So Good to Have Good News
Chodesh tov! With all that’s going on with COVID-19, we are so happy to be able to share so much good news this month, as well as return to our usual newsletter forum, highlighting various doctors and procedures related to our work.
Rabbi Yitzchok and Mrs. Chaya Melber Tahareinu Founders
Successful Certification Course Launch Immediately Spurs Additional Course Registrations for Fall
Our online, 10-week Tahareinu Certification Course started a few weeks ago and has been tremendously well received by all participants. We’re currently holding four simultaneous courses – one for women and three for men given in English, Yiddish, and Hebrew. Registration reached full capacity within days of announcing both men and women’s courses. Registrants include Rabbonim, madrichei chassanim, kallah teachers, bodkot, medical professionals, and other community lay leaders.
The goal of the course is to ensure that every individual engaging in questions related to women’s reproductive health and/or tahara is up to date on the most recent innovations, treatments, and medications that are available today. By providing updated information to leaders in communities throughout the Jewish world, Tahareinu can truly reach the masses efficiently in our communities.
Given the demand of the tzibur, a second session of courses will commence B”H immediately after the Yomim Tovim (Week of October 12th) through the week after Chanukah.
Register by August 31, 2020 and receive a 10% discount.
Hadassah IVF Now Offers Private – For Free
The new director of Hadassah Hospital’s IVF departments, OBGYN Dr. Anat Hershto-Kalman, is changing strategies for patient relationships by allowing everyone in any kupah (national HMO) the option to go private, at no extra cost. Previously, only those with the highest level of supplemental kupah coverage could arrange for covered private treatment, a process which was red-tape deep. Now, everyone in a kupah will automatically qualify for private physicians, allowing for patient choice, as well as continuity of care with the same physician.
Given that 95% of all English-speaking couples seeking fertility treatments come to Hadassah through Tahareinu, we were invited to meet with Dr. Hershko Klement to discuss our collaboration to date, and ideas for expansion. One thing to be hopeful about: medical documents translated into English.
Pelvic Congestion Syndrome (PCS)
Pelvic Congestion Syndrome is a lesser-known disease whose main symptom is severe pelvic pain for any woman who gave birth, often occurring around menstruation. Due to its symptom of pelvic pain, PCS is often confused with other gynecological conditions such as endometriosis, vulvodynia, or hemorrhoids, and therefore these conditions must first be ruled out via expert ultrasound, or MRI if necessary. Professor Bloom (mentioned below) treats PCS at Hadassah Ein Kerem. If you have consistent pelvic pain, call Tahareinu about how to proceed.
This newsletter features three doctors – a radiologist, a urologist, and a gynecologist – whose areas of expertise benefit Tahareinu callers.
Professor Allan-Isaac Bloom, MD, Radiology
In a recent newsletter, we highlighted a procedure for male factor called cell electrical activation, available under Dr. Aharon Peretz and undergoing further research by Dr. Shlomi Barak (both in Israel). This month, we feature doctors performing other procedures for male infertility.
Professor Allan-Isaac Bloom heads the Vascular and Interventional Radiology Unit, Dept. of Medical Imaging at Hadassah Ein Kerem Hospital in Jerusalem. He is a native English speaker, having studied medicine in Dublin and worked for several years at the University of California, San Francisco (UCSF).
Professor Bloom’s expertise applies to Tahareinu because he performs the minimally- invasive procedure called embolization for AUB (abnormal uterine bleeding), fibroids, blood clots, male infertility and other male health issues, such as prostate problems. Embolization can sometimes even alleviate the need for a hysterectomy for severe cases of AUB or fibroids in women. For men with prostate issues, embolization can solve the issue while preserving fertility.
In particular, Professor Bloom is a leading expert in treating a condition called PCS, or pelvic congestion syndrome (see above).
Dr. Ohad Shoshani, Urology Fertility
Dr. Ohad Shoshani is a urology fertility expert. Realizing that Tahareinu is a leader in advising about male infertility, Dr. Shoshani approached us for collaboration.
Originally from Chicago, Dr. Shoshani’s work is especially of interest to Tahareinu callers because his procedures can be performed at a much lower cost in Israel for non-residents, and mostly if not fully covered for Israeli nationals. Procedures include:
- Varicocele repair via microsurgery. This procedure can avoid the need for IVF. The fact that this microsurgery is an option illustrates that any male experiencing infertility can benefit from an expert opinion from a urologist specializing in infertility. In terms of cost, it is now available fully covered for Israelis, or available privately for a quicker appointment and slightly different procedure.
- MicroTESE. This method is used only for complex situations where there is zero count. A very costly procedure (around $50K), this method available in Israel for about 30-50% less than in other countries (about $17-25K).
Determining the best procedure for male infertility is incredibly individualized. In addition, there might be halachic questions regarding male involvement in fertility treatments and procedures. Tahareinu provides medical guidance within the parameters of halacha, although does not provide psak. CallTahareinu for individual case management.
OBGYN Dr. Dvorah Bauman Tours Hotline, Lectures on Contraception
Floored. Completely floored.
That’s how Mrs. Chaya Melber describes Dr. Dvorah Bauman’s impressions when visiting our Tahareinu hotline.
Dr. Bauman, an Israeli gynecologist, gave an evening lecture to Tahareinu hotline advisors on February 19, 2020 on the topic “Contraception: Ages, Stages, and Conditions,” after which she toured our offices and got acquainted with our hotline. Dr. Bauman clicked through the hotline knowledge trees and was astounded, proclaiming,
“This is just like flowcharts in the hospital – we have these same kinds of trees. We always stress to our medical students to first take the patient’s history, and this is what you, as Tahareinu advisors, are doing!” She practically didn’t want to leave, remarking, “If I had the time to answer these calls, I would!”
It’s no wonder that Dr. Bauman does not have the time. She is a household name for recommended Jerusalem gynecologists, and as a result, her appointment schedule is full, often months ahead. She specializes in adolescent gynecology (Maccabi), endoscopic gynecology (Misgav Ladach – Meuchedet), and sexual-abuse related gynecology. She also works out of Hadassah, performing both hysteroscopic and laparascopic procedures.
Even though Dr. Bauman’s lecture topic was birth control, she also covered a lot of ground on other aspects of gynecology. The following is a summary of the subjects she spoke about at the evening lecture.
- Individualized medicine. Dr. Bauman emphasized that individualized medicine is the ideal, especially for women’s health since so many factors are involved. This was partly why she was so impressed with our hotline – because we deal comprehensively with each individual caller.
- Risks of the mini-pill. The progestin-only pill, also known as the “mini-pill”, poses risks for depression, depending on the generation. Dr. Bauman therefore usually recommends the combination pill, whose levels of progesterone are lower because they are combined with estrogen. At the same time, as advisors, we have also seen that depression on the pill is so individual – even on the combination pill. So, we talk it through with the woman, and assess which generation of mini-pill might be suitable for her, or if she would prefer non-hormonal methods, such as the copper IUD or spermicide.
- The high risk of the Diane. Some acne-ridden teenagers are prescribed the Diane, a form of contraception, in order to regulate the hormones associated with acne. Dr. Bauman recommends against the use of this drug, especially in teenagers, because it is a growth inhibitor, causes weight gain, and increases insulin resistance. She only prescribes it for extremely severe cases, and even then, for a maximum of four months. Note: Due to its high level of estrogen (35), we never recommend the use of the Diane for contraception. As for acne, we recommend Yazmin for milder cases.
- HRT for cancer. Dr. Bauman offered a surprising perspective: The main symptom indicating breast cancer risk is high blood pressure. If BP is not high, there’s no reason to use hormone replacement therapy (HRT), which involves taking drugs with estrogen. At the same time, the jury is still out on HRT risk-benefit analysis. On the one hand, some research shows that HRT can lower the risk of ovarian or uterine cancers. This is especially applicable for ovarian cancer whose symptoms are not obvious, and therefore unfortunately is often diagnosed too late. However, HRT might increase breast cancer risk, which leaves us unable to outright recommend it for cancer prevention. (Of note, the mini-pill is not associated with cancer risk because it only contains progesterone, whereas the combination pill, which, like HRT, contains estrogen, and therefore could be increasing cancer risk. Note also that males can possess the BRCA-1 gene, and can get breast cancer.)
- Reconstructive surgery. Lo aleinu, Dr. Bauman specializes in vaginal reconstructive surgery, due to damage from an accident or abuse.
We appreciate Dr. Bauman’s training for Tahareinu, and especially her appreciation for our high-level hotline, helping women day to day. We look forward to continually collaborating.
Thank You Testimonial
“…The way you held our hand every step of the way, with such warmth and patience – it’s something only you can offer. We will always remember this special organization, Tahareinu, and your most amazing founders, Rabbi and Mrs. Melber. May Hashem repay you for the avodas haKodesh you do, and may you be zocheh to be shluchim to help bring many more healthy neshamas into the world…”
–Chavi S., Jerusalem
(Name changed to preserve anonymity)
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