Measles: What You’ll Need to Know About This New Outbreak in the US and in Israel

Measles: What You’ll Need to Know About This New Outbreak in the US and in Israel

Additional Info

  • Audio File hadassah/hd022.mp3
  • Doctors Moses, Allon E.
  • Featured Speaker Allon E.Moses, MD
  • Specialty Chairman in the dept of Clinical Microbiology and Infectious Diseases, at the Hadassah Medical Organization
  • Guest Bio Prof. Allon E. Moses, head of Hadassah's Department of Clinical Microbiology and Infectious Diseases, was elected president of the Israel Society for Infectious Diseases at its recent Conference. After graduating from Ben Gurion University of the Negev, Moses did his residency at Hadassah Mount Scopus Hebrew University Medical School and was a clinical fellow at Harvard University. He's been a lecturer and professor at Hadassah for over 20 years and has been Chairman of the Department since 2005.

    Learn more about Prof. Allon E.Moses, MD
  • Transcription Melanie Cole (Host): We’re hearing more and more about cases of measles being confirmed both in the states and abroad. Today, we’re talking about measles with Professor Allon Moses on this episode of Hadassah On-Call.

    Welcome. My guest today is Professor Allon Moses. He’s the current Director of the Infectious Disease Center at the Hadassah Medical Organization. Professor Moses, I’m so glad to have you back on the show. We know you have a long illustrious career at Hadassah, tell us a little bit about it before you help us understand the current situation in Israel with measles.

    Professor Allon Moses (Guest): Sure Melanie. Thank you for having me here on the program. So, I’m Director of the department which is called the Department of Clinical Microbiology and Infectious Diseases. And we actually have under one department, both infectious disease doctors and the clinical microbiology lab. It’s an unusual collaboration in this situation because in most places the two departments are separate. So, infectious diseases are not usually together with the clinical microbiology. We feel that this collaboration brings much better service to our patients because infectious disease doctors and the lab technicians work close by each other.

    Host: Let’s talk about measles Professor. Tell us about the current state of what’s going on with the recent measles outbreak at what’s happening around the world and in Israel? How would you characterize this?

    Professor Moses: Well there is certainly an ongoing outbreak. As we all remember, measles was a disease which we have not seen for many, many years and now in recent years, it’s come back. And this is very frustrating and, in many ways, worrisome. Until about a year and a half ago we hadn’t seen measles for a long time and in the past year and a half in Israel, we’ve seen over 4000 cases. This is highly unusual and as you can understand, the disease has some worrying parts to it and unfortunately, we even had two case fatalities. So, the disease is not a simple disease and patients who are not immunized against measles are prone to disease.

    In Israel, we’ve seen that 90% of patients who had the disease did not receive two vaccinations. So, it’s clearly a disease that confronts patients who have not been vaccinated properly.

    Host: Four thousand. That’s an incredible statistic Professor. Why is measles so dangerous?

    Professor Moses: Well first of all, it’s one of the most contagious diseases, 90% of prone patients who have not been vaccinated who would be close to a patient with measles will get the disease. So, it’s one of the most contagious diseases we know. It spreads by airborne particles. This means that the room a patient – if a patient is in a room with other patients, he can cough, his small measles particles are lighter than air, they stay in the air for awhile for several hours and the patient who has just walked in, if he has not been vaccinated can get the disease through his respiratory tract. So, it’s a very contagious disease on the one hand and on the other hand; the particles are in the air. So, it’s an airborne spread disease.

    Host: How scary Professor. So, who should be vaccinated for measles? When should this happen and if an adult has not been vaccinated; can they still be?

    Professor Moses: Sure, this is very important. The vaccination for measles has been around for many, many years. The current vaccine goes with two other vaccinations it’s called MMR, measles, mumps, and rubella. These three vaccinations are very effective. Every child should receive the vaccination between 12 and 14 months. It usually depends where he lives. In Israel, we give it at 12 months. That’s the first dose. And the second dose needs to be given a few years later and it’s given at the age of 4 to six years. we, in Israel, give it in first grade which is at the age of six.

    So, to achieve a 97% vaccination level, you need to receive two vaccines. So, it’s a highly effective vaccination and anybody who has received two doses is actually very safe. One dose is also effective, and we have seen that 93% of kids or patients who received one dose are immunized. So, it’s a very effective vaccine and unfortunately, those who are not vaccinated are at risk. They are the ones who will contract the disease. And when there’s enough patients who have the disease, it can spread around.

    Now, any patient – you asked me whether adults should receive the vaccine. Any patient, any person who has not received two vaccinations need to be vaccinated. If a person was born before 1957, he’s naturally immunized because this was before the vaccine era and we know that patients who were born before 1957 probably had the disease and therefore are naturally immunized. Anybody born after 1957 needs to have two vaccinations.

    Host: Then what about children under one year old Professor? People hear this term herd immunity. Does that protect us all even the unvaccinated people? What about our little guys?

    Professor Moses: Okay so the vaccine as I said is usually given after 12 months. For the first six months, the baby is usually immune because of antibodies which are transferred from his mother. And so there’s a period of time between six and twelve months when the young kid is not immunized and that’s certainly a worrisome time and we should try and avoid these small children to come in contact with the patients who have measles. There are solutions for contact for small kids and we usually give either a passive immunization or sometimes even a active immunization is given earlier. But the point is with herd immunity, that when you have over 90% of the population immunized; it sort of gives a guard against the virus, the measle virus penetrating into small pockets of unimmunized persons like the small children. But once you have too many cases, the herd immunity breaks. If you have thousands of cases, it’s much easier unfortunately for the measle virus to reach persons who have not been vaccinated.

    So, the herd immunity and in Israel, we know that over 95% of the population received the proper immunization, but even though this number is really fantastic and very high; we find populations especially the orthodox who have not been vaccinated and they form pockets of susceptible persons and once a single person is infected, it easily spreads between the other person who have not been vaccinated. So, the big issue here is populations who are hesitant or don’t agree to be vaccinated.

    Host: Well, we’ve heard so many theories about the MMR vaccine Professor. Please clear this up. People have fears of autism and weakening a child’s immune system causing asthma or even being attributed to food allergies. Please, for the listeners, clear this up. You are an expert, one of the world’s great experts in this field. Please clear this up for the listeners.

    Professor Moses: This has been indisputably proven. The MMR vaccine is safe. Not only is it very effective, it’s very, very safe. Autism is not in any way connected to the measles vaccine. This has been proved over and over again. I have no doubt in recommending my patients, anyone to receive the vaccine.

    Now there are persons who cannot receive it. Since it’s a live attenuated virus, anyone who is very immune compromised needs to ask his physician whether he can receive it or not. But the majority of the population not only can receive, must receive the vaccine. And if you look at the dangers of this disease; they are much more than the dangers of the vaccine. I said the mortality is about one to a thousand. But there are other complications and even late complications. We know that there are severe neurologic sequelae, although rare, but they can occur in patients who’ve had measles at childhood.

    So, I have no hesitation in recommending this very effective and nontoxic vaccine.

    Host: Thank you so much Professor, for making that so clear. The CDC has recently issued a health warning in Israel for measles as it relates to travelers. What do you want travelers to know or to do to protect themselves and are the vaccine recommendations different in Israel than they are here?

    Professor Moses: Well, I must tell you that in Europe there’s also an outbreak so, the Israeli Health Ministry has also put out a warning for Israeli going to Europe. Yes, we have a measles outbreak and anybody who comes to Israel should have two vaccines. Once you have received two doses of the vaccine, you are completely safe and should not worry. So, anybody who receives the vaccine, who is able to receive two doses is safe. The smaller children will receive one dose are – the vaccination rate is a little lower. So, they should consider if they are especially if they come from Jewish Orthodox community, they should consider twice if they come to families where there is danger for an outbreak. But for the regular tourists who visit the country, the danger is minimal. Certainly if you have two doses of vaccination.

    Host: As we wrap up Professor, tell us a bit about Hadassah’s new infectious disease center. What are some other infectious diseases that are just as prominent as measles right now that you are seeing in patients there?

    Professor Moses: Thank you for this very important question. We have just opened two weeks ago, the new ambulatory infectious disease clinic at Hadassah. And our clinic sees a variety of patients. We have our everyday infectious disease patients who come in after they’ve been hospitalized. We also have the AIDS medicine center of Hadassah. We provide care for the AIDS patients of the greater Jerusalem area. And we are also in charge of the Hanson Center which is the center for leprosy in Israel. It’s the national center. In Israel, there are some patients with leprosy as not everybody knows, and we encounter between one and five new leprosy patients in Israel usually those who come from – it’s foreign workers or new immigrants from Africa. So, it’s a rare disease but we see it and we see our patients in the new ambulatory care.

    And now we have a new plan to see and we’ve begun seeing patients who need multidisciplinary care. I’ll give you an example. We have a clinic for orthopedic infections. So, a patient who had an orthopedic surgery, hip prosthesis and unfortunately had an infection, instead of seeing an orthopedic surgeon separately and infectious disease surgeon separately and the radiologist separately; we provide the multidisciplinary service so the two or three experts who will see the patient at what time. We think that in this way, we can provide much, much better care for our patients.

    A similar clinic is opening for patients with diabetic foot infections. There they need the multidisciplinary care and we bring the experts to the patient instead of the patients going around and searching for opinions from three or four different disciplines. This is something very, very good for our patients.

    Host: What wonderful comprehensive care and so important for patients. Professor, give us your best advice about this outbreak of measles, what you would like travelers to know in Israel and abroad. People wonder if they should even be wearing masks on airplanes because it is an airborne disease. Please wrap this up with your very best advice as the expert that you are.

    Professor Moses: You know I think that we can not underscore the importance of receiving two doses of vaccination. At this point, it’s up to our ministry of health, the health officials to be sure that all populations receive the vaccinations. For the first time in Israel, the medical staff has been forced to receive vaccinations and medical personnel cannot come to the hospital if he has not received two doses of vaccine. The same should be in the schools. I know there is debate about this but if we have everybody vaccinated, we will be able to stop this outbreak since we have a very, very effective vaccine.

    Host: Thank you so much Professor for sharing your incredible expertise with us. It’s a bit of an unsettling time when we hear about the recent outbreaks, so thank you for all the great advice. Thank you again for joining us. And that wraps up another episode of Hadassah On-Call: New Frontiers in Medicine brought to you by Hadassah, the Women’s Zionist Organization of America. The largest Jewish Women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please head over to our website www.hadassh.org, and to hear more episodes in this podcast series please visit www.hadassah.org/podcasts. If you found this podcast informative, as I did, please share on your social media and be sure to check out all the other fascinating podcasts in our library. Until next time, this is Melanie Cole.
  • Hosts Melanie Cole, MS

Treating Heart Attacks in Record Time with the Most Advanced Technology

Treating Heart Attacks in Record Time with the Most Advanced Technology

Additional Info

  • Audio File hadassah/hd021.mp3
  • Doctors Danenberg, Haim
  • Featured Speaker Haim Danenberg, MD
  • Specialty Director of Interventional Cardiology at the Hadassah Medical Organization
  • Guest Bio Prof. Haim D. Danenberg, MD, served as a Medical advisor of Amnis Therapeutics Ltd (formerly ITGI Medical Ltd). Prof. Danenberg serves as Director of Interventional Cardiology at the Hadassah Medical Center. Prof. Danenberg serves as Member of Medical Advisory Board of Paieon, Inc. He serves as Member of Scientific Advisory Board at Lithotech Medical, Ltd. Prof. Danenberg is a Specialist in Cardiology. He served as the Director of Cardiovascular Research at the Hadassah Medical Center and before a Visiting Scientist, Harvard-MIT Division of Health Sciences and Technology, Boston, MA. Prof. Danenberg is an Associate Professor of Medicine at the Hebrew University of Jerusalem. He is the head of interventional cardiology at Hadassah Medical Center and serves as the Secretary of the Israeli Workgroup for Interventional Cardiology. He served as a Member of Scientific Advisory Board at Amnis Therapeutics Ltd until January 17, 2017. He served as a Director of ITGI Medical Ltd. Prof. Danenberg received his M.D. from Hebrew University and had a post-doctoral fellowship at the Harvard-MIT Health Sciences and technology division.
  • Transcription Melanie Cole (Host): Heart Disease is the number one killer of men and women and is more deadly than all forms of cancer combined which is amazing when you think of those statistics. Today, we’re talking with Professor Haim Danenberg on this episode of Hadassah On-Call.

    Welcome. My guest today is Professor Haim Danenberg. He’s the head of Interventional Cardiology Unit in the Department of Cardiology at Hadassah Medical Organization and he’s the Chairman of the Israeli Working Group for Interventional Cardiology. Welcome Professor. I’m so glad that you could join us today. Tell us a little bit about yourself and how you came to Hadassah Medical Organization.

    Professor Haim Danenberg (Guest): Well I can’t even remember how I came to Hadassah since I’ve – I’m in Hadassah actually forever. I started medical school here in Hadassah when I was 17-years-old, before my military service. And then after completing military service as a physician, got back to Hadassah, did my internship, residency in medicine, then cardiology, interventional cardiology and actually other than three years in MIT in Boston, actually all my career is here in Hadassah.

    After doing my fellowship in cardiology, I continued to interventional cardiology and I’m running this wonderful operation of interventional cardiology in Hadassah for almost 10 years now.

    Host: Wow. What a resume. So, tell us a little bit, because you have mentioned interventional cardiology. Not everybody knows what that is Professor. What is an interventional cardiologist and how is that different from say a cardiothoracic surgeon or a cardiologist?

    Professor Haim Danenberg: Well interventional cardiology I think is the hottest frontier in cardiology or cardiovascular medicine. We are the ones that are doing procedures within the heart without actually opening the chest or cracking the chest but rather in a minimally invasive procedures. We’re doing the coronary angiographies and whenever there is a need, whenever there is a blockage or clotting in a coronary artery; which brings to a heart attack or angina; we intervene. We can open the arteries, these very small vessels with balloons, with stents and bringing a cure to the heart. And in the last couple of years, we are part of the revolution in which we are treating not only coronary disease but structural heart disease. We replace valves, heart valves without opening up the chest, without surgery, actually without even anesthesia. We treat a leaking valve. We close holes within the heart. There is a lot to do in intervention cardiology. And yet, our daily practice is actually day and night treating patients with heart attacks.

    Here, we need to intervene in an immediate manner. Patients with heart attacks are brought directly to our Cath lab center. We are the ones who open the closed arteries.

    Host: Isn’t that fascinating? What an exciting time to be in your field as you said, it’s so innovative. For some of our listeners who may not have heard of the new and exciting Irma and Paul Milstein Center at Hadassah Hospital, you have some of the most advanced cardiac intensive care units in Israel. Tell us about that.

    Professor Haim Danenberg: We have I think the most advanced, not in Israel but worldwide. Very few centers can now compare with what we have here in Hadassah. Not in the intensive care unit and definitely not in our wonderful spacious state-of-the-art very, very modern Cath labs here in Hadassah. I was fortunate and I’m still fortunate to travel around the world and teach new procedures worldwide including in the US and very seldom I reach places that look even close to what we have here in Hadassah now.

    And having such a nice, as I said modern state-of-the-art Cath labs allows you to give your patients, I think the best therapy ever. It’s not only about the infrastructure, it’s mainly about the manpower and we’ve got an excellent team here. But combining the wonderful manpower, wonderful medical and paramedical team here in Hadassah with the outstanding infrastructure that we have; it’s a winning solution.

    Host: Well you mentioned a little bit before about the time factor involved if someone is suffering from a cardiac event and I’ve also heard that Hadassah has one of the lowest times of getting a patient into the Cath lab to prevent death from heart attack. Speak about that and while you are doing that, tell us about the Hybrid Cath Lab and what that means for patients and physicians.

    Professor Haim Danenberg: Okay so, as for time, from arrival to opening up the closed or clogged artery. In heart attack, time matters. When you delay treatment, when you delay therapy which in this case is bringing the patient to the Cath lab and treating the clogged arteries; time matters. Any delay costs the patient in muscle, in myocardial tissue, with the morbidity and mortality associated with it.

    And therefore, our goal for many years it to try and shorten this time period to the shortest possible. We changed our practice years ago. Patients that arrive with a heart attack don’t go through the Emergency Room anymore. The EMS [inaudible 00:07:02] the ambulances call our physicians immediately whenever they reach a patient with a heart attack, straight from the patient’s home. And we activate our system so whenever a patient with a heart attack arrives at the hospital; they come straight to the Cath lab. The team is ready, and the procedure is done in the most, in the fastest and swiftest manner possible.

    And indeed, we are proud to win year after year in the shortest time to therapy and this correlates directly with very low death rate from heart attack that we do see here in Hadassah.

    As for your other question, the Hybrid Room. Having a Hybrid Room allows you to do the most sophisticated and modern procedure as it combined. Every once in a while, surgery or minimal surgery with what we do in interventional cardiology. We are a Center of Excellence in doing first in men trials. Israel is a startup nation. So many Israeli startups and we are the ones that actually bring to practice the very new and modern devices, and this can be done only in Hybrid Rooms like the ones that we have here in Hadassah.

    Host: When people hear the word catheterization, they don’t really know what that is. Is this something that is mostly curative as you say in the case of a cardiac event or heart attack or can they also be diagnostic? What can you reveal with catheterization and tell us a little bit about some of the exciting biplane technology system that you use that can provide three dimensional imaging of the heart from two cameras at the same time. That is just amazing.

    Professor Haim Danenberg: Well the procedure is very often a diagnostic one. About almost 50% of our procedures are diagnostic. Every procedure starts with a diagnostic phase and based on the results, based on the information that we get in the diagnostic phase; we reach a decision whether we need to proceed to intervention. So, and the whole procedure is done via a tiny puncture either in the radial artery or very seldom now in the groin. We bring tiny catheters, those tiny, very tiny one and half to two millimeter catheters to the heart, inject and reach diagnoses regarding the coronary artery vasculature.

    The equipment that we have here including the biplane allows us to do procedures in a very accurate manner. The resolution is outstanding. We can do procedures with minute amounts of contrast media which have it’s adverse events or in some patients we need to be very frugal to save in the contrast and this can be done with the equipment, the imaging equipment including the biplane that we have here in our Cath lab.

    Host: Are there any new research projects that you are working on related to heart disease that you can speak about briefly?

    Professor Haim Danenberg: There are many projects that we are involved with. A lot of new devices to shorten procedure of time to improve outcome, to improve safety but I would like to share with you a project that we do currently which is actually trying to learn what’s important to our patients. Kind of the wisdom of the crowds of out patients and based on this, improve therapy that we provide to our patients and this is fascinating. We learn that it’s not always what we think as physicians, but patients wish is very important and when you try to provide your patients with what they think of in of course in a very safe and effective manner; it definitely improves their satisfaction and they go out with a big smile. Even sick patients do enjoy the therapy here when you try to provide it according to what they ask for.

    Host: What a great model of care Professor and certainly as patients, we need to be our own best health advocates. We are learning the more and more and women and heart disease and recognizing our symptoms. It’s all coming together truly. Is there anything else you’d like to add that you think is important for our listeners to know about in regards to heart disease and what you’re doing there in Israel and how really ongoing and comprehensive this field of study is.

    Professor Haim Danenberg: We live in an exciting period. There is so much research and development, things are changing and for the good. Yet, I think what’s very important from a patient point of view is how to refrain from becoming a patient. And this is keep the optimal lifestyle and we all know what is an optimal lifestyle. Eat less, exercise more, don’t smoke, treat all your risk factors whether it’s hypertension, dyslipidemia, diabetes, live right and refrain from getting to our hands. And I think this is the best advice that I can provide to everybody. Physicians and patients as well. And one more thing, happy Purim, it’s a holiday here in Israel so you Melanie and the listeners Chag Same’ach.

    Host: Chag Same’ach to you too as well Professor. Thank you so much for coming on, sharing your expertise and explaining to us about really what an exciting time this is in interventional cardiology as you say. What a burgeoning field and you’ve explained everything so well to us. Thank you again for joining us. This is Hadassah On-Call, New Frontiers in Medicine brought to you by Hadassah, the Women’s Zionist Organization of America. The largest Jewish Women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit www.hadassh.org, and to hear more unbelievable episodes in this podcast series please visit www.hadassah.org/podcasts, that’s www.hadassah.org/podcasts. I’m Melanie Cole. Thanks for tuning in.
  • Hosts Melanie Cole, MS

What You May Not Know About Strokes and How They Can be Prevented

What You May Not Know About Strokes and How They Can be Prevented

Additional Info

  • Audio File hadassah/hd020.mp3
  • Doctors Leker, Ronen
  • Featured Speaker Ronen Leker, MD
  • Specialty Director, Stroke Service and The Cerebrovascular Disease Center at the Hadassah Medical Organization
  • Guest Bio Professor Ronen Leker, MD is the head of the Cerebrovascular Service and The Peritz and Chantel Scheinberg Cerebrovascular Disease Research Laboratory at the Hebrew University-Hadassah Medical Center in Jerusalem.

    Prof. Leker is an expert on treatment and prevention of cerebrovascular disease including ischemic stroke and intracranial hemorrhage. Prof. Leker is actively involved in clinical and basic stroke research for over fifteen years both at Hadassah and at the National Institute of Neurological Disorders and Stroke – National Institutes of Health (NINDS-NIH) in Bethesda MD where he served as a staff scientist at the Lab of Molecular Biology and worked on the use of neural stem cells as a novel therapy for stroke. 

    Learn more about Professor Ronen Leker, MD
  • Transcription Melanie Cole (Host): Did you know that stroke can affect anyone, even younger people. It can be so scary to think about. However, Hadassah Medical Center’s pioneering researchers are leading the way in exploring a novel cutting-edge stem cell treatment to reverse the disability a stroke can leave in its wake. Today, we’re speaking with Professor Ronen Leker on this episode of Hadassah On-Call.

    Welcome. My guest today is Professor Ronen Leker. He’s the director of Stroke Service and the Cerebrovascular Disease Center and a Senior Neurologist in the Department of Neurology at Hadassah Medical Organization. Welcome to the show Professor Leker. Tell us a little bit about yourself and how you came to Hadassah Medical Organization.

    Professor Ronen Leker, MD, FAHA (Guest): Well, we’re going back in history now. So, I started studying medicine in 1981 and that was in Jerusalem at Hebrew University Hadassah Medical Center and this is how I came to Jerusalem. And since 1981, I’ve been at Hadassah except for a short stint at the NIH in Bethesda, Maryland for three years between 2002 and 2005, all through medical school, residency, Army service and whatnot, I’ve been at Hadassah. So, Hadassah is basically my second home.

    Host: Wow, that is a long time. Thank you so much for telling us about that. Now let’s talk about stroke a little. Please define what a stroke is. Are there different types of them and is death more prevalent than other after effects that might happen like paralysis as a result of stroke?

    Professor Leker: Well, there are two main types of stroke. The first type, the more common one is an ischemic stroke which happens when there is a disruption in the blood flow through the brain. It can be an occlusion of blood vessels outside the brain or inside the brain. But in any case, there is a reduction of blood flow to a particular part of the brain. And that part of the brain is then deprived of oxygen and nutrients and dies. And ischemic stroke comprises about 85-93% of all strokes.

    The second major type of stroke is a hemorrhagic stroke wherein there is a tear in the wall of a blood vessel within the brain, so blood spills from the blood vessel into the brain tissue and damages the brain tissue. And this is responsible for between seven and 15% of all strokes depending on where you are on the globe.

    As to your question, there are within ischemic stroke, there are numerous types of stroke. So stroke is basically a basket diagnosis. It is not a single disease. Stroke can occur as a result of an embolus that arises in the heart or a blood clot that forms in the heart and then just flows to the brain and occludes one of the arteries in the brain. It can be the result of an atherosclerotic disease in one of the arteries that lead to the brain and it can be the result of an occlusion in one of the small, very small, tiny arterials or very small arteries within the brain tissue itself. It can be the result of trauma. It can be many, many causes of stroke.

    And as to your second question, no, death is definitely not the main result of stroke. Stroke mortality in ischemic stroke we are talking about anywhere between two and four percent of the patients. But many patients are left with significant disabilities in terms of motor impairment or sensory impairment or cognitive impairment, but they are not dead.

    In hemorrhagic stroke, there is a mortality rate of about 30% to 40% which is much higher. But still, death is not the common pathway in stroke. Having said that, we should also remember that stroke is the between number two and number three killer in the world depending on which country you are in. So, it is a very common cause of death. But it’s not - the main result of stroke is not death.

    Each year, there are about 800,000 new cases of stroke in the US, around 18,000 in Israel and around a million or so in Europe. So, it’s very prevalent. It is a very common disease.

    Host: And I think we’re hearing more about it too, Professor in that there’s more awareness of like the acronym FAST and people are hearing about these symptoms and what to recognize. Tell us why time and you physicians say time is brain. Tell us why time is so important when someone suffers a stroke.

    Professor Leker: So, when you’re having an occlusion of a large artery in the brain; it has been calculated by one of my colleagues Jeff Saver from UCLA, that for each minute you delay treatment, two million neurons die in your brain which is a lot. So, time is definitely brain. And basically, once you deprive those brain cells, neurons from getting their share of oxygen and nutrients; they die very quickly. So, we need to really move fast and open the occluded artery as fast as we can if we want to save brain tissue and minimize the damage and reduce mortality in that matter.

    So, for ischemic stroke, we have two cardinal treatments that can do that. One is a medication that is given intravenously, and this is called TPA. That medication can be given to stroke patients up to four and a half hours from symptom onset. After that, if you give it; it increases the chances of having a brain hemorrhage. So, we cannot give it after that.

    And the second option is when you have a large vessel occlusion; we can go in with a catheter and sort of pull the clot away and reopen the artery in a procedure called thrombectomy. This can be done up to seven and a half hours and recently, it has been shown that in some patients we can do this up to 24 hours and at Hadassah, we’ve been treating patients up to 48 hours even after stroke onset. But this is a very special group of patients that have good collateral circulation which means that they have arteries that circumvent the occluded part and sort of bypass it naturally and so the tissue is supplied, although not at a very good rate. Otherwise, they wouldn’t have had the stroke at all but it’s still getting some perfusion, some blood getting into the tissue which maintains it alive, but not doing well. But it gives us time to open the artery even longer than what we thought, what we were taught that we can treat which was up to seven and a half hours.

    Host: What a great educator you are Professor, and thank you for explaining those treatments of mechanical thrombectomy and TPA and why it’s so important that you see patients as quickly as possible. In the recent death of American actor Luke Perry from a stroke at what seems to be a younger age. The man was in his young 50s. Is there a correlation between someone’s age and having a stroke? Are there certain risk factors that would change for a younger person versus an older person?

    Professor Leker: Certainly. Yes. But we need to remember that 25% of all strokes are in patients that are younger than 60. And anyone at any age can have a stroke even children can have it. So, most of our patients around 50% of our patients are between the ages of 60 and 80, 25% are over the age of 80 and 25% are under the age of 60. But in younger patients, in patients in that age group of 48, 50 and lower, we need to think of other causes of stroke, other than the usual heart disease, atherosclerosis which is also common in these patients, but we need to think of other stroke mechanisms as well such as hypercoagulability which can be genetic, drug use, some illicit drugs like amphetamines and cocaine have been associated with an increased risk of stroke. Even weed, marijuana has been associated with stroke. And also traumatic dissection of an artery like people that are getting hit in the neck area during sports or during a car accident can cause a tear in the wall of an artery which causes a clot to form there and part of that clot can embolize, can move with the blood stream upwards towards the brain and can occlude an artery in there.

    Also in hemorrhagic stroke, there are vascular malformations which can be genetic or acquired and, in these malformations, which means that the blood vessels are not the normal variety, they leak more and they can burst, it can have an aneurysm and have a subarachnoid hemorrhage while you’re exercising for instance. So, yeah, I mean in younger people, we need to think outside the box as you would normally think.

    Host: I think that’s what’s so scary for people is how would we know if we are a younger person and you’ve mentioned many of these risk factors. Would you advise people to talk with their primary care provider to see if they are at risk? If they are, is there any way to tell?

    Professor Leker: For sure, yeah. I think that the main traditional risk factors are high blood pressure, high cholesterol, diabetes, sedentary lifestyle, so you need to take care of yourself. That’s basically the usual advice we give people. Stop smoking, exercise, maintain a Mediterranean type of diet which is a diet rich in olive oil instead of vegetable oil, fish instead of red meat and vegetables and fruit and with high cellulose content. Exercise at least 30 minutes per day and keep your cholesterol low, keep your blood pressure low. Those are the modifiable risk factors.

    Of course, there are other risk factors for stroke that are nonmodifiable. For instance, you cannot change your genetic background. So, if you have a family, a rich family history of stroke, your parents had a stroke, your brother had a stroke, your sister had a stroke; you’re at increased risk. But if you take care of your modifiable risk factors; that is you stop smoking and you start exercising and you keep an appropriate weight and you lower your blood pressure and you take your cholesterol lowering medications; then you will lower your chances of having a stroke.

    Host: And that’s always really great advice Professor, and I thank you for kind of reiterating that because it’s so important that people do hear about those modifiable risk factors. Tell us about some of the exciting cutting-edge treatments including using stem cells that you’re developing at the Hadassah Medical Organization that could reverse some of the disability that could come in the wake of a stroke.

    Professor Leker: Right, well, so, we’ve discussed earlier the impact of thrombectomy and of TPA. But these treatments can only be given very early during the course of the disease and then as I mentioned, some patients are still left with significant disabilities whether motor, sensory, cognitive and then we don’t have a way of repairing that. So, stem cells represent a new and exciting way to try and help these patients once they have gone through the initial treatment, if they got it, if they got to the hospital in time or even if they didn’t get to the hospital in time; we can still help them maybe sort of recover. It’s part of the recovery process. So, stem cells are cells that reside in the brain and neural stem cells can transform into adult neurons and support cells which are called glial and basically, repopulate the brain anew.

    Right now there are two main strategies of using stem cells for stroke. The first is to use other cells, not cells from the brain itself, but cells from bone marrow or cells from bone or cells from dental pulp and all these strategies and modified embryonic stem cells. So, people take these cells, grow them in a dish and then transplant them to the brain by various methods after the stroke. So, this is one strategy. And this has been in clinical studies. So far results seem to be exciting, but it’s not yet there. I mean we’re not there yet in terms of everyday practice.

    The other strategy which my lab is working on is to take the neural stem cells which reside in our brain. They are residents there in your brain, in my brain, in everybody’s brain and the point is that when you have a stroke, and you are kind of older; these cells do not respond well, and we are working on methods to stimulate these cells and manipulate them in a way that they will transform into neurons and will be able to maybe replace the cells that have basically died during the stroke.

    This is a complicated process and we are at the stage of doing animal studies. We’re not yet in the stage of doing clinical studies in humans. There are a lot of risks associated with this kind of treatment. We were able for instance to multiply the number of these cells by thousands and hundreds of thousands, but the problem is that some of these cells can turn into malignant brain cells. So, we don’t want them to save a patient from stroke but then cause them a brain cancer. So, we are working on ways to neutralize these malignant transformation of these stem cells and to be able to monitor them more carefully so we will be left with a safe way of treating patients.

    So, this is exciting. There’s still a very long way to go. And we need a lot of funds to do that which is challenging as you may know. But we’re working on that and hopefully we’ll have a treatment within a few years.

    Host: Well I’m sure with people like you on the case, we certainly will. How exciting, really. What a fascinating field that you are in Professor. As we wrap up, where else do you see the field of stroke care going from here? And how does what you’re doing in Israel translate to the world model of care?

    Professor Leker: Well, we’re trying to be at the forefront of stroke care in the world. We are participating in studies. We are among the first – Hadassah is among the first centers in the world that used thrombectomy with the newer thrombectomy devices. So, we are publishing a lot and we’re doing a lot of research.

    I think that you’ll see more and more thrombectomy devices that will enable treating patients in a longer therapeutic window and in smaller blood vessels. So, right now, this thrombectomy field is sort of limited to larger blood vessels say within the brain. But I’m sure that with time we’ll be able to penetrate into smaller and smaller blood vessels and retrieve clots from there as well. So, this is one way that the field is going.

    The other way, is maybe to extend the time window for use of drugs that can be given systemically, intravenously and break the clot, like TPA. As I mentioned earlier, TPA can be given up to four and a half hours from symptom onset. But with maybe developing new drugs that can be given at an extended time window without the risk of having a hemorrhage; we’ll be able to treat patients who live in more rural areas where thrombectomy is not as accessible and this is pertinent to the states, I’m sure. Or Australia or New Zealand or places where you can live in a remote area which might have a primary care hospital but no endovascular neurosurgeons that can actually do the thrombectomy.

    So, we are working on drugs that can be given at an extended time window so that patients can benefit from that. And of course cell therapy which we just mentioned, with stem cells be it like from neural stem cells like the angle that we are attacking or mesenchymal stem cells or bone marrow stem cells or whatever that the other people are working on; it’s going to be interesting.

    Host: It’s wonderful information Professor. It’s really cool to hear as somebody listening to you describe these research studies, it’s absolutely fascinating. Thank you so much again for joining us today, for sharing your expertise because we’re hearing more and more in the media about stroke and you’ve really educated us today. Thank you again for being with us.

    This is Hadassah On-Call, New Frontiers in Medicine brought to you by Hadassah, the Women’s Zionist Organization of America. The largest Jewish Women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit www.hadassh.org, and to hear more episodes in this podcast series please visit www.hadassah.org/podcasts, that’s www.hadassah.org/podcasts. There are some wonderful podcasts on there for you to listen to and share with your friends. This is Melanie Cole. Thanks so much for tuning in.
  • Hosts Melanie Cole, MS

Make No Bones About It: Hadassah Osteoporosis Specialist Reveals Advancements

Make No Bones About It: Hadassah Osteoporosis Specialist Reveals Advancements

Additional Info

  • Audio File hadassah/hd019.mp3
  • Doctors Foldes, A. Joseph
  • Featured Speaker Prof. A. Joseph Foldes
  • Specialty Director of the Jerusalem Osteoporosis Center at the Hadassah Medical Organization
  • Guest Bio Prof. A. Joseph Foldes is the director of the Jerusalem Osteoporosis Center at the Hadassah Medical Organization.

    director of the Jerusalem Osteoporosis Center of Hadassah-University Medical Center,.   of the Hadassah Medical Organization in Jerusalem, Israel. 
  • Transcription Melanie Cole, MS (Host): Tremendous advancements have been made in the management of weakened bones, but there’s still so much work to do as awareness for those of us at risk with osteoporosis. Today we’re talking with Professor Joseph Foldes on this episode of Hadassah On Call.

    My guest today is Professor Joseph Foldes. He’s the senior physician and the former director of the osteoporosis center at the Hadassah Medical Organization in Jerusalem. Welcome Professor. Tell us a little bit about yourself and how you came to Hadassah Medical Organization.

    Prof. A. Joseph Foldes (Guest): Good evening Melanie and thank you for providing me with the opportunity to participate in this important podcast. It’s a very interesting question because just yesterday I celebrated 40 years for working at Hadassah. All my life actually since I finished my military service as a medical officer I've been working at Hadassah. With the exception of two years which I spent doing research at the Henry Ford Hospital in Detroit.

    Host: Wow. That is so interesting that you worked here in the states. So, let’s talk about osteoporosis professor. What is it? Explain to listeners a little bit about what it is, and do we know what causes it? How would somebody even know if they have the early stages?

    Professor Foldes: Generally speaking, osteoporosis is a condition of weakening of the bones leading to their increased fragility. The reason for this weakening of the bone is a combination of the amount or the density of the bone mass along with the changes of the internal structure of the bones and with internal properties like elasticity. It is more common in elderly women and men, especially in post-menopausal women. But it could occur at any age in both sexes provided there are some medical conditions or medications which are known to promote osteoporosis.

    One problem with osteoporosis, an important one, is that the disease is symptomless. So, there are no signs, no symptoms that one can feel telling him that he is developing osteoporosis until the complication occurs. The complication is the osteoporotic fractures. So, it is very important to try and identify the condition before the fractures occur. That is why it is important in certain circumstances to undergo the test of bone density, which is done by a machine called DEXA, which is short for dual energy x-ray absorptiometry.

    Host: Professor sometimes when we see people and their shoulders are all hunched, and their head is looking downward, we think osteoporosis and we don't want that to happen to us. What bones does it typically effect?

    Professor Foldes: That’s a very good question because interestingly, osteoporosis does not affect equally the whole skeleton, but there are several sites which there is predisposition for osteoporotic fractures. Those sites, important sites, include the spine, the spinal column where fractures of the vertebrae can lead to loss of height and to the development of kyphosis or bending. The second important location is the hip joints or the femurs with very dangerous femoral fractures that usually necessitate surgery and can also end up with a debilitating state. Other sites include the wrist, the ribs, the shoulder area, and the pelvis. These are the most frequently effected sites where the fractures occur.

    Host: Professor is there a genetic component to osteoporosis? Also, is there a link between osteoporosis and menopause?

    Professor Foldes: Well there is genetic contribution to osteoporosis, just like we know there is a genetic component for heart condition. But it’s not a direct genetic transmission. Along with the genetic predisposition, of course, there’s a lot of importance to environmental or lifestyle factors. Including physical activity, components of diet, smoking, normal hormonal development, et cetera.

    Host: Then let’s speak a little bit about, you mentioned the DEXA scan. Who should get this bone density test, professor, and what do the results mean? What are we to make of them?

    Professor Foldes: Well I will go back to the end of your previous question. Osteoporosis mostly effects post-menopausal women because of the loss of production of estrogen, which is otherwise manifested as the menopause. But it is important to remember that osteoporosis can affect man men. The problem is that men are less aware of this condition and probably they are less aware of health issues in general. Also, they do not have that external sign of menopause, which women have.

    So, the target population for measuring bone density by DEXA, in my opinion, is every woman who reaches menopause, every man about the age of 65, and any man or woman who is known to suffer from a medical condition that we know can promote osteoporosis. I will just give you a few examples. Celiac disease, multiple myeloma, hyperparathyroidism, or chronic steroid therapy. Just examples for conditions which can cause osteoporosis even in young men and women.

    Host: If somebody is diagnosed with osteopenia, they are told that they have the softening, the weakening of the bones that we mentioned at the beginning. What is the first line of defense?

    Professor Foldes: Well, you mentioned the term osteopenia. So, it is important to recognize that there is some difference between the term osteopenia and the term osteoporosis. Generally speaking, when we perform a bone density test, we categorize the result into three categories. One is normal bone, one is osteoporotic bone, and there is an intermediate condition which we call osteopenia. This is the most treated condition because once a person already has osteoporosis, usually we initiate treatment. What we can achieve by the treatment is usually arresting or slowing down further deterioration of bone density. We are limiting with our capabilities to restore the bone density. So that is why it is so important to try and recognize and identify conditions of osteopenia before fully developing osteoporosis. There we can intervene and try to slow down the bone loss and prevent the development of full-blown osteoporosis.

    What we can do is we can divide it into two parts. One relates to measures of lifestyle measures, like promoting physical activity, encouraging physical activity, especially activity types which are involved with bone loading or weight baring exercises. Then there are several diet related factors. Especially we deal with the calcium and the vitamin D. There are recommendations for the amounts of vitamin D and calcium that need to be consumed after the menopause. We encourage smoking sustention if necessary. If the woman is relatively young and she has a spontaneous unnatural menopause at a young age, probably she deserves some hormonal replacement for some years.

    All these measures we give them to patients with osteopenia or even with normal bone density, and as well as patients who have already developed osteoporosis. But if osteoporosis develops, then often we need to add medications. There are several medications on the market which are FDA approved. And all are approved after they underwent serious medical studies which shows that they reduce the risk of fractures significantly by about 50% compared to the control group which receives placebo. So, the purpose of the medication is not to correct the low bone density because that is something we cannot really do. We can only very partially correct the density. What we can do is significantly reduce the risk of future fractures.

    Host: That’s great information and so important for listeners to hear professor. Wrap it up for us what you want the take home message to be about osteoporosis, that risk of fractures which is so, so important, and even the dietary concerns. You mentioned vitamin D and calcium. Again, so important. Please wrap it up with your best advice as an expert what you would like us to take away from this episode.

    Professor Foldes: I would like to spotlight three points. One is to carry on healthy lifestyle. Secondly to undergo bone density tests periodically at appropriate age. Finally, while I encourage the audience to read medical information publicly released in the media, it is very important that they will be aware of the limited availability to understand what they read. I speak specially about the fears of the side effects of the intervention which are often encouraged by media and publications. People should know that for every medication which is improved there is a risk of side effects. But the risk of benefits far, far outweighs the risk of side effects. I encourage that no one will abstain from medication or discontinue medication without consulting with your physician.

    Host: Thank you so much professor for being on with us today and for sharing your expertise from so many years of working with patients that might have osteoporosis, or even the beginnings and the weakened bones and that risk of fractures. Thank you so much for coming on and giving us such important information. This is Hadassah On Call, New Frontiers in Medicine brought to you by Hadassah, the Women’s Zionist Organization of America. The largest Jewish women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care, and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, please visit hadassah.org. To hear more episodes in this podcast series, please visit hadassah.org/podcasts. That’s hadassah.org/podcasts. I’m Melanie Cole. Thanks so much for listening.
  • Hosts Melanie Cole, MS

World AIDS Day 2018: Hadassah Doctor Searches for a Cure

World AIDS Day 2018: Hadassah Doctor Searches for a Cure

Additional Info

  • Audio File hadassah/hd018.mp3
  • Doctors Elinav, Hila
  • Featured Speaker Hila Elinav, MD, Director, AIDS Center at the Hadassah Medical Organization
  • Guest Bio Dr. Hila Elinav is the Director, AIDS Center, in the department of Clinical Microbiology and Infectious Diseases at Hadassah Medical Organization.

    Learn more about Dr. Hila Elinav
  • Transcription Melanie Cole (Host): Globally there are more than 36 million people living with HIV worldwide. This year marks the 30th anniversary of World AIDS Day. Wow time goes fast, and if you’re of a certain age you know that in 1988 the World Summit of Ministers of Health started their program for AIDS prevention. Today we’re speaking with Dr. Hila Elinav on this episode of Hadassah on call.

    Welcome, my guest today is Dr. Hila Elinav. She is the Director of the AIDS Center in the Department of Clinical Microbiology and Infectious Diseases at Hadassah Medical Organization. Dr. Elinav, tell us a little bit about yourself and how you came to Hadassah Organization.

    Dr. Hila Elinav (Guest): Well I was born in a small village in the south of Israel and after my military service, I went to medical school in Hadassah. Actually all my medical career was in Hadassah except three years that I was doing research fellow at Yale University in Connecticut and when I came back from Connecticut, I was appointed as the Director of the AIDS Center in my hospital, in Hadassah Medical Hospital. Ever since I’m there.

    Host: Doctor, we hear so much less about HIV and AIDS these days. Is the epidemic over? Please tell us, what’s going on in the world in regards to HIV and AIDS and improving the quality of life for people living with HIV?

    Dr. Elinav: So unfortunately, the epidemic is not – didn’t end yet. We’re still working on it, but about 1.8 millions are diagnosed with HIV around the globe yearly and in Israel it’s about 400 new cases diagnosed yearly. People still get infected. Some people are being diagnosed with real AIDS, with the disease when they have advanced disease, and there’s a lot of things to do. Of course, the medications that are compromising the cocktail – they change dramatically the morbidity and mortality. People can live almost a normal lifespan and they need to be followed. There are side effects and there’s a lot to do – still a lot to do even in prevention. We have new methods. We still use the old fashioned condoms but there are medications to prevent infections before exposure and after exposure, but you still have to do a lot of about diagnoses of new cases and this is our daily life.

    Host: Doctor, recently the movie Bohemian Rhapsody came out about Queen star Freddy Mercury who tragically died of complications of pneumonia related AIDS. People thing AIDS isn’t really around anymore, not very common. Can you speak about this and has the stigma reduced at all in the last 20 years, and have you seen the movie?

    Dr. Elinav: Yes, of course I’ve seen the movie because I’m a big fan of Freddy Mercury and Queen but things changed a lot. When Freddy Mercury was infected actually there was very few medications that were available, they were very toxic, and they didn’t work for a long time. They worked for two or three years and then the virus became resistant to the medication. In 1996, new medications came to the market with different mechanisms and this made a tremendous change because this way we can really suppress the virus and when you suppress the virus to what you call today undetectable levels, you reconstitute the immune system and you turn the wheels back. You can take very ill patients and then with treatment they become healthy. Actually today I had a case of a patient who I thought is going to die a month ago, and today he went home; so it’s amazing what you can do. You can really take dying persons and make them alive and this is thanks to the cocktail – to the medications that we use that are combination of treatment. They are less toxic than what was used in the 1990s and it’s really a new era.

    Host: One of the themes, the main theme of this year’s World’s AIDS Day is knowing your status. How important is it to know your status, and what’s the best way to test for HIV? And people are concerned about testing, Doctor, because of confidentiality and privacy. Is this an issue?

    Dr. Elinav: Well stigma I think is still the most problematic thing in HIV medicine because people are afraid to be tested because they are afraid to be discovered as HIV and then they are afraid that there will disclosure to their family surrounding and this is a big issue, but it is very important because if you’re known as HIV positive, you can be treated on time and actually prevent all the complications that will be in the future if you are not treated. You can – you will actually stay as a carrier and you will never get sick. Now there’s another issue with knowing your status because if you are treated actually you are not infected if you are undetectable. The slogan today is You Equals You. Undetectable means untransmutable. Now because something in the last one or two years that we talk about and they look at their lives completely differently. They know that they can get married even to somebody that is HIV negative and this is not an issue anymore. Of course, we have to do a lot of work and speak with their partners but this is part of our daily life. Stigma is still I say the most problematic issue in HIV medicine.

    Host: I would imagine that it is, and Doctor, we’ve heard that you went out of your way to save a baby who was delivered at Hadassah Hospital recently. Can you tell us about it and tell us your experience with noncompliant mothers that might be HIV positive but they’re afraid to mention it because they don’t want to have a C-section. Explain a little bit about why this is.

    Dr. Elinav: Okay, first I will tell about the case. So this is a case of a new immigrant coming from Ethiopia. She was married to an Israeli but he was in Israel and she was in Ethiopia and she immigrated when she was in their eighth month of pregnancy and she never had pregnancy follow up in Israel and so when they came to the delivery room, the nurses asked the husband because she doesn’t speak Hebrew, was she tested for HIV? And he said, yes she was and she is negative but he didn’t know that the results were different from what he knew because the results were four years old when they were in Ethiopia. So actually she was infected somewhere in between and nobody knew and she delivered the baby. Now the nurses sends HIV test because it’s the protocol but we found that she was HIV positive after the baby was delivered. So this was a critical time and when we found out that there’s an HIV patient in the – that just delivered, we went to see her. She didn’t know her status. She really didn’t know and we asked her if she already started breastfeeding and she didn’t fortunately, but what we did – we talked with her. We told her don’t start to breastfeed, and then we – the pediatrician actually prescribed her medication to prevent the transmission of HIV to the baby because the most vulnerable time for the baby to be infected is during delivery. So they prescribed it and then I went home and then I decided to call to make sure that everything is fine and then I found out that these medications were not available in Hadassah because we hardly use them. Most of our women are treated during the pregnancy and what we give is only ABC to the baby and then we needed two other medications and I was fortunately around Tel Aviv and I called all my friends in the other AIDS Center in Tel Aviv and I found out the other two medications were in another pharmacy of one of the hospitals and I went there, brought the medication, and brought it to the baby and they gave it – we usually start medication immediately; it was 26 hours later, but it was not too late and we gave it to the baby and she’s negative so I’m very happy with this.

    Host: Wonderful story.

    Dr. Elinav: Yeah, it’s exceptional. We usually don’t have these cases because we try to – most of the women in Israel are screened. It’s not obligatory in Israel yet and we find women that were not diagnosed previously, we find them during pregnancy and then we start treatment like all the other patients and then the chances for a woman to transmit it to the baby are less than 1%, even without C-section, without IV, ABC, just normal delivery, she cannot breastfeed and we did ABC for the baby for four weeks and that’s about it, and this is common. This is the most common. This case was exceptional, but sometimes we have some adrenaline in our blood.

    Host: Wow I love to hear these kinds of stories and they’re very inspiring. What do you feel, Doctor, are some of the major challenges that still remain, and are you seeing that young people are having the conversation about AIDS and HIV status?

    Dr. Elinav: Actually since I work in the hospital and not in the community, I hardly meet those people. I know that the Israeli Task Force is doing a lot of talks in schools in Israel. You know I go from time to time to give a talk to young people, and so it’s not only about HIV but also about the other sexually transmitted diseases and I’m always trying to stress that this is preventable. It is better to prevent, but if you’re HIV positive, it’s not the end of your life. When you’re HIV positive, you should know that you should still dream and fulfill your dream and you’ll have normal life, you just have to take care of yourself better. It’s always better to prevent, but it’s not a disaster if you’re HIV positive. It’s more difficult, yes, but life is difficult.

    Host: So as we approach World AIDS Day, this Shabbat, December 1st, what message do you have? Tell us a little bit about the goal of this awareness campaign and summarize this episode for us. What would you like the listeners to take away from this, Dr. Elinav?

    Dr. Elinav: Well my first message is that everybody should be tested and for the medical stuff I always stress that you know you should not stigmatize the patient. If you think that something might be compatible with HIV, it doesn’t matter if this is a religious person or somebody from the Arab community, always test people for HIV and don’t be judgmental, so I just try to encourage people to check their status, and you know you can never know and it’s not very important how people got infected. When they are infected, you should always stress that here is a good prognosis and there is always bright future, and this is something – it’s a chronic disease that is much, it’s very easy to treat. You just need to be compliant, and this is a different era really. Nobody would imagine 30 years ago that people will live for 60 years after they’re being infected, that they can have babies, they can get married with HIV negative people, and I think that somewhere in the future we will have a cure. I’m very optimistic about it because a lot of effort is done in this direction and I hope that even before I retire I can cure my patients. Actually since I can help so many people with HIV or to prevent HIV, I feel that I do a lot and really this is what makes me love my work. I wake up every morning enthusiastic to go to the clinic and to go to the hospital, and I just love my work.

    Host: Wow you know it’s such an interesting topic and to hear about it so many years later is, for certain people, of my age group, Doctor, you know we heard about this so much growing up but then not so much anymore and I applaud your efforts and your stories and thank you so much for all the work that you’re doing and for the awareness campaigns and World AIDS Day is December 1st, coming up this 2018 so thank you so much for joining us and sharing all of your information and your hope for a future cure because that is really very exciting to hear. This is Hadassah On Call, new frontiers in medicine brought to you by Hadassah, the Women Zionist Organization of America. The largest Jewish women’s organization in American, Hadassah enhances the health of people worldwide through medication education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, please visit Hadassah.org, and to hear more episodes in this podcast series, please visit Hadassah.org/podcasts, that’s Hadassah.org/podcasts. I’m Melanie Cole, thanks so much for joining us today.
  • Hosts Melanie Cole, MS

After Pittsburgh, Hadassah Expert Offers Coping Strategies for Children

After Pittsburgh, Hadassah Expert Offers Coping Strategies for Children

Additional Info

  • Audio File hadassah/hd017.mp3
  • Doctors Galili-Weisstub, Esti
  • Featured Speaker Dr. Esti Galili-Weisstub, Head of the Herman Dana Division of Child and Adolescent Psychiatry at the Hadassah Medical Organization
  • Guest Bio Dr. Esti Galili-Weisstub is the Director of the Herman Dana Division of Child and Adolescent Psychiatry at Hadassah Hospital. She is the Former chairman of the Israeli union for Child and Adolescent Psychiatry, Member of the Israeli union of Child and Adolescent Psychiatry examination and was also the Secretary of the Israeli company for analytical psychology. 

    Learn more about Professor Esti Galili-Weisstub
  • Transcription Melanie Cole (Host): In the aftermath of tragedies such as the terror attack on the Tree of Life Synagogue in the Squirrel Hill neighborhood of Pittsburgh; as parents we often find ourselves at a loss as to how to help our children, what to tell them when things like this happen. Today we are speaking with Dr. Esti Galili-Wesstub on this episode of Hadassah On-Call.

    Welcome. My guest today is Dr. Esti Galili-Wesstub. She’s the Director of the Herman Dana Division of Child and Adolescent Psychiatry in Hadassah Hospital. Dr. Galili-Wesstub thank you very much for taking the time to talk to our listeners on such short notice following the tragedy in Pittsburgh, Pennsylvania. Tell us a little bit about your career at Hadassah, working with children in Israel and around the world that have been traumatized by events like the shooting in Pittsburgh.

    Dr. Esti Galili-Wesstub (Guest): Mine and our experience in Hadassah in charge of the lesson psychiatry basically stems from responding to the needs of children and adolescents in the Jerusalem greater area. It basically – we started to broaden our work with a second intifada starting at the late 2000s and we have seen unfortunately well over 800 victims of terror and aggression in the Middle East. But we felt very early on that we can share our experience with other areas in the world. That included the post-tsunami in 2005 in Sri Lanka. It included fires in Australia, working in Kiev a little bit, working in India and then our team from the trauma units traveled to France after the terror attack on the school. Some of our colleagues traveled to Berlin to work with refugees there. And recently even psychologists from our team traveled to Las Vegas post the shooting there of civilians by a gunman. So, I’m not sure I even mentioned everything, but we do feel an obligation to our population but also an obligation to victims of trauma anywhere in the world.

    Melanie: Dr. Galili-Wesstub while we know that you are not in Pittsburgh this week; we hope that you can enlighten us on therapies and treatments for children and adolescents after traumatic events such as this one. What are you looking to do with these children?

    Dr. Galili-Wesstub: So, I think there are two things that we should keep in mind. One is that we have to be very flexible both in evaluating the immediate response to trauma and also by tailor making the right therapy for each family and each child. It is not like a cooking recipe. There are several techniques. Maybe the more popular ones are trauma-focused CBT and then there is CPT something that comes from the west of the United States from California. There are other forms of therapy, MDR probably things that you have heard of or SE, but I think that the most important thing is to keep an open mind about each child and his family and to think what’s right for them. But at the first stage, I think what is important is to evaluate the immediate response to try and understand the reality of each child and each family, their stressors pre-event which will make them more vulnerable to develop unfortunately symptoms after and also to evaluate their support system. Support systems can predict very well your ability to deal even with a horrific trauma.

    Melanie: That is so interesting doctor and we understand that all traumas are different. From your expertise, how do these kinds of events affect children both short and long-term? What do you see if the child doesn’t necessarily have that great support system that you are speaking of?

    Dr. Galili-Wesstub: First of all, I don’t think our traumas are that different. I do think that the big difference lies in the fact that your trauma was totally, totally out of context. Nobody expected that. And I think that’s in a way unfortunately in Israel or in the Middle East we almost expect our children to experience some kind of trauma. I do think that it’s unfortunate. So, I think that the problem in Israel that we have something that we call acute on chronic. So, there’s a chronic reality that something might happen, so you are in a certain kind of mode and then it does happen and, in a way,, it repeats itself either by news or by somebody else you can see that happening in the south of Jerusalem around the Gaza strip again and again and again and again and again. I think the big difference is that luckily, luckily that the community and the United States does not expect something like that to happen and it is like a thunder in a sunny day, a thunder storm in a totally sunny day. So, basically there’s a good chance that a large number will recover and in the long-term probably the chances of chronic PTSD are fairly, fairly small. But given that when somebody needs to be related to, they will be related to and it will not be neglected. And the ways to do it is to be in touch from the beginning, to give everybody that was exposed to the trauma whether directly or closely indirectly from that community a very accessible line to professionals and to ask questions if they are raised like of behavioral, of emotional, of any kind of symptom or suspected symptom. And when you treat things right away, you have a better chance of containing it.

    The other thing is, that it’s highly, highly important to support the parents of the children because there’s a very strong connection between the parents’ reaction and the child’s reaction and it is mostly notable if the child is young. If the child builds his reality through his parents’ eyes. So, if the parents are doing well, we can assume that the children will also do fairly well. Or that they’ll be aware enough to look for support for their children as early as possible.

    Melanie: So, you’re saying that the parents, we need to process and deal with our own feelings of grief and fear before we can really help our children, that they are going to reflect based on how we react to these kinds of things, yes?

    Dr. Galili-Wesstub: Exactly, but I wouldn’t say before. Because I think at the same time or because we can’t – it might take us if the parents were present or they lost someone dear to them in the shooting, it might take them weeks to process it. Their children can’t wait weeks. But they have to be aware that what they do affects their children. It doesn’t mean that the parents should be false, it doesn’t mean that the parents should try and hide their feelings from their children. They should just be aware that what their children share, what their children think and in certain times they would ask for guidance or support. I think children are very aware of what their parents feel. And you can’t hide anything, and you certainly want to give the children the message that being sad, being afraid, being angry, feeling helpless is normal. They can feel it. Sometimes they can see their parents feel it. It doesn’t mean that their parents are not available to give them the support they need or the therapy that they need, if it comes to that.

    Melanie: So, then let’s talk about helping our children as we help ourselves as adults because this did affect so many of us and as you said, like a thunderstorm on a sunny day. How do we find out what our children already know? With social media, they hear things all around doctor. How important is listening to their fears and concerns and how do we approach it with them? Give parents listening some coping strategies.

    Dr. Galili-Wesstub: So, nowadays you would assume that the child already is exposed, I would say certainly over six years of age at least here unfortunately. Unfortunately, they all have cell phones and they all see what’s happening. So, I think that it’s important to sit down with the children and to say you probably heard or I don’t know if you heard but this and this happened and to ask them, what do they know about it. Do they want to ask anything? It is important to encourage them to talk but not to force a psychological or emotional openness if they are not ready for it. The idea is again, again and again, I don’t know how – in how many ways I can stress it, is to be sensitive, flexible, containing and encouraging, but not to force anything. Some children do not want to verbally process their feelings. It doesn’t do them any good. They want to play, they want to draw pictures, they want to spend time with their friends. If they are functioning okay, you don’t need to force them to go through any kind of psychological process. You have to be open, flexible and attentive.

    Melanie: Are there things we should look for? Red flags? You say if they are feeling normal, what should we be looking for?

    Dr. Galili-Wesstub: So, I mean first of all, it’s the basics. It’s sleeping, eating, concentrating, being interested in their surroundings. Now things could be different for the first few days if somebody lost a grandfather or a grandmother, they might not have I think it’s obvious to all of us a good appetite and they might not be able to do their schoolwork for a few days. That’s normal. That’s what we call psychoeducation. We have to understand ourselves and to understand it for our children that we are affected emotionally, and we react to it. But if you see after a week or two that things are not starting gradually to improve, then you have to be worried. If weeks after, a month after, a month and a half after you see that the kid doesn’t want to see friends, doesn’t want to do their extracurricular things that they used to enjoy, doesn’t want to go to sports, doesn’t want to play music, doesn’t sleep at night or oversleeps because he is hiding away in his room and in his bed, etc. You have to look for changes in behavior to allow some changes in the immediate period and reaction, but to encourage a child that they will find strength and come back to themselves. And to show them that even if we are sad or frightened, we do have enough strength to keep on doing important things.

    Melanie: Wow doctor, so is that when the parents step in and try and use their strength and support or is that the time to seek professional help and if so, who do we look to?

    Dr. Galili-Wesstub: It’s both. It’s both. But I think it’s responsible if a parent has a line and open line to contact someone professional to consult and they could come for a meeting and describe what’s going on and decide together whether there’s a need for an intervention or not. I think it’s very important that they have some professional help available just to consult and evaluate the situation. And you can turn to a psychologist or a clinical social worker. I think usually they have enough training to be able to evaluate and give the support that’s needed. I think that rarely you need a psychiatrist and very rarely you need to intervene with medications. In extreme cases, you do. And it helps and it’s very good that it does. But usually we start off with therapy. Most likely, with supporting the parents, individual therapy for the child, if they are young it could be play therapy or some kind of art therapy. But if they are older, it could be individual therapy, sometimes we feel it should be a family intervention, sometimes we do group work. It really, really depends on the child, on the specific trauma they were personally exposed to and to their family needs. Sometimes if a child had a pre-existing some kind of psychiatric or psychological problem; they would be more vulnerable to develop PTSD and we should be aware of that and then we should maybe consult with a person that was treating the child before and knows then about how to best address the intervention.

    Melanie: Doctor one of the schools’ principals in Pittsburgh said that routines for children are essential to normalization. Is that true? How can we keep their routines normal if they are not part of that more rare group of children that have real trouble processing this or maybe had a pre-existing situation? Are we supposed to try and normalize their routine or does that make it seem like we are pretending it didn’t even happen?

    Dr. Galili-Wesstub: I think – there is exactly the flexibility we are talking about. Keeping their normal routine gives the message that basically the world is a good place, bad things happen, but we are not helpless. We do have control over our life. Maybe not 100%, but for the most part, we do and I’m sounding a bit- maybe a bit shallow, but it is important, and life goes on and we can enjoy life and we have enough strength to continue. Having said that, it does demand that the teachers and the parents keep their eyes open. And if adhering to their routine and the normalization is best for the majority of the children; it could be one child that it’s not working for them. Then they should not have the feeling that they are damaged or there is something wrong with them. But we should be able to give them the specific support that they need and if they don’t have the strength to go on with life as it was before; we will encourage them to take their time and we will assure them that we know that within days or weeks, they will go back to their normal functioning. So, for the majority of the kids, talking about the events and at the same time expecting them to go on with their life as it was before is very, very important.

    Melanie: Then please give us your final thoughts on helping children cope with tragedies that directly affect their communities and you do this all over the world doctor, so, give us a little bit of advice. What would you like us to know about helping our children and proceeding forward ourselves?

    Dr. Galili-Wesstub: I’ll tell you – I’ll share with you maybe one of the most moving experiences I had. When we were with a team in Sri Lanka post tsunami and we were giving the lecture about PTSD in children and how to deal with it and what would we expect the outcome would be. And it was a room full of doctors and social workers mainly, there weren’t many psychologists in Sri Lanka. And one of the doctors stood up and said you are sharing and experience from several hundred victims of terror, but we have lost over 40,000 people in the tsunami and I cannot see how it is relevant. And I was kind of taken aback and thinking and not really knowing how to answer. And then a woman in a light blue sari stood up, later I learned that she was the head of their pediatric college, which I didn’t know at the time. And she said to him, do you know where this person is coming from? She’s coming from Israel. Do you know that they lost 70 years ago about half of their people and they built a state after? So, she can tell you about what it means to lose 40,000 people and to recover. So, I do want to tell you that our psyche is built for regeneration and recovery and most of us recover well. And fortunately, I do know that your community has the means, both financially and academically and professionally and emotionally to support each other and I think you should remember that and to know even though I’m not romanticizing trauma by any ways; once you have experienced trauma, and it’s horrible, you do have the ability to recover and you do have the ability to grow. So, I do think that optimism is realistic, not a wish.

    Melanie: Thank you so much doctor, for being on with us today. What an inspiring story you told at the end and you gave us hope, you gave us encouragement and you gave us really great coping strategies and ways that we can not only help ourselves, but more importantly our children to deal when things like this happen. It’s so important that we hear your message and that we hear your word. Thank you again for joining us.

    This is Hadassah On-Call, New Frontiers in Medicine brought to you by Hadassah, the Women’s Zionist Organization of America. The largest Jewish Women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit www.hadassh.org, and to hear more episodes in this podcast series please visit www.hadassah.org/podcasts, that’s www.hadassah.org/podcasts. This is Melanie Cole. Thanks so much for joining us today.
  • Hosts Melanie Cole, MS

Celiac Disease Awareness

Celiac Disease Awareness

Additional Info

  • Audio File hadassah/hd015.mp3
  • Doctors Wilschanski, Michael
  • Featured Speaker Michael Wilschanski, MD, Director of Pediatric Gastroenterology at the Hadassah Medical Organization
  • Guest Bio Prof. Michael Wilschanski is the Director of Pediatric Gastroenterology at the Hadassah Medical Organization. He was born in London, England and graduated from the University of London (Royal Free Medical School) in 1985. He founded the Electrophysiology Laboratory in Shaare Zedek and moved it to Hadassah. This laboratory is unique in Israel and deals with electrolyte transport in vivo  and in vitro. 

    Learn more about Michael Wilschanski, MD
  • Transcription Melanie Cole (Host): Celiac disease is one of the more common diseases that results from both environmental and genetic factors and here to tell us about celiac disease today is Professor Michael Wilschanski on this episode of Hadassah On Call.

    Welcome. My guest today is Professor Michael Wilschanski. He’s the director of Pediatric Gastroenterology at the Hadassah Medical Organization in Jerusalem. Professor tell us a little bit about yourself and how you came to the Hadassah Medical Organization.

    Michael Wilschanski, MD (Guest): Well I was born and trained in England and we came on Aliyah in 1985. I worked at a different hospital but then it’s very clear that Hadassah is the major hospital in Jerusalem, so I moved over there about 18 years ago and I’m head of the pediatric gastroenterology in both Ein Kerem and Mount Scopus and I’m very happy to be working at Hadassah.

    Melanie: So, let’s get into celiac disease a little bit. Is it really considered a disease Professor? Tell us what it is.

    Dr. Wilschanski: That’s a very good point to start off with. I actually am one of those people who think that it is not a disease; because actually people who have celiac and as long as they conform with the diet, are entirely healthy. So, there’s not really a disease per se. So, it is a condition. It is very, very common. It is one in one hundred people around the world. So, it’s very difficult to say that it is a disease so common. It is a condition. It is an intolerance to gluten which is part of wheat and barley and it is – if the person is – has a genetic background which causes this problem and it is not looked after; then the gluten does cause damage to the intestines and this causes major problems, both in children and in adults. But as I say, once again, if it is sorted out and it can be sorted out very, very easily just with dietary changes, no medications, no IVs, no drugs and the person will live a normal life. So, I agree that it is in choice of medicine whether it is disease or not.

    Melanie: Can a child grow out of it? Is it something that if they follow the diet and we are going to speak about treatments just a little bit and the diet; but can they grow out of it? Is it something that will change as they grow?

    Dr. Wilschanski: Yeah, everyone asks me that question whether you can grow out of it. And the reason for that question is because in the layman’s understanding, it’s a bit like milk allergy or peanut allergy, let’s try and put the kids back on peanuts or back on milk later on and see what happens. Celiac is not like that at all. Celiac is an intolerance which unfortunately is lifelong and therefore, normally one does not grow out of it per se. I cannot say that. The reason why – another aspect of this is that if the child is so compliant with the diet or the adult is compliant with the diet; he feels no symptoms for years on end, so therefore he feels like he or she feels like he has grown out of it. But actually, he is still on the diet. So, that’s another way of looking at it. But actually, per se, it is not something which one just grows out of.

    Melanie: Professor, do we then really need a cure for celiac if gluten free diet, a strict gluten free diet takes care of all of these symptoms that we are going to discuss, and do you see that compliance with a gluten free diet is very, very difficult especially among adolescents.

    Dr. Wilschanski: Yes, it is difficult, but much easier than it was ten or fifteen years ago. It’s very interesting, as a pediatric gastroenterologist, all the families who walk into my office who are getting medications for other diseases say when can we just have a diet to cure this problem. I just want to be on a diet then I don’t need the medication. And then the celiac families walk in and they say I just want a medication. I don’t want to be on this diet. So, it’s just a question of how you look at it. Many, many of our celiac families get on extremely well with the diet and of course it is a pain in the neck. I agree with you. Sometimes going to a party, going to a wedding, sitting on the airplane, getting gluten free food is not the easiest. But still, I would think that it is better than getting certainly injections. I can talk about – there are a lot of research going on to actually give some medication which will prevent the gluten from entering the lining of the intestine and that could be – so it could be that in the not too distant future a celiac person could eat gluten and have a like a capsule likely, the adults and children who are lactose intolerant can drink milk with a tablet; they could possibly be something like that and that will be happening soon I hope. So, there is on the horizon various ways to stop gluten causing the damage but actually, as I said once again; being on the diet is an absolute cure as well.

    Melanie: So, then tell us about your latest research in celiac at Hadassah Medical Organization. What’s exciting? What are you doing?

    Dr. Wilschanski: Well as I said, we are seeing many, many more celiacs than we were a few years ago and everyone is seeing that. All of these kinds of problems are much more common, both in pediatrics and in adults. And we are doing some nice research at the Hadassah Medical Organization. We have had two studies published recently and one of them was we noticed that the gluten free diet actually does contain a lot of calories because if you do avoid – it seems to be that avoiding the gluten, one tends to eat a lot of carbohydrates and a lot of calorie containing food and a wonderful dietician has done some work on our patients and we have actually proven that. That the gluten free diet is what we call obesogenic, in other words it can cause you to gain weight. Many, many of our families have that because – and this is something which we are educating the medical community from Hadassah that one has to be careful to certainly increase fruits and vegetables with the celiac diet and not – to watch out for the obesogenic part of it. That’s one study we have just published now.

    And the other study which we published is that we noticed that because if celiacs do not keep the diet and they do not absorb calcium well; then there is a problem with their teeth. And we have noticed that many of our children mainly, with celiac, certainly the ones who before the diagnosis have bad teeth and we have done some research on that as well and have published about that certainly in the beginning of the diet therapy one has to be more careful about dental hygiene and that there may be an enamel issue that the enamel is not well made in celiacs. So, that’s another study which we have done recently.

    And another one which we are doing, is a lot of our families complain – there are some neurological issues with celiac because if you think about this; the gluten is actually not good for this particular individual, it goes around the body and affects various organs no necessarily just the intestines and we have had some – there are well known neurological issues with celiac and one thing which we have noticed is that there is a sleep disturbance. All of our certainly younger children as soon as they go on the gluten free diet; suddenly their sleep pattern improves. They don’t wake up in the night. So, actually we are doing another – some more research so I can’t tell you the results of that yet, but we are doing it right now at Hadassah looking at various aspects – working together with the sleep clinic in Hadassah to try and sort this out. So, there are lots of things going on in Hadassah with celiac and we are very proud that this is all happening.

    Melanie: Wow, that is so interesting Professor, so the obesogenic; that is fascinating as well as you have noticed that gluten free diet is high in calories and so let’s just start there and we don’t have a lot of time, but I would like to delve into these just a tiny bit and the dental hygiene; I was researching that as well and that’s fascinating. What would you like listeners to take from this as far as the high calories that are found in a gluten free diet, or the dental hygiene issues that you have noticed in your research? What would you like your patients and listeners to know and do about this?

    Dr. Wilschanski: I think both at the moment. Why not? I think it’s something which because we did the study with the dental department in Hadassah. Of course, not everybody has access to these wonderful doctors there as well. And I think generally, one should look into the dental health of our new celiacs. Certainly, if you have a child who – obviously with the families generally are very concerned about growth of course and getting the blood tests back and anemia and everything else getting back to normal; but I think if the people who are listening would take that into account also. I think one should be a little bit more careful about dental health with dental hygiene with our celiacs.

    One interesting just sort of a case report which we had, and we actually had one child who was referred from the dental clinic. He actually did not have much GI issues. He was growing well and didn’t have much stomachache or diarrhea or the usual symptoms, but he had terrible teeth and he had – and one of these very bright Hadassah dentists took celiac antibodies and they were sky high. So, actually, we were referred this young boy from the dental clinic and the celiac was diagnosed because he had bad teeth. So, I think that’s another issue which our listeners can understand, that is something which we need to look into and why not to make sure that our celiacs have excellent teeth.

    The thing about the obesogenicity is interesting. It’s true that years ago we thought that celiac – you look at the old pictures and they had all these thin little children with protuberant abdomens and they looked very, very sad themselves, malnourished. Now that isn’t the case at all. Now we’re diagnosing celiac much earlier; the blood tests are very, very good nowadays. We are getting the- they are being diagnosed earlier so the children are generally not malnourished and I think that putting a child on a gluten free diet with all the different substitutes there are, and the dieticians are excellent getting substitutes for gluten. But one has to just be careful with calories and to make sure that the calories are not too great because we have been seeing and sometimes as you know, the families also – sometimes the whole kitchen changes to being gluten free because they have a child with celiac and everybody seems to be gaining weight. And that is because of the gluten free diet. I would like people to know that one should be a little bit more careful.

    Melanie: So interesting and how does what you are doing at Hadassah Hospital in Israel affect global treatment of celiac? Wrap this up for us with your best information, your take home message what you would like listeners to know about celiac and what you are doing there at Hadassah.

    Dr. Wilschanski: I think the take home message is that we are still missing too much of our celiacs. We are diagnosing; they come to Hadassah too late and I think the message is if – let’s say I’m talking to the parents here – you see that the children are not gaining weight or they are not doing well even just as I said before, neurological or psychoneurological issues, they are not doing well in school or there are other feeding problems that the child doesn’t want to eat certain things; then one should just ask the primary care physician to do the celiac test. It’s a really simple test and we are diagnosing it – the good doctors are diagnosing it very, very early. That’s point number one.

    Point number two, I think that Hadassah is at the forefront of pediatric gastroenterology and certainly we have a very large clientele of celiac and we are – as I said, we are doing research as I have mentioned. Not every celiac needs to come to Hadassah of course, one can certainly manage that very well in anyplace in the world, but sometimes if the listeners want to send their children for a gap year or something whatever it is then certainly at Hadassah, we are very able to look after them.

    Melanie: Thank you so much Professor Wilschanski for being with us today, for explaining celiac and your exciting research and your common-sense advice, really about dental hygiene for people with celiac especially children and for the weight gain that could come along with that strict gluten free diet and it’s such interesting information. Thank you so much again for being on with us today. This is Hadassah On-Call: New Frontiers in Medicine brought to you by Hadassah, the women’s Zionist organization of America. The largest Jewish women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit www.hadassah.org and to hear more episodes in this podcast series please visit www.hadassah.org/podcasts, that’s www.hadassah.org/podcasts. This is Melanie Cole. Thanks so much for listening.
  • Hosts Melanie Cole, MS

Protecting Hospitals and Patients from Antibiotic-Resistant Bacteria

Protecting Hospitals and Patients from Antibiotic-Resistant Bacteria

Additional Info

  • Audio File hadassah/hd014.mp3
  • Doctors Moses, Allon E.
  • Featured Speaker Allon E.Moses, MD
  • Specialty Chairman in the dept of Clinical Microbiology and Infectious Diseases, at the Hadassah Medical Organization
  • Guest Bio Prof. Allon E. Moses, head of Hadassah's Department of Clinical Microbiology and Infectious Diseases, was elected president of the Israel Society for Infectious Diseases at its recent Conference. After graduating from Ben Gurion University of the Negev, Moses did his residency at Hadassah Mount Scopus Hebrew University Medical School and was a clinical fellow at Harvard University. He's been a lecturer and professor at Hadassah for over 20 years and has been Chairman of the Department since 2005.

    Learn more about Prof. Allon E.Moses, MD
  • Transcription Melanie Cole (Host): In recent decades, we've been facing an alarming increase in injections by bacteria that resistant to all existing antibiotics. Antibiotic resistance is a growing problem both in the United States and around the world. Today we're speaking with Professor Allon Moses on this episode of Hadassah On Call.

    Welcome. My guest today is Professor Allon Moses. He's the Chairman in the Department of Clinical Microbiology and Infectious Diseases at the Hadassah Medical Organization in Jerusalem, Israel. Welcome to the show, Professor Moses. Tell us a little bit about yourself and how you came to the Hadassah Medical Organization.

    Professor Allon Moses (Guest): Hi, Melanie. Very nice to talk to you today. I've been at Hadassah for many years. I started as a resident of medicine and then went through infectious diseases. I began my training in infectious diseases at Hadassah, and then spent two years at Harvard Medical School in the hospital. I did some clinical work and research, and then I came back to Hadassah Medical Center, and I've been Chairman of the department for the past thirteen years. We are the Department of Clinical Microbiology and Infectious Diseases. It's an unusual department where under one roof, the infectious disease doctors work together with the clinical microbiology lab, and I can tell you about that later.

    Melanie: Wow, what a great story about yourself. So give the listeners a little quick description of what an infectious disease is, and why it's important that the Department of Clinical Microbiology and Infectious Disease work together in the same area.

    Allon: So infectious diseases is a field where we treat any disease caused by microorganisms; bacteria, viruses, parasites, and fungi. And so the diseases caused by these microorganisms are infectious diseases. They can be in various parts of the body. In the lungs it would be pneumonia, in the head it could be meningitis, et cetera. So any of these diseases is treatable by us.

    It's important for us to be close to the clinical lab because the clinical microbiology lab is where the technicians identify the bacteria. They grow them, they identify them, they see their susceptibility. Are they resistant or are they sensitive to antibiotics? And if we work together under one roof, it's possible for us to collaborate, and we always are proud that our infectious disease doctors are able to tell the technicians about the patient so it's not just an anonymous test that they're working on, and the infectious disease doctors can learn from the technician’s various secrets of the microbiology. So we feel that it's a mutual and nourishing collaboration.

    Melanie: Professor, there seems to be a growing list of bacterial infections that are resistant to bacteria. We hear about this in the media all the time now. Please tell us a little bit about how this has changed the landscape of treatment for infectious diseases.

    Allon: You know, resistant bacteria are part of the biology. If a bacteria is in contact with antibiotics, the natural thing that happens to the bacteria is to mutate and becomes resistant. We know from the first antibiotics in the 1940's, the famous penicillin, that just after a few months of treatment with penicillin, the first resistant bacteria emerged, and these were Staphylococci. Now we know that Staphylococci are about 99% resistant to penicillin. So over the years as bacteria are faced with antibiotics, they develop resistance.

    Now so when antibiotics are used, the good side of it, we cure the infection. The bad part is the resistance forms, and therefore when antibiotics are used where they are unnecessary, we develop unnecessary resistance.

    So the first rule is to give antibiotics only when they are necessary. For example, for viral infections we should not give antibiotics. We should give antibiotics for short periods of possible- if there's a specific infection we need to treat, or for short periods of time we need to treat it with a specific antibiotic and not a very broad spectrum antibiotic.

    So we are faced with the fact- we have a saying, 'When you use it, you lose it.' So as long as we are using antibiotics, bacteria will become resistant to them. Over time, and this has been a growing problem for the past fifteen years, we are faced now with bacteria which are more and more resistant and actually we have- fortunately we have bacteria resistant to all antibiotics.

    Years ago, the Infectious Disease Society of America came out with a slogan, 'Bad bug, no drug.' And this is getting worse, and I must say as an infectious disease doctor, we've been saying this for the past ten years, but during the year or two that we are not faced with a real problem. It is not uncommon for us to have a patient who has a resistant infection with a bug that we do not have any antibiotics. So this has become to be a worldwide problem. We face the problem in our hospital, but the same as all over the country, and much of it is in the world. Some countries have less resistance, unfortunately in Israel we have many resistant bacteria.

    Melanie: Professor, is the use of antibiotics only in humans, or also in animals? And along the lines of that question, since this resistance is happening, and that overuse of antibiotics, does that include antibiotics that show up in our milk, in our food, in our chicken that are being used for livestock? Is that kind of all combined?

    Allon: That's a very good point. The humans, when they meet the antibiotics, it doesn't matter if they come through the doctor's prescription because of an infection, or if they come through the food that we eat. It's definitely a known problem that antibiotics are used, for example, in chicken as a growth promoter. Antibiotics are used occasionally in cows to treat all sorts of infections, and the antibiotics which are given to the animals which are then served in our dinner, if they have antibiotics, they are passed to the human.

    So we must be aware that some governments do not regulate well enough the use of antibiotics in animals, and that's a way for antibiotics to increase resistance in the animals, and then these animals also pass their bacteria to humans.

    Melanie: So along those lines, hospitals are seeing this issue within their own surroundings. Tell us some of the most common causes of hospital acquired infections. What kinds of infections are spread in the hospital, and how are they spread?

    Allon: So we deal for the past thirty years in infection control, and for the past ten years, infection control has been put into a very central part of our everyday lives, and infection control really has two parts. One is the hospital associated infections. A patient comes in for surgery, and unfortunately his wound is infected, so we try to prevent hospital acquired infections, sometimes it's termed healthcare associated infections.


    There are two other parts of infection control, is to try and eliminate the forming of resistant bacteria, and these are actually two processes which are linked because healthcare associated infections are often over 70% caused by those resistant bacteria. So we put a lot of effort, the medical profession has now put many guidelines into how to control infections, and infection control has become for years now a very important part of our medical life, and through those guidelines, how to prepare patients for surgery, how to treat central lines inserted into patients, how to prevent pneumonia in the hospital. These guidelines help us lower the number of infections- of healthcare associated infections.

    Melanie: Professor, what strategies do you use to reduce the spread of healthcare associated infections and resistant bacteria? And is this something that gets implemented within the healthcare setting with all employees, like washing their hands, for example?

    Allon: Well we've increased our infection control team. We now have doctors dealing solely with this in the hospital. We've increased the number of nurses in our infection control team. I must say that our administration has been very supportive. The head of the hospital is now head of the infection control committee of the hospital, so we really feel that infection control comes from the top all the way to the person who cleans the rooms, and we put a lot of effort into thinking how can we reduce infections?

    In fact at Hadassah, the year 2018 has been chosen to be the infection control year, and we are trying to have all sorts of projects in different departments all aimed at lowering the number of resistant bacteria and the number of hospital acquired infections.

    Melanie: Professor, you do some amazing research. Tell us a little bit about your bacteriophages therapy. What is it? And how can it help in this bacteria resistance that we're seeing?

    Allon: The bacteriophages story is an amazing story. Many years ago, Russians already found bacteriophages, which are viruses attacking bacteria can be used for medical purposes, but they never really were able to provide this as medicine. Since we now have these bacteria which are resistant to any antibiotics, we look for new methods to treat. And just a few weeks ago, we were able for the first time in Israel to use specific bacteriophages against a patient's bacteria.

    The way we did this, and this was done in collaboration with Professor Schooley from California University, and his work was in Navy State Laboratory and adapted stage therapy. They all worked together to help us to provide our patients with new treatments. A professor at my department, Professor Nir-Paz was the physician scientist, worked in collaboration with a Dr. Hazan from the Hebrew University from our medical school. Dr. Hazan is an expert in bacteriophage production, and together we were able to take the patient's bacteria to find specific phages which would act against the bacteria. Once we found these phages, and this was with the help of Professor Schooley, we were able to take the bacteriophages and inject them to the patient.

    The specific patient was a cab driver who had a severe accident, he broke both of his legs, and one of the legs got infected with Acinetobacter resistant to all antibiotics. And with the help of these bacteriophages, which were injected to him intravenously, we were able to hopefully cure his infection. Until we gave him the bacteriophages, the wound was infected, oozing with pus, and now that we've given him the treatment - this was already three or four weeks ago - we could see that his wound was healing, he was able to be discharged naturally. A few days ago was his first day in rehabilitation.

    Now this is the beginning, this was the first patient in Israel to get this treatment, maybe the fifth or sixth patient in the world, and we are hoping at Hadassah to- this is Nir-Paz and Doctor Hazan, we are hoping to have the phage treatment center which would provide solutions for patients who have bacteria resistant to all antibiotics. This is the future.

    Melanie: That's absolutely fascinating, Professor. So to wrap up, what would you like listeners to take away from what you're doing at the Hadassah Medical Organization? Is there something that we can all do to help stop the spread of infectious diseases that are becoming resistant to antibiotics? And for providers, we're learning more about stewardship, and antibiotic stewardship. So what would you like us all to know about what you're doing there and how we can get involved?

    Allon: Well I think that everyone should know, if they're patients, that they must ask their doctor to wash their hands. Hand hygiene is first and foremost important. You always have to ask your doctor whether you really need antibiotics. So this is a general recommendation if someone is unfortunately a patient.

    In terms of help for our project, I think that any support for opening our Hadassah Center for Phage Treatment would be fantastic. It's a way- we are working in a small lab, and to be able to overcome all difficulties of producing mass production of phages which would be delivered to our patients, it takes a lot of effort and also the support which we are looking for. In fact, Professor Nir-Paz and Dr. Hazan just received a very nice grant from the Binational Foundation in Israeli and America. So I think it's the beginning, but our future is to open a big center which will provide treatment for the whole of Israel.

    Melanie: Wow, thank you, Professor, so much for being with us today and for sharing your expertise on this fascinating topic of bacteriophages therapy and the research that you're doing at the Hadassah Medical Organization, and also the ways that we can really get involved and use good information about antibiotic resistant bacteria and infectious diseases. Thank you again for joining us today.

    This is Hadassah On Call: New Frontiers in Medicine, brought to you by Hadassah, the Women's Zionist Organization of America. The largest Jewish women's organization in America, Hadassah enhances the health of people worldwide through medical education, care, and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, please visit www.Hadassah.org, and to hear more episodes in this podcast series, please visit www.Hadassah.org/podcasts. That's www.Hadassah.org/podcasts. I'm Melanie Cole, thanks so much for listening.

  • Hosts Melanie Cole, MS

Sexual Abuse and the Bat Ami Center

Sexual Abuse and the Bat Ami Center

Additional Info

  • Audio File hadassah/hd013.mp3
  • Doctors Bauman, Dvora
  • Featured Speaker Dvora Bauman, MD
  • Specialty Director of the Bat Ami Center for Victims of Sexual Abuse at The Hadassah Medical Organization
  • Guest Bio Dvora Bauman, MD is the Director of the Bat Ami Center for Victims of Sexual Abuse at The Hadassah Medical Organization.

    Learn more about Dvora Bauman, MD
  • Transcription Melanie Cole (Host): Global estimates published by the World Health Organization indicate that about one in three women worldwide have experienced either physical or sexual partner violence or non-partner sexual violence in their lifetime. Today we're speaking with Dr. Dvora Bauman on this episode of Hadassah on Call.

    Welcome to the show. My guest today is Dr. Dvora Bauman. She's the Director of the Botany Center for victims of sexual abuse at the Hadassah Medical Organization. Welcome to the show, Dr. Bauman. Tell us a little bit about yourself and how you came to the Hadassah Medical Organization.

    Dr. Dvora Bauman, MD (Guest): Thank you so much for this option. I’m a gynae obstetrician- gynecologist obstetrician, mainly in gynecology, and my specialization is pediatric and adolescent gynecology work where I learned mostly in London. And so doing that I was encountered with many little girls, which some complained about irritation there, et cetera, and part of them were practically sexually abused. So I just was very involved just in the beginning of my test and examination, in those cases of sexual abuse. So finally, I started to be more and more involved in this Botany Center, and I got to be the Director in the end.

    Melanie: That's so interesting, and while doing my research for this interview, I noticed that your philosophy is a bit different than what many people might be used to seeing for victims of sexual abuse. Tell us a little bit about your philosophy of care for the very sensitive nature of the work that you do, Doctor.

    Dr. Bauman: Yes, thank you for this question which is very important because, you see, what happens with women, I wouldn't say the kids, but the kids as well, but many young women is that when it's very crime in the middle of the street, in the middle of night, it's very clear that it's abuse or rape.

    But most of the cases are not like this. About 80% of the cases is something happens in their home, something that happens with their partner, not always happen- could be an intimate partner or something, and the people- the girls the victims, are very confused. They are not sure if the crime was done to them or it's normal. Mostly in children, they don't really know if it's part of life and a part of normal behavior or it's a crime, and they're very confused. And this way of confusion makes the trauma even bigger.

    So, I think that the most important thing at the beginning is to make those things clear. To explain to the child, to the girl, to the adolescent, to the woman that love and partnership is something that you have to be agreed. It’s something that you want the same way that the other one and when it's done without your willing and without your permission and without your emotional involvement, it's not right. And from that point, to abuse if the way is very short. I hope I explained that very clear.

    Melanie: You absolutely do, and you make it so clear for us to understand. So, tell us about the Botany Center. How did it come about and what used to be the protocol for victims of sexual abuse prior to the Center's opening? Is it the only one in Jerusalem?

    Dr. Bauman: Yes, it's the only one in Jerusalem. We have in our country, which counts almost to eight million, we have four centers like that. And our Center, is for Jerusalem and surrounding which is about one million of people of residence. And it's a very special place because, if I may tell a bit of history, is that as you know abuse and rape and everything; those things we have from the Bible, so it's very, very old things that happened, or crime we would say happened. But up to, I would say, the 1980s nobody really knew how to care, how to give care to those people. And what happened that in Israel, for example, many years ago that the young very slim girl came to one of the hospitals before the world centers like that, and so they took care of her. They gave her antibiotics, and they gave her everything, but she was looking so young and so slim that nobody saw that maybe she would be pregnant and finally the pregnancy was discovered when she was on her 27th week, a girl of eighteen years.

    So it was a really dramatic disaster and from that on, people decided that for these victims, we have to have real protocols like in all medicine, you know? And so the protocols were involved with Minister of Health and today we work according to very clear guidelines. When a victim came, after having psychosocial approach and everything, we do the medical examination, we do the forensic examination, and we give them a medical treatment to prevent sexual transmitted disease, to prevent unwanted pregnancy, and of course we follow-up them to see that they stay healthy. At least in my part, it's mostly I would say the medical. We have also social and psychosocial therapists who are taking care to follow up with psychological trauma and everything.

    Melanie: Are all your victims women or are some men also victims of this type of abuse?

    Dr. Bauman: Most of them, of course, women. I will tell you a bit of statistic that below the age of ten, the victims are the same number boys and girls, so in the young population, we have just the same. In the older population, let's say after puberty, adolescence, it's mostly women. In our center, the statistic shows that 88% are women and about 12% are men, but that's not the statistic we know because the statistic we know, as you said, one in three or four women is a victim of sexual abuse, and one in six men is a victim of sexual abuse.

    So the point is that we see so few men, it’s still a problem that disclosure in this population of men is very difficult because as you can understand it, I'm not a psychologist, but a man mainly in Israel, in many countries, which the man feels he is a soldier, is combat soldier, he's a strong person to come to this center and to say, “I was abused.” They feel still that maybe it shows them like not strong enough.

    Melanie: That's such an interesting analysis, Doctor. So, tell us a little bit about how you assess the level of trauma and is the victim's recovery influenced by how soon after the assault that the victim is seen? Give us a little of the multidisciplinary care that these victims receive when they are coming to see you.

    Dr. Bauman: Our Center, Botany Center which is placed in Hadassah, works like emergency room. We have staff on call which has three disciplines. It's always a social worker, a nurse, and a medical doctor, mostly gynecologist, and for children under the age of ten to twelve, those are pediatricians. So we have always a team consisting of three disciplines.

    Once the person is coming to the emergency room, she or he doesn't have to go to the big emergency room, they just go in the beginning and they say, “I came to Botany.” Immediately they are taken to this special center. Once you are in Israel- Jerusalem, you should come and see our Center. And they come to the center which is a small nice office, close to the emergency, but really very in a discreet place. And then our staff is called, we are working twenty-four hours, seven days a week, 365 days a year. So we just give our assistance every minute in the whole year.

    And once this victim comes today at the center and we come, so we start to work as a team. The social worker is really starting to- what is called to interfere in the trauma, to prevent post-traumatic stress disorder, to talk to them and to give them back their confidence. Because I would say that the main trauma they have, it's not physical. I mean the physical is really big trauma, but the most trauma, they're traumatized psychologically because we are talking about a very intimate part of your body that you always cover and you decide to open them just the people that you really trust them and you love them and what happen is that somebody who didn't ask your permission, who didn't wait to see if you agree for that and he really raped you. That's the word.

    Melanie: This is such an interesting topic, Dr. Bauman, and the way that you approach it is also heartening to hear. All the things that you're doing for these victims. Around the world, we're hearing about "Me Too" campaign, it's very top of mind these days. Are we relating this conversation in a way? Are you seeing this happening in Israel? Are more women speaking up? Do you feel that there's more of an empowerment that's going on in Israel that might kind of be affecting globally?

    Dr. Bauman: Yes, thank you so much for this question, because when I'm teaching students, we do like a discussion. “What do you think about ‘Me Too’? What are the advantages and disadvantages?”

    So of course, there are few disadvantages and if you agreed and start from few disadvantages is that it is feeling like more feministic side that more women are involved and I'm looking more for the men, although in the space, there are also some men that can stand up for this movement. But in Israel, it's mostly women and it's my feeling that there is less place for men, which I'm still looking for them because they are disappearing. We don't see them. But that may be the only one disadvantage.

    But if we would talk about advantages, they are huge. It's like a revolution and when there is a revolution, so there is always a bit of blood, there is always a bit of tear, but it's a revolution. It’s a huge revolution because this movement or revolution means that women that were abused or were raped and were ashamed to stand up and to say, “It was done to me,” because they felt they are guilty in something. Maybe in the skirt, maybe in this and that, but they feel some guilt in it and what doing this revolution is that it's changing. It's moving the guilt from the victim today to the person who did it, okay? And that's very important because nowadays, we will understand very much what happened to them. It's not their guilty, it's the guilty of the perpetrator, the guilty of the person who did that and nothing would explain or giving the reason why it was done. There is no excuse for that.

    So the rules- so that's what for me, this movement and the ‘Me Too’ is doing that. It changes the real guilty from the woman to the other. So, when the woman feels less guilty and less shame, they can talk about it, they can go to the court, they can do anything and that's for me the most important thing.

    Melanie: Wow! That's really amazing to hear. So, as a wrap-up Dr. Bauman, what would you like our listeners to know about how they can possibly help if they know a victim of sexual abuse? How can they help a person get the professional help that they need after such a traumatic experience? What advice would you give someone if they know someone or if they themselves feel that they have been abused?

    Dr. Bauman: Yes, so again, it's also something that I discuss always with students in medical school and we're talking about that there are a lot of publications that show that unfortunately most of the victims are not talking with the doctors about what happened, about the past of sexual abuse and on the other side, doctors are usually not asking. And when I'm training with the students, understanding why the doctors are not asking, so the reasons are- the first, they don't know what to do with that.

    For example, they ask and the woman says disclose it and says, "Yes, I did have sexual abuse that day in my childhood,” or something. So they freeze and they don't know how to respond. So students and the doctors of the future, I'm telling them that they have to do it very naturally. They have, for example, when they take medical history, we usually ask in medical history do your parents have hypertension therapy to set that right? That's a normal history you have to ask the woman and tell her that's true.

    I know one in every three women or one in four women is a victim of sexual assault, and because it affects your health- and that’s true, it's affect the health or maybe if you think about it. So the sentence would be, “And because it affects you, it might affect your head, I would like to know if you had such a bad experience in your life?” So if you put this question as a really routine question, you will find out how many women and maybe men. I'm an gynecologist I don't treat men, but I see a lot of women when I ask this simple question, they just start to talk about it, and when they talk about it, I don't have to become a psychologist at that moment. Usually the second question would be, “Did you talk about it? Did you speak to somebody about it? And if you didn’t, maybe you want now? I can call a social worker, I can call a psychotherapist.”

    I'm a very lucky because I’m in a hospital, so have all these facilities and even, for example, if a woman came for routine examination, and we start to talk about it and all these feelings, all the experience of the traumas loading up, so sometimes I tell her, "Listen, I don't mind if we don't do the gynecological examination now. Just relax and come in a few weeks and we'll do it.” So I think it makes the difference.

    I think that after disclosure, people feel much better. They seek for assistance, for medical assistance, for psychological assistance. What is very important is that statistic shows that 45% of children who had sexual abuse don't disclose this topic until the age of after twenty-five or thirty. So they live with this information for this trauma and they don't share it with anybody. So we as medical team, as the social team, as a society we have to help those people to disclose things, to try to get to their heart.

    Melanie: We certainly do, and we applaud all the great work that you're doing on behalf of all of these victims, Dr. Bauman, because it really is something that's affecting the whole planet, and you are out there helping these victims, and it's just wonderful to see, and I hope that we take heart and hear your good advice because women- we do need to stand up, and not feel guilty, and not feel shame, and thank you for reiterating that. Thank you for encouraging this and for women stepping up. Thank you so much, Doctor, for being on with us today. This is Hadassah on Call: New Frontiers in Medicine brought to you by Hadassah, The Women’s Zionist Organization of America. The largest Jewish women's organization in America, Hadassah enhances the health of people worldwide through medical education, care, and research innovations at the Hadassah Medical Organization.

    For more information on the latest advances in medicine, please visit www.Hadassah.org, and to hear more episodes in this podcast series, please visit www.Hadassah.org/podcasts. That's www.Hadassah.org/podcasts. This is Melanie Cole, thanks so much for listening.     

  • Hosts Melanie Cole, MS

100 Years in Sight, The Hadassah Medical Organization; A Century and Beyond of Eye Care Innovation

100 Years in Sight, The Hadassah Medical Organization; A Century and Beyond of Eye Care Innovation

Additional Info

  • Audio File hadassah/hd012.mp3
  • Doctors Chowers, Itay
  • Featured Speaker Itay Chowers, MD
  • Specialty Chairman of the Division of Ophthalmology of the Hadassah Medical Organization
  • Guest Bio Itay Chowers, MD is a Professor of Ophthalmology, and Chairman at the Division of Ophthalmology of the Hadassah – Hebrew University Medical Center. Prof. Chowers has completed medical school at the Hebrew University and an Ophthalmology residency at Hadassah. He then performed vitreoretinal and research fellowships at the Wilmer Eye Institute of the Johns Hopkins University School of Medicine (2000- 2003). Prof. Chowers served as a chairman of the Israeli retina specialists association (2013-2016) as well as the head of ophthalmology education in the Hebrew University School of Medicine (2011-2014). He sees patients at the retina service in Hadassah and is involved in multiple clinical trials and basic research projects focused on retinal diseases in general and Age Related Macular Degeneration.

    Learn more about Itay Chowers, MD
  • Transcription Melanie Cole (Host): It's the 100th anniversary of ophthalmology at the Hadassah Medical Organization. Can you imagine a century of eye care innovation? Hadassah's ophthalmologists may save your eyesight 100 years after ridding Pre-State Israel of trachoma. Today we're speaking with Professor Itay Chowers on this episode of Hadassah On Call.

    Hello. My guest today is Professor Itay Chowers. He's a Professor of Ophthalmology and Chairman of the Division of Ophthalmology of the Hadassah Medical Organization in Jerusalem, Israel. Welcome to the show, Professor. Tell us about yourself as you're new to the department. Tell us about your field and how you came to Hadassah Medical Organization.

    Itay Chowers (Guest): Hi there. Well I'm actually of Hadassah from the time that I was born because I was born at Hadassah about fifty-three years ago, and I did my American school at Hadassah, also my residency, and following the residency I spent three years at the John Hopkins Medical Center in Baltimore. Then I returned to the department at Hadassah and I became Chairman about half a year ago in this department which has, as you mentioned, very long and important tradition in ophthalmology.

    Melanie: Professor, since you're the new Chair, what is your vision - no pun intended - but what do you see as some future goals for the department? What are you hoping to see happen?

    Itay: So our department is a lot of the main departments in Israel. We have been leaders in terms of incorporating new techniques to treat patients. And our main and most important goal is to treat and provide service to people with sight diseases. To have this service as advanced and comprehensive as possible, and also is accessible as possible. So these are my first and most important goals.

    In addition to that, we also aim and do my best to keep the tradition of having cutting edge research both basic translation of and also clinical research in the field of ophthalmology. These are my tasks and my plan is to pursue these in the coming years.

    Melanie: Professor, it's the 100th anniversary of the Department of Ophthalmology at Hadassah Medical Organization. Tell us the story please of when Henrietta Szold and her mother visited Pre-State Israel all the way back in 1909, and they were horrified to see children with flies in their eyes. So tell us about Hadassah's first project to cure trachoma, and is it still widespread?

    Itay: So yeah, that's actually a very- I would say that's a moving story, thinking about what happened here more than 100 years ago when Henrietta Szold visited Israel, and when she got here, she saw people getting blind, and perhaps especially children from trachoma, which is an eye disease which was very prevalent and still is prevalent in some parts of the Middle East, but not anymore in Israel. When she noticed these people that became blind as the result of the poor hygiene, and she knew that was prevalent here, she decided to go ahead and do something about it. She had managed to impede, be so successful, because as I mentioned before, trachoma does no longer exist in Israel. Many ways thanks to her initiative vision in sending professionals who were able to cure, to treat these patients at that time. And actually that's what started the Hadassah Organization and eventually the Medical Center.

    Melanie: Wow, Professor. What a fascinating story, and although the dreaded disease is endemic in many countries in the world, you won't see it in Israel today, yes?

    Itay: Yeah, that's true. We don't see it anymore. What we see today is just individuals that immigrate or make Aliyah to Israel from other countries in the Middle East. So we see the consequences of trachoma, which is the scarring of the cornea tissue, the front part of the eye, but it's not active anymore, and thank God. Today we just don't see the scene that Henrietta Szold saw more than a hundred years ago.

    Melanie: Professor, based upon the fact that the hospital is one of the number one trauma centers in Israel, how much of those trauma incidents do you see in the Department of Ophthalmology? Tell us about some of your exciting eye saving surgeries.

    Itay: Well unfortunately we do see quite a lot of trauma cases, and stomach trauma cases, especially in Jerusalem and especially at Hadassah because we are a main center to treat trauma in general. In many of the patients that come to trauma have multiple organs involved, maybe including the eyes, and some have just solitary eye movement. The reason for such trauma can vary, but we do see many patients that get trauma in association with an attack. If sharp nails go into their eyes, rock throwing. But also daily activities such as people that work, blacksmiths, other professions that are exposed to a high velocity iron or metal, particles moving around them. So yeah, that's something that we see actually quite a lot here at Jerusalem.

    Melanie: And you even had an exciting surgery recently in December where you helped save a policeman's eyesight. Tell us a little bit about that.

    Itay: Well actually that's a case that I remember quite clearly, and it started at the Nablus Gate or what we call in Israel Sha'ar Shechem, in the old city when the 2 or 3 terrorists opened fire on a group of policemen, and one of them was hit in his eye with shrapnel from that attack. And as I mentioned, it was Friday night and I remember getting the call at home. It was actually quite late at night, and when I came to the hospital, examined that specific policeman, he had actually quite severe trauma with foreign bodies that we could not identify them initially inside the eye globe. We were quite concerned that this might be a very bad trauma that might lead to severe substantial loss of vision.

    In that case, we were able to operate on that policeman, and during that- and after several hours we were able to remove these shrapnels from the eye, and to close the opening that the trauma made in his eye wall. Another issue was to understand what these shrapnels are made of because we know that some specific materials can be toxic to the eye content, particularly to the retina, and if you know that this is one of these specific toxic metals, particularly iron, you have to make sure you remove every tiny bit of this from the eye.

    These specific shrapnels that this policeman had were actually quite strange in their appearance, and we asked for help from the police. The police have a very sophisticated lab that can analyze such materials, and they were able within a very short time to analyze these particles and to identify them as made of tin, which is by itself not toxic to the retina.

    The end of that story, of that eye and that policeman, was actually quite a happy one because after a few weeks at home he completely recovered and went back to service, and I see him now every several months just to follow him, and he's doing perfectly fine.

    Melanie: Isn't that so cool? What a wonderful story, Professor. Looking forward to the next ten years in the field, what do you feel will be some of the most important areas of research as you're discussing what kinds of materials got in that policeman's eye, and you were able to save his eyesight. Where do you see this field going? What's going on that's really exciting?

    Itay: Well actually the profession is very exciting. It's at the front of science and medicine, the development of new devices. Here at Hadassah in the Department of Ophthalmology, we are very fortunate to have cutting edge research in the field of stem cells, developing new techniques to cure degenerative eye diseases, and particularly age-related muscular degeneration. This is a project that is led by Professor Eyal Banin from my Department.

    In addition to that, there are also projects in curing genetic eye diseases by using gene therapy and delivering a normal gene to replace a gene that is mutated or malfunctioning in eyes of patients with retinal degeneration. And the third field that is really advancing and we here at Hadassah are taking part in this exciting research is new imaging tools, a new automatic way to analyze imaging devices that can automatically interpret the condition of the retina and can enable us to screen multiple individuals very quickly, and thus identify the disease very early. So I think these three fields' kinds of gene therapy and the new imaging tools as it is will be in front of technology in the next few years.

    Melanie: Wow, isn't that amazing? A hundred years later and Hadassah Medical Organization's outstanding ophthalmology department is really marking its centennial and known for groundbreaking treatment and care that may save all of our eyesights. Professor, thank you so much. Is there anything you'd like to add about the department? About Hadassah Medical Organization?

    Itay: Well I think that Hadassah Medical Organization in general is a very unique institution. As you probably can assume, it's located in a very, very interesting but also exciting at sometimes and tough region of the world. We are serving a very diverse and interesting population. Both our staff and our patients come from different backgrounds, and still we manage in this unique setting to be at the front of medicine, at the front of science. So I think Hadassah in general, the medical organization is very special, and the department of ophthalmology is unique and has all these special things that characterize Hadassah, but even further because we have a very strong outreach to other developing countries. We train in our department more than a hundred ophthalmologists from developing countries from Africa, South America, and other parts of the world, and I'm very proud to be part of such an institution and to lead such a department.

    Melanie: Thank you so much, Professor, for being on with us today. What great stories you have to tell, and I can absolutely tell that you have a passion for your work, and that the ophthalmology department at Hadassah Medical Organization will do great things with you as its Chair. This is Hadassah On Call: New Frontiers in Medicine, brought to you by Hadassah, the Women's Zionist Organization of America. The largest Jewish women's organization in America, Hadassah enhances the health of people worldwide through medical education, care, and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, please visit www.Hadassah.org. And to hear more episodes in this podcast series, please visit www.Hadassah.org/podcasts. That's www.Hadassah.org/podcasts. I'm Melanie Cole, thanks so much for listening.
  • Hosts Melanie Cole, MS
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