health – Page 20

Good news on Alzheimer’s

For the last three years, I have been researching, interviewing and writing articles for Senior Line, the magazine published three times a year by Jewish Seniors Alliance of Greater Vancouver. In that capacity, I read everything I can about dementia, especially Alzheimer’s disease, medical care for seniors and residential facilities for seniors.

A year ago, I succumbed and started paying for a digital subscription to the New York Times. Using their “alerts” system, my inbox is filled with relevant, current articles on these topics. I scour the media (Vancouver Sun, Zoomer Magazine, Jewish Independent, CBC News Network, CNN, documentary channels, movies portraying Alzheimer’s disease, and online newsletters from organizations such as CARP and COSCO) searching out information about these senior issues. I also began visiting the Louis Brier Home and Hospital regularly, interacting with people with dementia (with the assistance of Davka, my Standard Poodle).

Why was I obsessed with Alzheimer’s disease? The truth is that I was swimming in a turbulent sea of fear, dread and panic – analyzing every forgetful moment and constantly measuring my intellectual capacities, to be sure that I wasn’t “losing it.” This had been going on for the past five years.

My feelings and thought processes began to evolve as I gained knowledge and understanding of the causes, the progression of this condition and, of utmost importance, the changes in attitude towards the management of seniors residences and the programs offered to seniors with dementia. Most surprisingly, among the gloom and doom scenarios of “the grey tsunami” and “the stark demographic shift,” I began to understand that there is actually good news about dementia and Alzheimer’s disease. Yes, you heard me: good news!

Today, reaching the age of 100 is no longer shocking. I personally know three people who have reached that age. Seniors of my generation, and the Boomers and Zoomers, are living longer. Within this large cohort, dementia is a product of the natural aging process. The longer we live, the higher the probability of dementia. Is there anyone among you who wants to die at 65 or 71 (the risk of Alzheimer’s begins to increase dramatically at the age of 65)? Wouldn’t you rather live to 86 or 94? Of course! Well then, your chances of having dementia will increase.

At 77, I am more active and more productive than I have ever been. I know that, at any time, I may begin to deteriorate. The influence of genes is crucial: one grandmother had dementia, the other did not. My aunt has Alzheimer’s and, recently, a close relative was diagnosed with the early signs of the disease. I am shocked and saddened, but now I am able to accept the possibility, putting it in the context of the result of aging well and living longer.

What have I learned? Maria Shriver, in her Feb. 25 article on WebMD “We can handle the truth: the facts on Alzheimer’s,” writes “try to put your denial impulse aside and take a hard look at the truth about Alzheimer’s. Because the fear that causes you to deny things – like our risk of getting this mind-blowing disease – can actually be the motivator you need to stop ignoring the facts….” We know the risks and the consequences, but we are in denial and unprepared to deal with it – personally, financially and as a society. It seems that by pushing through my ignorance and my fear, I have come to a place of harsh reality and hope.

The intense desire for the discovery of a cure for dementia, or a preventive strategy for Alzheimer’s disease, is universal. Exciting research is happening in labs across the globe but, until a “miracle cure” is found, let us not refuse to act because there is no cure. Denial is the enemy of hope.

How much do you want to know about your risk of getting the disease? Here is a list of ways to learn more:

Review your family history with your doctor.
Review lifestyle factors like diet and exercise with your doctor.
Review your medical history with your doctor, including questions about brain trauma.
Take a genetic test to determine whether you have genes that raise your odds of getting the disease.
Get a brain scan to spot signs of the disease.

But, if you are like 41% of the people in the survey “Insight into Alzheimer’s Attitudes and Behaviors,” you have not – or are not willing to – take any of the proposed steps, according to a Feb. 25 article by Ashley Hayes on WebMD. Another 46% say they aren’t worried about getting Alzheimer’s in the future, mainly because they take care of their health and also because they can’t do anything about it. Thirty-four percent of respondents say they’re concerned about getting the disease in the future and, of those, 69% say they’re concerned because they don’t want to become a burden to their family, with 60% concerned because there’s no cure.

Michael Smith, MD, WebMD’s chief medical editor, states, “There is great concern about the impact of this disease, but denial, fear or other unknown factors seem to be preventing us from taking the necessary steps to prepare.”

People do not seem to realize that they can lower their risk. A few suggestions are offered: stay mentally or intellectually active, eat a healthy diet, take vitamins or supplements, exercise at least three times a week and stay socially active.

There is a positive link between physical exercise and brain health. There is a relationship between the foods, drugs, alcohol and nicotine we ingest and their impact on the brain. Hopefully, more informed, more realistic children will notice when a parent’s mental capacities are diminishing (if you haven’t), and they will get us to the physician or gerontologist early, wasting no time; perhaps to participate in a clinical trial or to get a new drug that could slow its progression. Plans must be made, contingency scenarios must be worked out. The best way to break through denial is to challenge it.

The good news

Dementia rates have been plunging. It took a few reports and more than a decade before many people believed it, but data from the United States and Europe are becoming hard to wave off. The latest report finds a 20% decline in dementia incidence per decade, starting in 1977.

A recent American study, for example, reports that the incidence among people over age 60 was 3.6 per 100 in the years 1986-1991 but, by the years 2004-2008, it had fallen to 2.0 per 100 over age 60. With more older people in the population every year, there may be more cases in total, but an individual’s chance of getting dementia has gotten lower and lower, as Gina Kolata reported in a July 8 New York Times article.

The psychological definition of “denial” is an unconscious defence mechanism characterized by refusal to acknowledge painful realities, thoughts or feelings. My anxiety, fear and dread have disappeared. I have faced the dreaded monster, I have embraced the enemy. I now visit with people suffering from Alzheimer’s. I have spoken to my children frankly about my wishes if I should become incapable of handling my affairs. I have decided where I wish to live if I must move into a seniors residence to receive care. I am aware of the newer approaches to residential care and housing arrangements. I have informed myself of the resources that my community can offer me.

Now, every day is an invitation to excel, to learn and to enjoy. I have become ambitious, physically stronger and more committed than ever to appreciate my good health and sense of well-being.

Dolores Luber, a retired psychotherapist and psychology teacher, is editor of Jewish Seniors Alliance’s Senior Line magazine and website (jsalliance.org). She blogs for yossilinks.com and write movie reviews for the Isaac Waldman Jewish Public Library website.

Advance in treatment

Dr. Mark Freedman, left, and Dr. Harold Atkins. (photo from Ottawa Hospital)

A Canadian research team led by Dr. Mark Freedman and Dr. Harold Atkins at Ottawa Hospital has managed to reverse severe multiple sclerosis (MS) using a patient’s own stem cells.

Freedman is a professor of neurology at the University of Ottawa, a senior scientist at the Ottawa Hospital Research Institute and the director of the Multiple Sclerosis Research Clinic.

“Considering the fact that, when I got into this business, no one even knew what MS was, then, following that, they didn’t know what to do with it, there were certainly no treatments available,” Freedman told the Independent. “So, we had to gain an understanding of some of the processes involved…. We’ve since come up with therapies that have been very effective in dealing with the disease.”

According to Freedman, “MS is a condition that refers to very specific immune system irregularity where, instead of being the defence of the body, the body mistakenly believes that the lining (called myelin), the insulation of the wires of the central nervous system, contains something foreign and proceeds to reject it. This rejection is going to live as long as the body believes the myelin is foreign or that foreign parts exist in it … which means, it’s a lifelong disease, as the immune system will continue to attack the myelin.”

Freedman went on to describe the immune system as an army in our body that is both there to protect us from foreign bodies, like viruses and cell mutations, such as cancer, and is also there to help us heal.

The problem is, in cases where the immune system turns on healthy body cells, Freedman said, “If you can’t identify who the bad guys are in the army – that’s been the attempt in the last 20 to 30 years – then you have to decide whether or not to hold back the entire army. If you do that, you take away protection from the body.

“We’ve always been caught between a rock and a hard place by allowing the army to function, [but] trying to at least curb its function when it comes to attacking the brain. All the therapies that have been developed, more or less, try to handcuff the army a little bit and prevent it from attacking the central nervous system.”

In trying to distinguish the good guys from the bad, researchers have found that each individual’s MS presents unique good guys and bad guys; not only different ones but at different times.

Freedman and his team wanted to find a way to eliminate the entire immune system with a mix of chemotherapy drugs, enabling them to start fresh, using a patient’s stem cells. “What if we flushed out the entire army and built in a brand new one?” he proposed. “This, theoretically, would not have the same mistakes, where it believes the central nervous system myelin is foreign and will attack.

“What we found out was, in fact, that, regardless of the genetic makeup of the individual, the disease ceased once we replaced the entire immune system. The trick was to do what no one else had done.”

The treatment starts by extracting stem cells from the patient and cleaning them, ensuring there is nothing remaining with the same cell mixture that may carry over the disease once the stem cells are replanted.

After killing off the entire immune system, which, Freedman pointed out, “of course has some dangers associated with it,” he said, “technology allows us to do that with success. After that, very quickly, patients settled down. They no longer had MS attacks and, over many years, their body started to heal.”

In a sense, Freedman and the team created a reset button for the immune system.

“Having a competent immune system that no longer attacks the central nervous system and can actually heal, we saw that, in our patients, it wasn’t just a short-term phenomenon,” he said. “We followed them for more than a decade.”

Freedman believes that anyone with MS can benefit from the procedure, with the important cautionary caveat that, as the procedure is complex and has risks, someone with a mild case of MS who can be treated with currently available therapies might not want to have it done.

“For some people, the risk is not necessary,” said Freedman. “But, for other patients who have disease that is quite aggressive and not easily amenable to treatment, these are the patients who should probably go this route.”

Freedman and his team are continually looking for ways to reduce the toxicity of the treatment, while also looking for ways to determine which patients are more likely to recover well. “In the meantime, we continue to use the treatments for patients who we deem early enough to respond to the treatment, at a stage that it will offer them some help,” he said.

“Unfortunately, everyone with MS comes out of the woodwork when you say you’ve got something … people who have been in wheelchairs for 25 years wanting to be signed up, as they feel they have nothing to lose. Well, you have your life. You could lose that. We aren’t ready to jump on such patients, as it could be inappropriate.”

Freedman advised that patients first speak with their neurologist, who hopefully understands their disease and can advise them whether or not this is a treatment they should consider.

“It’s not something that a patient can decide on their own,” said Freedman. “This isn’t a treatment that’s for sale. We want to help people who can be helped. We apply treatments to people who are likely to benefit and who are unlikely to be harmed.”

Rebeca Kuropatwa is a Winnipeg freelance writer.

Cancer research breakthrough

Assistant Professor Avi Schroeder of the Technion faculty of chemical engineering and the Technion Integrated Cancer Centre. (photo by Ashernet)

Technion researchers in Haifa have developed a new technology for determining the suitability of specific anticancer drugs to a specific patient – before treatment begins. The study, just published in Nature Communications, was led by Assistant Professor Avi Schroeder of the Technion faculty of chemical engineering and the Technion Integrated Cancer Centre. The researchers packed miniscule quantities of anticancer drugs, as well as placebo packages (which contained no drugs), inside dedicated nanoparticles they developed, which have the ability to flow in the bloodstream to the tumor. Attached synthetic DNA sequences served as barcode readers of the activity in the cancer cells. After 48 hours, a biopsy was taken and the anticancer drugs were found mainly in dead cancer cells – that is, they had killed them – while the placebos were found mainly in live cells – that is, they had not killed the cells. A comparison between various anticancer drugs also found differences in effectiveness.

Getting through menopause

Harriet Berkal unveils the secrets of menopause. Berkal began the support group Menopause Matters after experiencing a lack of help when she went through that stage of life. (photo by Manny Berkal-Sarbit)

Medical advocate Harriet Berkal recalls eagerly anticipating going through menopause, imagining it to be a fabulous life stage without having a period every 28 days or so.

“Now, if I could go back and have my periods and not go through this other nonsense, I would say, give me my periods back,” Berkal told the Independent.

Berkal works as an executive financial consultant for Sarbit Advisory Services in Winnipeg and has been struggling with menopause-related issues for the past seven years. She has leaned from experience that there is next to no help out there for dealing with the effects of menopause, and this has led her to take matters into her own hands and create a support group.

“One problem with this issue of menopause is, if you complain to a physician about something like weight gain, a symptom of menopause, they bundle everything you say after that behind that carriage,” said Berkal. “So, my GP missed the fact that I had a thyroid condition, because it was thrown into menopause – the same way that people get thrown into the irritable bowel syndrome (IBS) or the fibromyalgia hole … where anything you complain about is automatically assumed to be related to that, when it might not actually be.”

Menopause symptoms for many women include hot flashes, night sweats, migraine headaches, bladder infections, gastroesophageal reflux disease, lost libido, and painful intercourse. There are also some very rare reactions, such as feeling as though you have bugs crawling all over you, and emotional depression or anxiety, which are also related to hormonal fluctuations.

While typically menopause begins in one’s 50s, it can start in one’s 40s, where the cycles become more erratic, and, in some cases, even earlier, from induced conditions via cancer treatments, for example.

As Berkal searched for solutions, she decided to share the information she gathered with other women undergoing menopause. She approached Winnipeg’s Jewish Child and Family Services (JCFS) about starting up a learning and support group.

The idea was welcomed and the group was called Menopause Matters. Some 20 women meet once a week for five weeks to learn about different approaches to dealing with menopause symptoms and management.

“Most of the primary group are those in the throes of menopause and who aren’t functioning well,” said Berkal. “We had about 18 at last week’s meeting. It was an emotional meeting. There were some people who were extremely – not just frustrated with the system, but at the end of their rope. They don’t know who to turn to, what to do. We provide them, each week, with a different speaker and go through the whole gamut of solutions from traditional to non-traditional.”

Some education is provided by the clinic Vitality Integrated Medicine, which is run by a former pharmacist. Participants are informed about drug interactions, different kinds of tests to help determine actual lacks in their systems, and three different kinds of estrogen. According to Berkal, what often happens is that menopause-affected women consult their doctors and are told they need estrogen, and then they just take whichever one is prescribed.

Recently, Menopause Matters participants had a guest speaker who is an acupuncturist discussing stress control and how it affects hormones, and various acupuncture relaxation techniques that could help. “She brought needles and tried them out on some people,” said Berkal. “People were appreciative of that approach.”

Another scheduled guest speaker at the time of Berkal’s interview with the Independent was gynecologist Dr. Maggie Morris. She was to speak “about mainstream methods for dealing with things like Premarin estrogen application.”

Berkal’s personal experience with conventional medicine in general is that its practitioners are uncooperative from the moment she mentions that other approaches will be presented.

“The pharmacies have these ready-made solutions,” she said. “They aren’t one-size-fits-all solutions in my mind. We’re trying to provide people with a range of different solutions and methods to cope with this. One solution doesn’t do everything. You don’t want to mask symptoms. You want to get to the root. Everyone’s jockeying for position here and everyone has different approaches, so you should try figuring out what system fits you the best.”

Another speaker booked to address the support group is to talk about the importance of exercise, while another will highlight a treatment called Mona Lisa Touch, which involves the use of a laser inserted into the vagina to stimulate vaginal collagen production.

“It rejuvenates the tissue in the vagina without hormones, so you can get increased libido and increased moisture,” explained Berkal. “It helps create a better balance of health in the vagina.

“Many women get bladder infections, because the bladder and the vagina are closely linked. And, if you don’t have the right environment in the vagina, which is decreased because of menopause, you can end up with UTIs [urinary tract infections] … which I had probably 10 of last year before I started treatment.”

When Berkal underwent menopause, she said, “It was a pretty extreme and exacerbated reaction. Mood swings are a very big issue. Last week, there were several women in the group who said, ‘Does anyone feel like they’re going crazy?’ Almost everyone raised their hand.

“Hormones are so powerful. When they are working great, that’s great. When they are depleted, you are left with a shell of a body, susceptible to bone loss, memory fog, you think you’re getting the early stages of Alzheimer’s … but really, you’re not.”

Berkal believes that integrated medicine is the right direction and, in fact, integrated clinics are popping up in many places.

“But, the fact that I couldn’t find a menopause support group was mind-boggling,” said Berkal. “I approached the Mature Women’s Clinic at the Victoria Hospital and asked if they would start a support group. They said ‘no.’

“Why would they not want to help women in need? Yet, when the pharmaceutical companies sponsor a forum for one of their gynecologists to speak, they get thousands of women to come down who are in dire need of help … but they are only giving one approach.”

Shelley Levit, a social worker at JCFS, was very receptive to the integrated approach Berkal described, and the concept of letting women choose for themselves what they want to pursue.

Berkal hosted a Menopause Matters free, five-week support group from Sept. 15 to Oct. 13, via JCFS.

“We call it ‘the Sisterhood of Sharing,’” said Berkal. “Sharing is deeply required in order to feel camaraderie and kinship with these other women who really have no one else to talk to. It wasn’t intended to be targeted at Jewish women specifically. It’s like cancer – not specific to any ethnicity.”

Berkal wants to see if the group would be receptive to having partners and spouses join, so they can be present and hear from other women.

Rebeca Kuropatwa is a Winnipeg freelance writer.

Words have power to heal

Mark Waldman has been working with neuroscientist Dr. Andrew Newberg for almost two decades, including on their latest book, Words Can Change Your Brain. (photo from Mark Waldman)

According to Dr. Andrew Newberg, neuroscientist at Thomas Jefferson University, and Mark Robert Waldman, communications expert, in their book Words Can Change Your Brain: 12 Conversation Strategies to Build Trust, Resolve Conflict and Increase Intimacy, one “single word has the power to influence the expression of genes that regulate physical and emotional stress.”

Waldman and Newberg have been collaborating for almost two decades, and have written 14 books about relationships and neuroscience. They have also published many neuroscientific papers and journal articles exploring how different forms of spiritual practice and positive thinking affect the brain.

“This particular book was my idea, because I’d been working on a form of dialogue practice going back to about 1993,” said Waldman of Words Can Change Your Brain.

“A very well-known ancient Jewish meditation is to gaze at a candle until you feel that you and the candle become one … so you and the candle become the sense of united fire or energy,” he said. “You can do the same thing by focusing in on your breathing. You immerse yourself in the cool air coming into your nose, the warm air exhaling, feeling the rising and falling of your chest. When your mind wanders, you simply come back to your breathing as a training mechanism for learning how to stay in the present moment.”

All of these mindfulness practices, said Waldman, have been well documented as having many benefits – from helping lower anxiety, physical stress and emotional stress, to equipping people with better control of their emotions and raising their self-awareness and social awareness.

Waldman suggested starting by bringing mindfulness into daily activities, like eating.

“If you were to slow down and pick up a small piece of food, and hold it on your tongue and savor that one piece of food, you would discover all kinds of different flavors and sensations that we’re not normally conscious of,” he explained. “If you apply mindfulness to eating, you end up eating less and enjoying your food more. This has become an activity that’s been integrated into weight-loss programs and programs to help people interrupt eating disorders like bulimia.”

In 1993, Waldman and Newberg began asking themselves questions like how often are we aware of the words we speak, of the feelings behind those words, of how those words affect the person we are speaking to; how often do we take the time to really savor and pay attention to what the other person is saying, their facial expression, their tone of voice?

They started to develop what they dubbed “dialogical meditation,” which eventually morphed into “compassionate communication.”

After more than 20 years of research into what speaking mindfully means, they began working on Words Can Change Your Brain, which includes all their new research findings.

“Some of what we discovered, based on many different types of neuroscientific studies, is that the slower you speak, the more the listener’s comprehension’s increases,” said Waldman. “Their body also relaxes when you speak more slowly. And, with less physical tension, there’s more ability to be socially connected and engaged with the other individual.

“As our research unfolded, we recognized a very important neurological fact – that, consciously, we can only be aware of about seven to 10 words at a time. So, we created what we called a ‘communication game.’ We have people sit down and face each other and we ask them to speak very slowly and briefly, just one sentence. While they are doing so, we want them to experience what those words actually feel like. Then, they pause after speaking one sentence briefly. They pay close attention to the other person’s face and tone of voice while they speak … and you go back and forth like this.

“What we discovered from the very first time we did this experiment in 1993 is that 25% of those in the room, after doing this slow speaking and listening exercise, had tears rolling down their faces.”

Participants in this process were paired with people they did not know and they were not told what to say in their one sentence. The researchers found that, even when they conducted this experiment in a room with 1,500 people, within four to seven minutes, many people found themselves experiencing profound, intimate dialogue.

“They had to let the other person listen deeply to that one sentence and respond,” said Waldman. “So, we were keeping people in the present moment, grounded, not just in the thoughts they had that we are normally trying to turn into words, but to pay attention to the other person’s facial expression and tone of voice.”

Waldman went on to explain that, when it comes to communication, of the seven different elements of effective communication, words are Number 7. Number 1 is facial expression, followed by tone of voice, body language and the emotional or mental state you are in.

“So, the more relaxed you are, the more you’re actually in the present moment, the more the other person can understand what you’re saying, be affected by what you’re saying,” said Waldman.

The research found that, when participants closed their eyes and recalled a pleasant memory, visualized someone they greatly love or an event that brought them great satisfaction, 90% of them had a half-smile on their faces.

Waldman described this as a “Mona Lisa smile that, when other people see it, it triggers the trust centres in the person’s brain. You neurologically trust someone who has this Mona Lisa-like smile.”

Waldman believes that this research lends itself well to teaching managers, salespeople, teachers and those just entering the dating world. “What would happen if you slowed your speaking down and listened more closely, if you maintained that small half-smile on your face?” he asked. “As you speak, you can generate better intimacy and stimulate more collaboration and cooperation.”

Words Can Change Your Brain also documents that one single negative word triggers a dozen different stress neuro-chemicals in the brain, while spoken positive words have very little effect on the brain.

“So, the brain is designed to encode into memory every negative thought, feeling and event that we have, yet it doesn’t really do that with positive experiences,” explained Waldman. “However, if you have a brain that is filled mostly with negative memories, you’ll become chronically anxious and, eventually, chronically depressed.

“When we bring in the research of Barbara Frederickson and learn that, in relationships and in business, if you deliberately increase what she calls, ‘your positivity ratio,’ to five-to-one or to seven-to-one, for every negative thought or feeling you have … if you deliberately generate another five, six or seven positive thoughts or images … that’s how you begin to build a brain filled also with positive memories. You’re creating a form of neurological optimism. And, it turns out, these types of positive mindfulness exercises are some of the best ways to eliminate anxiety [and] depression and build more self-love and self-compassion. If your positivity ratio falls below three-to-one, you can predict very accurately that a relationship is heading toward divorce or that a company is heading toward bankruptcy.”

As Waldman presented their discoveries to the business world, he was reminded that, in this world, almost no one will give you more than 10 to 60 seconds. Most people cannot do a five-minute meditation, he said.

But, Waldman found that, if people download the mindfulness talk on their phone or computer and are willing to take 10 seconds to do one mindful yawn when they hear the alarm ring – simply notice how a yawn feels – there can be benefits.

“We have over 43 documented studies that show that yawning is one of the fastest ways to slow down an overly stressed brain,” said Waldman. “In fact, a dozen yawns or so can temporarily alleviate symptoms of Parkinson’s, epilepsy, migraines, what have you. So, yawning is the fastest way to alleviate mental stress.

“We ask a person, once an hour, to take 10 seconds to do one mindful yawn…. Take 20 seconds to do one mindful stretch, recall one pleasant memory…. Think about one single word, a value word, that you want to anchor yourself in for the next hour, something like ‘confidence,’ ‘focus’ or ‘calmness.’”

Thinking of Judaism’s role in all of this, Waldman said, “I think, for me, Judaism gave me the framework to question, challenge and think deeply about everything, which is just one of the most thrilling spiritual states I find for myself. I think this is how Judaism has influenced me in the past and continues to guide me in the present.”

Rebeca Kuropatwa is a Winnipeg freelance writer.

Cancer makes me angry

Cancer. Now I’ve said it. Just saying it tightens up my gut. It makes me want to swallow. I look around to see if anyone can sense the anger, the blind rage that surges through me. I find myself breathing faster. The fight-or-flight chemicals prompted by fear are racing through my body. Mostly, I try not to think about it because of the instant effect it always has upon me. I don’t know about others, but I hate it. Just the thought of it makes me angry.

To me, the idea of cancer is like a living presence, dressed up in the image of death, stalking through our lives, the destroyer of health and happiness. It looks this way and that, it looks for those at whom it will swing its lethal scythe. I know it’s really like spores in the wind, poisons in the soil, air and water, or genetic predispositions hiding in our DNA, waiting for the merest provocation to flower like a deadly bloom of nightshade. I know it is like an evil charlatan that smilingly gives way to our defensive measures, only to strike back with deadly force when we have let down our guard. I know it has so many disguises and tricks that we have to learn the new ones every day that we are alive. It takes some of our best minds to keep us relevant in that battle.

I know about all the new promises, new hopes yet to be realized. We learn something new every day. But, so does cancer, reacting to counter every twist and turn we make. We are not there yet in spite of all the public promises that are made. It is not politically correct to say it, but the same promises were being made during the time cancer was a living presence in my home. So I retain the hate that I learned.

When it struck in our home, we reacted with shock. We marshaled our resources and radically changed our lifestyle. My late spouse gave up her stressful and demanding work. She was a simultaneous translation interpreter. She was the manager and creator of her own firm, one that was preeminent in Canada, but she delegated her work and ceased professional activity. She underwent a mastectomy, radiation and chemo. We changed our diet toward the completely macrobiotic and a shelf full of recommended natural products. The result – in six months all traces of the disease were eradicated! We declared victory. My spouse became a poster child, a survivor, to rally the spirits of all victims of the disease. After a year, we relaxed our guard and returned to our previous way of life.

Four or five years later, two cancer cells were discovered during the regular screening that had been maintained. The number of cells quickly multiplied and, after a time, a regular regime of chemotherapy was reintroduced, accompanied by multiple discomforts. This continued for years. No material effect on the disease’s progress was ever noted. Eventually, several metastases were discovered, until the cancer was generalized. None of the chemotherapy offered appeared to have had the least effect.

My role changed over time, as I became a full-time caregiver. Indeed, after years of feeling like a helpless bystander, there was great consolation in, at last, being able to play a useful role. I had the feeling I was witnessing hand-to-hand combat with the cancer, a living, breathing adversary. I hated the losses we were sustaining on a daily basis. The success of radiation sessions in fighting off the external manifestations of the cancer felt like victories.

At one point, the cancer prevented the kidneys from working. The doctors asked if we wanted them to intervene. Although my late wife declined, because she was suffering the effects of uremia, which impairs judgment, my resounding yes won the day. The intervention was successful. We went off on a two-week holiday in Italy. I treasure to this day the sight of her dancing to her own music on a sunny balcony in Tuscany.

The medical resort to radiation to eliminate ugly lesions that appeared, time after time, on various areas of the body, seemed like a blessing. But, the ultimate effect of these sessions was to destroy the ability of the body to produce the red and white blood cells we depend on for life. I did not understand that these were a signal that the medical profession had given up any hope of a remission, because the doctors continually talked to us of impending victory. I did not question it, full of continuing hope as I was. In effect, they were offering palliative care, while continuing to test drug combinations on my late wife.

Eventually, these blood cells could only be provided for her by external means. We learned, after a time, that these infusions of blood cells, enormously costly, were the only way to keep my late wife alive. I always assumed these would continue, but I marveled at the generosity of the system on which her life depended. The various chemotherapy combinations, with all their accompanying distress, continued to be presented by doctors as the answer and the cure. She followed every prescription faithfully in spite of the discomfort they engendered.

Suddenly, we were informed by the hospital administration that my late spouse was to be assigned to hospice care in our home. Calls to the doctors went unanswered. Any assistance I could provide was replaced by outside help. We were told that the life-giving infusions were being withdrawn. She expired after three weeks, 10 years after first contracting the disease.

I do not know if the doctors ever confided to my late wife the real state of the struggle in which we were engaged. If they did, she never shared the details with me. We never ever spoke of her impending demise.

I remain a survivor of the experience, full of anger at the caregivers, anger at my helplessness and ignorance, and full of rage against the inexorability, the implacability of the disease. Its overwhelming power in the face of our defences, even after once having been initially repulsed, gives me little faith in the happy claims of any early relief in our struggles against the disease.

I appreciate that there have been some small victories, that some conditions have become treatable instead of fatal. I am grateful for that. I appreciate that we must encourage those who are facing the challenge and the threat. I know that they, and we, have to continue fighting it like soldiers on the frontline, despite our many losses. Cancer, I hate it!

Max Roytenberg is a Vancouver-based poet, writer and blogger.

Yellow dates for New Year’s

To make biblical date honey, Middle Eastern Jews boil and press dates that range in color from yellow to brown. (photo by Barry A. Kaplan)

The Torah describes Israel as eretz zvat chalav u’dvash, the land flowing with milk and honey, although the honey was more than likely date honey, since beekeeping is not mentioned in the Bible.

The word honey in Hebrew, dvash, has the same numerical value as the words Av Harachamim, Father of Mercy. We hope that G-d will be merciful on Rosh Hashanah as He judges us for our year’s deeds.

To make silan, or biblical date honey, Middle Eastern Jews boil and press dates that range in color from yellow to brown. Apples can be dipped into the date honey in the hope for a sweet new year. In the markets in Israel during this season, one finds strings of these dates.

In the 2011 article “Cooking class, it’s a date, honey,” cookbook author Faye Levy writes: “For many Jews, apples are the Rosh Hashanah fruit par excellence. For me, fresh dates are the fruit that herald the coming of the New Year. As soon as I see the bright yellow dates at the market, I begin to plan my menus.

“I’ve heard people say they’re not fond of fresh yellow dates. I have learned to enjoy them at their khalal [initial] stage, when they are crunchy and less sweet, but I prefer to wait until they become honey-brown, [the] stage called rutab.”

There are several kinds of dates grown in Israel, including Medjool, which Levy notes “are delicious and easier to find than perfectly ripened yellow dates.”

But, regardless of type, dates are a traditional Rosh Hashanah food, and form part of the Sephardi seder, which dates to the Babylonian Talmud.

“An elaborate Maghrebi [the region made up of Morocco, Algeria, Tunisia and Libya] specialty calls for nut-stuffed dates that are used to stuff a chicken or a large fish,” writes Levy. For Shabbat, she explains, dates might be added to dafina, which is a Sephardi meat stew cooked overnight to eat on Saturday lunch, or Moroccan hamin, another slow-cooked overnight stew for Saturday eating. The dates “contribute a subtle sweetness that mellows the flavor of the sauce. A dish from Baghdad from the Middle Ages calls for stewing lamb with dates and sweet spices.”

Silan, which Levy notes was brought to Israel by Iraqi Jews, is also known as date molasses or date syrup.

Varda Shilo, author of Kurdistani Cooking (in Hebrew), describes how to make it. Dried dates are simmered in water to porridge consistency, then the mixture is spooned into a cloth bag, moistened with more water and squeezed to remove the juice. This juice is simmered until thickened and is kept in jars.

Shilo explains that breakfast is the meal at which date honey is most often enjoyed in the Middle East, mixed with tahini (sesame seed paste) and served with bread.

Kinneret Farm silan makers suggest other ways of using date honey, such as adding it to stir-fried vegetables, as a sweetener for beverages, in sweet-potato pancakes, with an added dash of cinnamon.

“Dates are best known for their uses in sweets,” writes Shilo. “They are a favorite filling for the rich Middle Eastern cookies called ma’amoul and for rolled cookies resembling rugelach that are popular around the region.”

“In Persia,” write Reyna Simnegar, author of Persian Food from the Non-Persian Bride, “walnut-stuffed dates are a Rosh Hashanah treat. The stuffed dates are drizzled with a little syrup and sprinkled with cinnamon.

“Another popular way to serve dates is as a snack with tea.”

“Cooks in Egypt use the firm, fresh yellow dates to make jam,” says Levana Zamir in Cooking from the Nile’s Land (in Hebrew). “They also use them to make stuffed dates. First, they remove the dates’ very thin peel with a sharp knife and cook the dates in water until they are soft. Next, they pit the dates without cutting them in half.

Instead, they push the pit out with a hairpin so that each date can be stuffed with a blanched, peeled almond. Then they make a clove-and-lemon-flavored syrup from the dates’ cooking liquid. One by one, the stuffed dates are carefully added to the syrup, simmered and then cooled. The sweets are served with Turkish coffee and a glass of cold water. Making them is quite an undertaking but … these stuffed fresh dates are a delicacy fit for kings.”

Some Moroccans dip apples in honey and serve cooked quince, which is an apple-like fruit, symbolizing a sweet future. Other Moroccans dip dates in sesame and anise seeds and powdered sugar in addition to dipping apples in honey.

In her book The Foods of Israel Today, Joan Nathan writes about having lunch at Jerusalem restaurant Eucalyptus, when owner/chef Moshe Basson put a bowl of tahini “on the table and swirled in a date syrup called silan or halek, which he explained was a biblical ‘honey,’ one of the seven foods in the land of Canaan cited in the Book of Deuteronomy. Today, visitors can see a 2,000-year-old date-honey press, similar to an ancient wine press but smaller, near the Dead Sea at Qumran, the sites where, in 1947, a Bedouin youth found the Dead Sea Scrolls hidden in earthen jars.”

Nathan writes further that Ben-Zion Israeli, one of the founders of Kibbutz Kinneret, dressed as an Arab and, in 1933, went to Iraq and smuggled 900 date saplings back to Palestine. Over the years, with many trips, he brought back more than 7,000 saplings from Iraq, Iran and Kurdistan; about half took root. Shmuel Stoller later brought saplings from Egypt and Saudi Arabia. In the 1970s, Medjool and Deglet Noor varieties were introduced from the Coachella Valley in California.

If you are wondering about dates and your health, Judy Siegel-Itzkovich writes in the 2013 Jerusalem Post article “Local dates are best variety to fight disease”: “All nine varieties of dates grown in Israel and found on any supermarket shelf have characteristics that make them better than other varieties at helping protect those who consume them against cardiovascular diseases.

“This has just been demonstrated by Prof. Michael Aviram and colleagues from Haifa’s Rambam Medical Centre and Technion-Israel Institute of Technology. The research was published in the prestigious Journal of Agriculture Food Chemistry.”

The research team found that the most effective varieties for health are yellow, Barhi, Deri, Medjool and Halawi dates, and that, despite there being about 20 different types of dates growing around the world, those from the Jordan Valley and the Arava are the best.

Aviram warned Siegel-Itzkovich, however, that silan won’t help much. “As silan is a sweet concentrate that does not contain fibres, it is far from the real thing,” he said.

The article also noted, “A study the researchers published in the same journal four years ago showed that eating three dates a day does not raise blood sugar levels in healthy people, but it does reduce blood triglycerides and even ‘improves the quality’ of blood cholesterol by reducing its oxidation. These effects reduce the risk of heart disease, stroke and other vascular diseases, they said.”

Nonetheless, Aviram advised diabetics against eating a lot of dates, as they are high in sugar.

photo - Antioxidants from the group of polyphenols found in pomegranates, red wine and olive oil help remove plaque from inside the arteries — Antioxidants from the group of polyphenols found in pomegranates, red wine and olive oil help remove plaque from inside the arteries. *(photo by Barry A. Kaplan)*

In addition to the health benefits of dates, the Post article also highlighted 2009 research Aviram had led, showing that “antioxidants from the group of polyphenols found in pomegranates, red wine and olive oil help remove plaque from inside the arteries. In the new research, the team found that dates can bring about the slowing and even regression of atherosclerosis (accumulation of fatty plaque) in the coronary arteries, and that eating one of the three specific date varieties is most effective.

“The material in dates has the clear ability to speed up the removal of excess cholesterol from endothelial cells inside blood vessels, the team said.”

While dates have been grown for thousands of years and their health benefits have been cited since ancient times, it is only in relatively recent history that science is confirming many of the beliefs.

High in fibre and also containing many minerals, such as potassium, zinc, magnesium and calcium, Aviram and his team, writes Siegel-Itzkovich, “recommend following a Mediterranean diet – with its variety of vegetables and fruit (including dates), fish, whole grains and olive oil – rather than eating just one or two ingredients, so that a whole range of oxidative factors that cause atherosclerosis can be neutralized.”

Sybil Kaplan is a journalist, foreign correspondent, lecturer, food writer and book reviewer who lives in Jerusalem. She also does the restaurant features for janglo.net and leads walks in English in Jerusalem’s market.

Living with prostate cancer

Sima Elizabeth Shefrin’s new book, Embroidered Cancer Comic, will be launched on Sept. 15 at the Roundhouse.

Cancer is a word often whispered. Sex is certainly not spoken of in polite company. Yet Sima Elizabeth Shefrin tackles both topics in her new book, Embroidered Cancer Comic (Singing Dragon, 2016), which receives its Vancouver launch on Sept. 15 at Roundhouse Community Centre.

The comic begins with Shefrin’s husband, Bob Bossin, coming home from the doctor with a diagnosis of high cholesterol. “Oh, he also said my PSA was up,” Bossin tells Shefrin. After some understandable delays, Bossin gets the needed biopsy. While the couple are enjoying a funny movie together, the call from the doctor comes: prostate cancer.

In a mere 30 pages, with text and illustrations by Shefrin, Embroidered Cancer Comic shows Bossin’s uncertainty over treatment options, his efforts to learn more about the cancer, the emotional stress on him and Shefrin, as well as the effects of the cancer and its treatments on the couple’s sex life.

“The strain of the prostate cancer journey on relationships cannot be overstated, yet patients and their partners are left to figure this out for themselves,” writes Dr. Peter Black of Vancouver Prostate Centre – Bossin’s surgeon – in a brief commentary at the end of the comic, where both Shefrin and Bossin also share more of their story.

Helping others was one of Shefrin’s goals.

“I’m hoping the book will help couples in this situation be able to communicate,” she told the Independent.

Already, it’s had an impact.

“I thought it had potential for being a major project, especially after I got the publishing contract,” said Shefrin. “But then, of course, you don’t leave that in the hands of the gods. Singing Dragon has been very good for getting publicity in Britain, in both the comic and the medical worlds. In Canada, I’ve done most of it myself.

“I believe that this book can do real good in the world,” she said, sharing that a man in Quebec had written her “about what a difference it had made to both him and his wife.”

She said, “That’s what I’m hoping to do. I believe in the comic, so I’m willing to do whatever pushing I need to, to get it out into the world.”

Shefrin is a noted fabric artist, her website name – stitchingforsocialchange.ca – perfectly describing the nature of her work.

“I have often used my art to work through life events and to create awareness and conversation about taboo or contentious subjects,” she writes at the end of the comic book. “But nothing has made me feel as vulnerable as the creation of this comic. At the same time, it has helped me realize that, when you’re there, cancer becomes a part of daily life, like buying groceries or washing dishes.”

It took Shefrin three years to sew the embroidered line drawings, which were then photographed for the book. When asked if she ever thought of creating the images in a more expedient way, Shefrin said, “Fabric is my medium. The books I illustrated are mostly paper collage, but even when I work in paper, I think like a fabric artist. I did drawings first and then embroidered them, and I always liked the embroidered result better than the original drawing.”

The book “started out as a piece of art,” she said. “I thought I might self-publish or maybe simply photocopy a kind of catalogue for a show. But, one day, I came across the Graphic Medicine site and realized that there was a whole world out there of people making comics about medical issues. I’d had no idea.

“So, I started looking at the site regularly as well as at their Facebook page. Occasionally, there would be postings for people looking for comic strips on this and that and, if it was vaguely relevant, I’d send out my work. I do this a lot and often it comes to nothing. But, a couple of months later, I got an email from Jessica Kingsley saying they might be interested in publishing my work. It took me about an hour to figure out who they were and how they found me. They published it through their imprint, Singing Dragon. After that, the focus shifted and became about creating the comic, a story with a beginning, middle and end, instead of an art series. Now that it’s in print, I’m back to creating the quilts for the art series.”

The book has received many very positive reviews, including one in the U.K. medical journal The Lancet – and, according to the book’s Facebook page, it earned “a lovely personal note from Judi Dench,” who is mentioned in the comic. Specifically, when Shefrin asks her husband, “Who really excites you?” his answer is Dench.

The most touching review of the book comes from Bossin. “And because you live with cancer, whoever you live with lives with it, too, as Elizabeth’s comic shows so tenderly,” he writes. “For me, there is no one I would rather live with cancer with. No one.”

Those curious about what Dame Judi said and other stories behind the comic’s creation can ask Shefrin and Bossin at the Sept. 15 launch, which starts at 7 p.m. The quilted original illustrations are on display at the Roundhouse’s Window Gallery until Oct. 30.

JACS Vancouver launch

When Paul Steinberg first read The Big Book, the “bible” of Alcoholics Anonymous, written by founder Bill Wilson, he scribbled disagreements in the margins. His sponsor later saw them and took him to task. “Do you really think you know more than Bill Wilson, who wrote a book that has saved the lives of millions of people?” he said. “Maybe it’s time for you to start looking for things you can connect with in the book, not things you disagree with!”

photo in Jewish Independent - Beit T’Shuvah Rabbi Paul Steinberg helps launch JACS Vancouver on Sept. 8 — Beit T’Shuvah Rabbi Paul Steinberg helps launch JACS Vancouver on Sept. 8. *(photo from beittshuvah.org)*

Steinberg took the advice to heart, and a journey began. He is now the rabbi of L.A.-based Beit T’Shuvah, a Jewish centre for addiction recovery that integrates the wisdom of the 12-step program with Jewish spirituality, culture and community. He will be speaking at Congregation Beth Israel, together with Rebecca Denham of Jewish Addiction Community Services Vancouver, on Sept. 8, 7:30 p.m. The event, which officially launches JACS Vancouver, is called Opening the Door: A Conversation about Addiction in the Jewish Community.

Steinberg first came to Beit T’Shuvah, which this year celebrates its 30th anniversary, as a rabbi, a Jewish educator and an alcoholic looking for healing. After living there for five months in recovery, he began doing part-time spiritual counseling as part of the centre’s work therapy program. Eventually, he took on that role full time, then became the pulpit rabbi of the centre’s synagogue, a congregation with hundreds of attendees on Shabbat.

“The centre is unusual in many ways, one of which is in having a synagogue with a fully functioning congregational life on site,” Steinberg told the Independent. “The congregation is made up mostly of residents of the centre, alumni and their family members. Being so close to Hollywood, we have an amazing roster of artists and musicians who come to shul here – the music rocks.”

Steinberg’s rebirth was dependent on his discovering a deeper Judaism, and that is something he is passionate about sharing with other Jews in recovery. “We believe, as evidenced by the success of the 12-step program, that the spiritual is essential in recovery,” he said.

In 2014, Steinberg published the book Recovery, the 12 Steps and Jewish Spirituality: Reclaiming Hope, Courage and Wholeness, about his journey and the insights it afforded. He explained that, for many Jews, the 12 steps are uncomfortably associated with Christian spirituality, despite the open-ended approach to God in the method. “Some Jews recoil from AA for that reason. We need to give Jews access to the 12-step structure in Jewish terms,” he said.

“The addict’s world is very narrow, obsessive, self-centred. Opening up and surrendering to a greater power – whether that’s thought of as God, the universe, the Dao, the collective spirit – breaks that entrapment and allows change. It is the essence of a Jewish approach to recovery. On that ground, the disciplines of Jewish life – community, service, study, prayer – can do their work.”

Discomfort with the spirituality of AA is far from the only obstacle Jews struggling with addiction face. Steinberg said there is tremendous stigma around addiction in the Jewish community, especially around drugs and alcohol. As Rabbi Abraham Twerski discusses in the foreword to Steinberg’s book, AA groups were refused the use of synagogues for many years, reinforcing their habit of locating in church basements.

“The old saying was a shikker is a goy (a drunkard is a gentile),” said Steinberg. “Jews are not supposed to be alcoholics. The reality is that there are many Jews struggling with substance abuse, even very outwardly successful Jews. There are doctors, lawyers, businessmen and even rabbis. I was outwardly a success, but I was living a divided life. My life had to completely fall apart before I would deal with my alcoholism.”

Many struggling Jews do not know where to turn when they suffer from addiction. “It is amazing how few Jews will turn to their rabbi or their community for help,” said Steinberg. “The synagogue is all too often not seen as a place where you can air your dirty laundry, where you can be vulnerable.”

The desire to provide Jews with a place to find healing from addiction as Jews is what drove the creation of JACS Vancouver. “It is imperative to provide a safe place for Jews to get help, and to provide them with the Jewish tools they need for that healing to be successful,” said Denham.

“Addiction is an epidemic in North America,” said Steinberg. “It’s not just alcohol and street drugs; it’s also gambling, sex addiction, workaholism, pornography, opiate addiction. We need to face the brokenness in ourselves and our community without stigmatizing it, so that the healing can begin.”

To RSVP for the Sept. 8 event, email [email protected].

Matthew Gindin is a Vancouver freelance writer and journalist. He blogs on spirituality and social justice at seeking her voice (hashkata.com) and has been published in the Forward, Tikkun, Elephant Journal and elsewhere.

New CEO for seniors

David Keselman (photo from the Louis Brier)

After an extensive search, the Dr. Irving and Phyliss Snider Campus for Jewish Seniors, comprised of the Louis Brier Home and Hospital and the Weinberg Residence, have appointed David Keselman chief executive officer.

“David is the ideal candidate at this time for the organization,” said Louis Brier board chair Arnold Abramson in a press release. “David’s experience will benefit Louis Brier directly in our commitment to providing quality patient care for residents. We feel that his innovative approach, enthusiasm and leadership style will enable Louis Brier as it moves forward with both our clinical operations and our upcoming site redevelopment.”

Sandra Bressler, chair of the Weinberg Residence, echoed Abramson’s endorsement.

“I plan first to get to know and understand the environment, both clinical, social and political in the organization and in B.C. in general,” Keselman told the Independent. “The relationships with stakeholders (both internal and external) are important, as well as familiarizing myself with the Jewish community and finding opportunities for integration as appropriate.”

Born in Lvov, Keselman was raised north of Haifa, in Kiriyat Yam, and served three years in the Israel Defence Forces. At 21, he followed his high school sweetheart to Toronto and began working at Baycrest, Toronto’s major Jewish home for the elderly. He has a doctorate of health administration from Central Michigan University, and a master’s of nursing and a bachelor of science in nursing from the University of Toronto, and he worked in acute care for many years.

In Toronto, the couple had two children, now aged 20 and 17, both of whom attended Jewish day school. They live with their mother but are following in their father’s footsteps – his son is enrolled in the nursing program at Ryerson University and his daughter plans to become a nurse as well.

Coming with his partner to Vancouver from Yellowknife – where he was vice-president of patient services at Stanton Territorial Health Authority – Keselman is looking forward to getting back to a place with a Jewish community. While he admits that he does not connect with the synagogue experience, he feels connected to many aspects of the Jewish community.

“As I get older,” he said, “the affinity and need to get closer to my roots becomes more important. Seeing that I grew up in Israel, keeping our community strong and active is imperative on many levels, not only to ensure that our tradition and culture continue to exist, but also because a strong community here ensures the strength of Israel and its ability to cope with the many adversities it is facing.”

Keselman comes to the campus in the 70th anniversary year of the Louis Brier.

“I am excited about the renewal plans,” he said, “and look forward to a future design that integrates culture, tradition, values with evidence-based and best practices to create a dynamic environment that provides a holistic continuum for patients/residents of the Louis Brier and their families, with an aim of creating a centre of excellence in geriatric care anchored in the philosophy of client- and family-centred care.”

Keselman has a five-year history of involvement with Accreditation Canada, the organization that certifies health-care facilities, where he has gained considerable knowledge in the area of quality improvement and risk reduction. He has held a wide range of executive roles in Ontario and the Northwest Territories, and is an associate instructor at both the Ryerson University School of Nursing and Athabasca University.

“I believe my experiences to date culminate in a progressive, open-minded, transformational leadership style that will support the team, stakeholders and, of course, the residents of the Louis Brier in achieving quality outcomes and satisfaction from the environment and the services delivered in the organization,” he said.

Sounding like a West Coaster already, Keselman said he is looking forward to a very different lifestyle in Vancouver than he had in Yellowknife. Jewish community is a big bonus, he said, but so is the increased opportunity for fitness – Keselman has taught aqua fitness and spin classes for almost 20 years. According to Abramson, Keselman is expected to be on-site at the Louis Brier on Sept. 14.

Michelle Dodek is a freelance writer living in Vancouver.