed together for the health and well being of this child. Delivery occurred at term and the child died in my presence in her parents’ loving arms. I attended the child’s funeral and obviously had a very close spiritual tie to this family. Although obviously devastated by these events, this couple was able to maintain their faith, and somehow had the emotional strength to return to my office for a future pregnancy. Fortunately this was a healthy child. I was very surprised and honored when I learned that they had named the child Steven, because of the courage and strength that I gave them to face the loss of their daughter. Another courageous patient was a woman who had become totally blind due to uncontrolled diabetes during her teen years. In her 20s she wanted to restore her life and as part of that wanted to have a child. With her hard work and the dedication of her diabetic educator, she achieved her goal of a healthy child and in fact had a second child subsequently. Although she will never be able to “see” her children, she always maintained that they were the two most beautiful children ever created. By the way, I subsequently have been married to that diabetic educator for the last 17 years. These are only two of hundreds of stories of brave women facing reproductive adversities that I have been honored to share in this unique part of their lives. Steven L. Warsof, MD Professor Primary Specialty: Maternal-Fetal Medicine Secondary Specialty: Obstetrics & Gynecology Medical Education
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44 | Jewish News | May 20, 2013 | Health Care | jewishnewsva.org
Push your brain and your body, says sports physician and author Jordan Metzl by Elisa Spungen Bildner
MONTCLAIR, N.J. ( JTA)—When I was growing up in the 1960s in Skokie, Ill., reading was the main sport in my family. I’m pretty sure it was also the main sport in most families in my predominantly Jewish neighborhood: Neither my friends nor I ever heard the phrase “traveling soccer team” cross our parents’ lips. Which is not to say we didn’t mosey over to nearby Devonshire Park to ice skate or knock some tennis balls around on the public courts. We did, but only after we finished our homework. For Dr. Jordan Metzl, a Jewish kid growing up more than a decade later in Kansas City, Mo., it was quite different. Metzl, a sports medicine physician at New York’s Hospital for Special Surgery who was listed in New York magazine’s 2012 annual index of best doctors, is the author of The Athlete’s Book of Home Remedies:
1,001 Doctor-Approved Health Fixes & Injury Prevention Secrets for a Leaner, Fitter, More Athletic Body! (Rodale Books, 2012). “I grew up with a very Jewish upbringing inside the bigger bubble of mid-America,” Metzl says, but he’s proud that his parents “got it right: They got the balance of Jewish social consciousness, academics and sports,” even though they were up against an ethos in their kids’ Jewish day school that downplayed physical education. Metzl, 46, who has finished 29 marathons and nine Ironman triathlons, is on a mission to get Jews—and, of course, his other patients—off their tushes. Like the ultimate handwringing Jewish mother, he worries about Jews “getting soft,” not like his young Asian patients, products of first-generation or immigrant families that push their kids both academically and on the sports field. “Forty years ago, Tiger Mom would have been Matzah Ball Mom,” Metzl says. He’s a big believer that Jews must not only
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push their brains but their bodies, and is fond of the Latin dictum mens sana in corpore sano, “a sound mind in a sound body.” Although he loved athletics growing up in a family that treasured both, it was in medical school that Metzl discovered he could concentrate better when he was active. “My performance as a doctor absolutely correlated to daily fitness,” he says. As a medical resident in Boston, the hospital made an offer that employees who ran the Boston Marathon would get a day off from work. Metzl signed up, ran and ever since has been encouraging fitness as preventive medicine. The sports doc’s new book is dedicated to the “millions of athletes who wake up each morning at 5:30, with no fanfare, and drag themselves out of bed to keep fit.” Metzl calls the Iron Strength Workouts “simple (but intense!)”; his routines emphasize functional strength training based on a movement pattern rather than isolating an individual muscle in a bicep curl or leg extension. For those who want to try an Iron Strength Workout, there’s a free video on Runnersworld.com but beware: “KILLER. This workout kicked my butt,” reads one online comment that seems representative. I checked with my trainer at the Jewish Community Center of MetroWest in West Orange, N.J., Nimika Patel, to see if there are a lot of “me’s” in the Jewish athletic world or whether they are all Metzls. Patel’s clients come in not necessarily to train for their next competition, but because of “osteoporosis, depression, fibromyalgia— you name it,” she says. “They all want to look good, of course, but there is always another reason they’re here.” Like Metzl, Patel emphasizes what’s called functional fitness, which helps bodies get stronger at everyday tasks. Steve Becker, vice president of health and wellness services at the JCC Association, the North American umbrella for the Jewish community center movement, says fitness facilities are moving away from cavernous rooms with one strength machine after another to offering more open space for people to train in a way that improves quality of life, using equipment like resistance bands and medicine balls. “Being fit is about more than the one rep max or seeing how much you bench press,” Becker says. “It’s about lifting up
grandchildren or schlepping luggage across the airport.” JCCs are featuring boot camp classes, yoga, pilates, small group training, zumba—you name it, he says—but also encouraging their members to look more broadly at wellness and healthy living. Go to www.simonfamilyj.org to see all of the options available at the Simon Family JCC in Virginia Beach including private or group classes, swim lessons, and the latest in everything for those seeking a healthy lifestyle. “If you’re 8 or 85, get off the couch,”
Metzl says. “The benefits kick in if you do half an hour of walking every day.” Sure, do extreme sports if you like them, he says, but what’s most important is finding something you’ll enjoy, that you’ll keep doing. “If there were a drug known to reduce blood pressure, cardiovascular disease, depression, diabetes, self-reported pain of arthritis, increase longevity by five years and improve quality of life by every metric, a doctor who didn’t give it to every patient would be committing malpractice,” says Metzl. “We have this drug, and that drug is exercise.”
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CASE STUDY Out of the mouth of babes Holly Puritz, MD
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uring medical school, it was an amazing surprise that I loved being in the OR. When I combined that desire with loving long-term relationships with patients, being an OB/GYN appeared as the perfect mix for me. I truly love delivering babies and still don’t mind getting up in the middle of the night to do so! One story that always makes me smile involved a patient who was pregnant with her third child. She wanted her two boys who were about five- and seven-years-old at the time, to “meet the doc who first held them.� The mom made a big deal about bringing them to her appointment, getting them out of school, dressing them up. They were very prepared for the visit! We, too, were prepared and I wanted it to be a special and fun meeting. I gave these adorable boys ‘doctor gloves,’ listened to their heart beat and then let them listen to the baby’s. At the mom’s next appointment, she greeted me by saying that her oldest son wanted her to find another doctor. “Why?� I asked. I thought our meeting had gone just fine. The mom replied that he had said, “Doctor Holly was very nice, but not very smart.� He told his mom that when he asked me if the baby was a boy or girl, I had replied, “I don’t know.� And when he asked how big the baby was, I said, “I’m not sure.� Then, to top it off, when he asked if the baby was going to have lots of hair like he did, I again replied, “I don’t know.� So, the young man told his mom, “I don’t think those are hard questions for someone who delivers babies all the time. I think you need to get another doctor!� I guess it’s good to be brought down a notch. Oh, and true to my loving long-term relationships with my patients, she and I still laugh about it!
Holly Puritz, MD OB/GYN, The Group for Women Medical Director of OB/GYN Services at Sentara Leigh Hospital
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Chair American Congress of Obstetrics and Gynecology (ACOG) in Virginia. Medical Degree Tufts University, Boston, Mass. Board Certified and Fellow of American College of Obstetrics and Gynecology
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jewishnewsva.org | Health Care | May 20, 2013 | Jewish News | 47
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48 | Jewish News | May 20, 2013 | Health Care | jewishnewsva.org