health care

Days pass quickly at Paul’s

Nita and Michael Levy run Vancouver’s Paul’s Club. (photo from Paul’s Club)

It’s a Thursday morning in downtown Vancouver and a group of spirited, educated and friendly individuals gather for a morning coffee and pastry. They discuss world events, their likes, dislikes, and more. Lost in conversation, they find connection in the face of a shared obstacle: early-onset dementia. Welcome to Paul’s Club, a Vancouver-based adult day program for individuals living with this condition.

Founded in 2012 by Nita and Michael Levy, Paul’s Club is a grassroots social and recreational program where “everyone’s diagnosis is left at the door,” said Nita Levy, who is a retired registered nurse. She and her husband were inspired by the experience of her brother-in-law, Paul, who battled early-onset Alzheimer’s disease at the age of 62. Fortunately, his family discovered a program in England that catered to the needs of someone like Paul, who was physically capable and full of life. That program also made an enormous difference for Paul’s wife, Ann. “We saw Paul’s experience through the eyes of my sister,” said Levy, noting that freedom and normalcy were welcomed back into her life thanks to the relief provided by the program.

Upon retirement, the Levys were aware that, although quality adult-day programs exist in Vancouver, there were no options for people like Paul. The couple appreciated that people living with early-onset dementia often share Paul’s liveliness and would benefit from human connection in a social environment free from their regular obstacles. From its early days, Paul’s Club has aimed to “help us all stay socially and physically engaged, but, most of all, to have fun,” said Levy.

Paul’s Club is in the Hampton Inn & Suites by Hilton, on Robson Street, a location free from any associations of ill health. Inviting features such as large windows, comfortable couches and palm trees create a welcoming physical space for members. The club operates three days a week, from Tuesday to Thursday, between 10 a.m. and 4 p.m. Members can choose to attend one, two or all three days. The program remains open for 50 weeks a year. “You can’t close a program like ours,” said Levy. “Our members are young, and so a lot of their partners have had to become breadwinners.” Thanks to Paul’s Club, many of these individuals can continue working during the week, she said.

The Levys are joined by program director Chelsea Grills, who brings expertise in managing the disease with a degree in therapeutic recreation. Paul’s Club hosts 15 to 18 members each day, supported by as many volunteers as they can welcome – to the members, volunteers are known as friends, who just want to spend the day with them. No one wears a name tag, and everyone participates in the daily activities. This is one of many efforts to ensure that everyone is treated with the utmost respect. “This is a disease that can rob people of their dignity,” said Levy.

A typical day at Paul’s Club begins with the team greeting members in the hotel lobby. They are welcomed upstairs for tea, coffee and breakfast. Members can be engrossed in conversation for up to an hour, but, by 11 a.m., “we’re moving,” said Levy. Physical activity is an integral part of the program. The Levys love to try different forms of exercise to engage members. Currently, the crowd favourite is dance, based on the group’s shared love for music.

Understanding the significant benefits that music can have on those with cognitive impairments, music is played throughout the day, songs spanning various decades and styles. If dancing is not on the agenda, there will be a walk, yoga session or exercise class. Following this is lunch at the Italian restaurant located below the hotel. Grill gathers members’ orders in advance to alleviate the potential stress of decision-making at the restaurant. After the meal, everyone reconvenes upstairs to discuss current events, play trivia games and, most of all, laugh together – the group laughs all day long, no matter the activity, said Nita Levy.

The final activity is a walk on the Seawall, ending at a nearby gelato parlour. Members have the option of traveling home via HandyDART, eliminating the need for their families to coordinate their transportation.

Paul’s Club’s programming is designed to provide members with a sense of belonging and respect. “We can’t change the diagnosis of our members, but we can ensure that they experience a great day,” Levy emphasized.

The days unfold quickly “because we’re engaged, and this is fun,” she said.

Paul’s Club aims to see who their members are beyond their diagnoses. The Levys and Grill try to empower members by focusing on what they can do, rather than what they cannot. “One can always have a quality of life,” said Nita Levy.

Paul’s Club can carry out its mission largely through support from Vancouver Coastal Health Authority and whatever contributions families are able to make, Levy said. “We have never declined anyone on financial grounds, and we never will.”

On July 30 at Nat Bailey Stadium, Paul’s Club will host their annual fundraiser. The event will include an all-you-can-eat barbeque and bar, and a baseball game. Their goal is to raise $30,000, with $10 of each ticket sold going directly to Paul’s Club. Tickets – $60 for adults and $45 (inclusive of tax) for children 4-12 – can be purchased at paulsclub2023bbqandbaseball.eventbrite.ca.

To learn more about Paul’s Club, visit paulsclub.weebly.com.

Alisa Bressler is a fourth-year student at Queen’s University in Kingston, Ont. She is an avid reader and writer, and the online director of the arts and culture publication MUSE Magazine. Bressler is a member of the Vancouver Jewish community, and the inaugural Baila Lazarus Jewish Journalism Intern.

Ageism in medicine

“Studies show that one-third of Canadians admit to having been treated differently due to their age,” said Dr. Samir Sinha, director of geriatrics at Mount Sinai and the University Health Network Hospitals in Toronto.

Sinha, who is also a professor of medicine at the University of Toronto and the director of health policy research at the National Institute on Ageing, spoke on ageism in medicine and strategies for patients to combat this form of discrimination in a webinar presented by the National Council of Jewish Women of Canada (NCJWC) on June 6. He noted that the date of the webinar coincided with the start of Seniors Month in Canada, and shared that he was drawn to collaborate with NCJWC because Mount Sinai Hospital was founded 100 years ago “by a dedicated group of Jewish women.”

Sinha defined ageism, also known as age discrimination, as the act of imposing stereotypes, prejudice and discrimination on others or oneself based on age. He said the term was coined relatively recently, in the 1960s, even though it had existed in Canadian society long before then. He emphasized that “51% of Canadians agree that ageism is the most tolerated social prejudice, and 80% of Canadians agree that older adults (age 65+) are seen as less important than younger generations.”

This sense of diminished importance is commonly manifested in three forms: feeling ignored or invisible, being treated as devoid of value or contribution, and facing assumptions that seniors are always incompetent. Such experiences can have adverse psychological and emotional impacts, including social isolation, diminished trust in healthcare providers and negative self-perception. Sinha highlighted that although ageism may present itself universally, its impacts differ, and it “does not affect all older adults equally,” he said. Intersectionality, defined as the interconnected nature of social categories such as race, gender, age and more, can enhance the degree of ageism that a person faces, he said. In Canada, certain segments of the population are especially vulnerable, including immigrants or those born outside the country.

Narrowing in on Canada’s healthcare system, Sinha shared that healthcare professionals often hold ageist attitudes, perpetuating stereotypes that seniors lack agency and are frail, depressed or irritable. “This can ultimately manifest in undertreatment or overtreatment,” he said.

Undertreatment involves withholding resources or treatment options that would not be withheld from younger patients, while overtreatment refers to an exaggerated approach to patient care. Sinha said these issues were amplified during the COVID-19 pandemic, citing examples where older adults were denied access to ventilators due to assumptions about their life expectancies. This demonstrated the arbitrary use of age to determine life expectancy, he said, while other important health factors should also be considered.

Undertreatment is a key issue among patients with dementia – “many people in society consider dementia a normal part of ageing, but it is not,” said Sinha. He described the stigmatization faced by individuals living with dementia, which often leads to ageism in healthcare settings and subsequent undertreatment due to their condition. In cases like these, “labels can kill,” he said.

Referring to himself and his fellow geriatricians as a “rare and endangered species of physician,” as described by the New York Times, Sinha stressed the scarcity of geriatricians in Canada – only a few hundred among the country’s approximately 100,000 doctors. Nevertheless, he affirmed that “the few hundred of us have long advocated for older persons to be properly cared for in a health system that often does not adequately address their needs.” Further, he emphasized that “everyone has a role to play” in combatting ageism. This sentiment was echoed by Rochelle Garfinkel, manager of donor relations at NCJWC, who reminded the audience that “the tree planted today provides shade for future generations.”

“Eighty-five percent of the boomer generation wants their ageing experience to be different than their parent or grandparents,” added Sinha. He suggested strategies such as more comprehensive training for healthcare professionals and acknowledging the disproportionate impacts faced by marginalized groups.

In her introduction to the webinar, Linda Steinberg, NCJWC president, noted that defining the impacts of ageism will be central to NCJWC in the coming years. NCJWC is the oldest Jewish women’s organization in Canada, she said, and is currently comprised of five sections across the country’s major cities, including Vancouver.

Weinberg Residence’s 20th

Vanessa Trester, manager of the Weinberg Residence, speaks to those gathered at the 20th anniversary party. (photos by Galit Lewinski)

The Weinberg Residence has just entered its 20th year. The assisted living and multi-level care facility opened in 2003 as the city’s first Jewish residence for people who choose the round-the-clock care and companionship they might not have at home. A celebration took place Aug. 21.

photo - Sandra Bressler, who just completed her term as chair of the Weinberg Residence board, cuts the birthday cake while Vanessa Trester, manager of the residence, looks on — Sandra Bressler, who just completed her term as chair of the Weinberg Residence board, cuts the birthday cake while Vanessa Trester, manager of the residence, looks on. *(photo by Galit Lewinski)*

The Weinberg is located at the Dr. Irving and Phyliss Snider Campus for Jewish Seniors, which is also the location of the Louis Brier Home and Hospital. While the residents and staff are celebrating this anniversary milestone, plans are afoot for big changes in the years to come.

The Weinberg, which is a private, but not-for-profit, facility, opened at a time when the idea of assisted living was relatively fresh. The concept is a step between fully independent housing and supportive living – residents are able to live independently but sometimes need or desire a little assistance with things like personal care, and they enjoy the liberty of not having to cook.

The Weinberg includes a kosher dining room and special meals for Jewish holidays, as well as private dining for family events. There is 24-hour staffing, as well as a range of cultural, therapeutic and recreational activities. The Chava and Abrasha Wosk Synagogue is located on the campus, with regular and holiday services available without having to leave the premises.

The multi-level nature of the facility means it can welcome people across a large span of ages and physical needs.

“What’s really unique about the 24-hour care unit is the different residency options that historically we’ve offered within the unit,” said Vanessa Trester, manager of the Weinberg Residence. In addition to the assisted living option, there is the possibility of convalescence periods, post-surgery recovery, shorter stays, including for out-of-town guests who need support, as well as palliative support.

photo - Dr. Norman Stein, who has been a resident at the Weinberg Residence since it opened, speaks at the residence’s recent 20th anniversary party — Dr. Norman Stein, who has been a resident at the Weinberg Residence since it opened, speaks at the residence’s recent 20th anniversary party. *(photo by Galit Lewinski)*

Trends in senior living have had an impact on the Weinberg, as they have had on all such facilities. Health authorities are encouraging aging in place, with governments funding more services to keep people at home longer and out of institutional care. As a result, said Trester, residents tend to be coming to the Weinberg at a later age than they might have in times past.

“It just means people are coming later in life,” she said. People who come in their 90s, rather than their 70s or 80s, will most likely have higher needs and require additional services upon first arrival.

“We see more people who are requiring 24-hour care,” said Trester. “The longer people wait, the more their needs increase.”

The residence was built by the Jewish community, Trester stresses, who raised $11 million to make it a reality.

“We are the Jewish campus,” she said. “So there should be a lot of pride and contentment from the community.”

However, like so many other institutions in Vancouver’s Jewish community, the Weinberg and the entire Snider campus are facing dramatic changes.

The campus is located kitty-corner to the Jewish Community Centre of Greater Vancouver, whose $450 million redevelopment plan, called JWest, represents the most ambitious construction project in the history of Jewish Vancouver. Originally considered as part of that project, the 4.3-acre Snider Campus site will be revamped independently.

“There are tentative plans in place for Louis Brier redevelopment,” said Dr. David Keselman, chief executive officer of the Louis Brier Home and Hospital and Weinberg Residence. “There are assumptions of what it should be, can be and may be. It all really depends on approvals from the City of Vancouver, funding from Vancouver Coastal Health, all this kind of stuff.”

Management is in the due diligence stage, Keselman said. But even though the Weinberg Residence is far newer than the Louis Brier Home that shares the campus, both institutions are almost certain to be replaced in the future.

“The new build, of course, will be looking at going up versus horizontal,” Keselman said. “It depends on what the decisions are going to be, and approvals we get in the end, how big that building is going to be and how many beds it’s going to end up being.”

The Brier began as a seven-room seniors facility 70 years ago. It has transformed, grown and moved over the decades – and time marches on.

Timing of the redevelopment also depends on how fast approvals can be obtained, plans are finalized, costs are determined and funds are raised. “I’m going to say anywhere between eight to 12 years,” Keselman said.

Special visitors at Louis Brier

Loni the Percheron Horse comes in the entrance of the Louis Brier Home and Hospital. (photo from Louis Brier)

Loni the Percheron Horse and his side kick Beau the Shitzu visited the Louis Brier Home and Hospital the afternoon of Sept. 7. This was the third (and last) time this year that the pair visited the home.

photo - Loni the Percheron Horse's sidekick Beau the Shitzu at the Louis Brier — Loni the Percheron Horse’s sidekick Beau the Shitzu at the Louis Brier. *(photo from the Louis Brier)*

The program is designed to give residents the opportunity to have a personal experience with one of these beautiful, gentle giants – and not-so-giants – in the comfort of their own home. Horses evoke a sense of peace and tranquility, as do dogs. It is no secret that visiting with animals is therapeutic.

photo - Loni the Percheron Horse visit with residents of the Louis Brier — Loni the Percheron Horse visit with residents of the Louis Brier. *(photos from Louis Brier)*

Belief in God gives strength

Author Cheri Tannenbaum gives a talk about her book, A Woman of Few Words. (photo from Gefen Publishing House)

“Happiness is a choice,” writes Cheri Tannenbaum in her book Woman of Few Words: My Creative Journey with Dystonia (Gefen Publishing House, 2019).

No one would blame Tannenbaum for not being happy, for staying in bed, for giving up. But that’s not who she is. “From the first day of my illness to this very day,” she writes, “I wake up each morning, say Modeh Ani (the prayer said upon waking in the morning), push myself out of bed, and consciously and deliberately choose life.”

Born in Edmonton, Tannenbaum is the oldest child of Samuel (z”l) and Frances Belzberg; the family moved to Vancouver when she was 16. With refreshing honesty, Tannenbaum shares her struggles with anorexia, but also some of the ways in which she was a “happy, fun-loving, gregarious, outgoing flower child” when she was in her teens. She writes about how she became religious, and it is her strong belief in God that has buoyed her since she became ill with dystonia at the age of 20, the first sign of which was that her “handwriting suddenly became totally illegible.” As well, her voice became monotonic, and other symptoms appeared, including severe difficulties in walking and, eventually, speaking, a symptom that, very much later in life, was remedied, as the unexpected result of medication intended for another purpose.

Woman of Few Words details Tannenbaum’s life with dystonia, which, according to the Dystonia Medical Research Foundation, which was founded by her parents, “is characterized by involuntary muscle contractions and spasms.” She openly talks about the time she attempted suicide and the difficulties she had in having children. She offers thoughts on living with the illness and lessons she has learned, as well as several pages on dystonia and many inspirational quotes from various sources.

Tannenbaum has a bachelor’s in psychology and a master’s in human development. She has followed her passion – art – in more than one creative direction. She has a long-lasting marriage, three children, grandchildren, and family and friends who care about her, and she has lived in several places in the world, making her home in Efrat, Israel. As she writes, “Dystonia is not my essence, nor does it define me.” It does, however, present many challenges.

“If I didn’t have the belief that there is an all-loving, all-powerful G-d who runs the world and has a master plan, then all challenges are just random; things that happen are just occurrences coming from nowhere…. Most probably, those challenges would feel meaningless and purposeless,” she told the Independent.

Tannenbaum responds to every reader who sends her a note. “The notes I have gotten have been extremely positive, telling me how I have helped them or given them a different perspective, etc.”

She said, “If I were to have gotten only one response that I have touched one person’s soul then I have accomplished what I set out to do – baruch Hashem, I have gotten more than one.”

Tannenbaum’s mother shared some of the ways in which her daughter’s illness affected the family.

“Cheri’s illness was slow in showing itself so, at first, her tripping or falling or dropping things was almost a joke for her siblings,” said Belzberg, who has three other children. “I took her to our family doctor, who said it was just teen angst, then that it was physiological, so she saw a psychiatrist, who said she was fine, so back to the GP.

“As her condition became worse, I began shopping for different kinds of medical advice locally and even to Scripps Clinic in California, and still no answers.

“In the meantime,” said Belzberg, “Cheri met Harvey, married and moved to Los Angeles … and her condition worsened.”

Belzberg said it took almost five years for them to get a diagnosis and a name for her daughter’s condition: dystonia muscular deformans. “There were, at that time, three known patients,” said Belzberg. “Today, we have several hundred on this continent alone.”

With no known patients and no known treatment or cure, Belzberg said, “My husband mobilized with the help of two doctors from UCLA [University of California, Los Angeles], Dr. John Menkes and Dr. Charles Markham; we gathered about five or six known neurologists from across the U.S. and began to do research. Meetings were set up for every two weeks and both my husband and I monitored the meetings between the experts … with the whole purpose of finding everything there was to know about the disease and how to treat it.

“Word got out that this was being addressed and there was more interest from within the research community,” she said. “We got a grant from the NIH [National Institutes of Health], plus our own … financial support, to establish ourselves, and began a series of research conferences with different doctors with different specialties. That was almost 40 years ago and, this June, there will be the Samuel Belzberg 6th International Dystonia Symposium in Dublin, Ireland, the latest in our international annual meetings.

“Through our persistence, as parents, we have created an international research body with a large patient list and researchers waiting to have their grants financed,” said Belzberg. “We also – as parents and ones who are crucially and emotionally involved – started our own scientific board and monitored them ourselves. We set a precedent – no other research board that we know of allows lay people to actually participate, verbally, in the discussions as they ponder their findings.”

Belzberg noted that funding is always a concern because dystonia “is not a well-known disease or a recognizable name, though we fall in the category of MS [multiple sclerosis] and Parkinson’s.”

Asked what advice she would have for a parent of a child with a chronic illness, Belzberg said, “Every family has to deal with their own crises emotionally, spiritually, within their own strengths, and persist in finding answers. Chronic illnesses can be very wearing both for the patient and the family, so it takes a great deal of tolerance and understanding on the part of each to make it through the day.”

For someone who just found out they have a chronic illness, Tannenbaum said, “I would first give them a big hug and sit with them, hold their hands and just listen to them vent – how they feel about the diagnosis, their anger, their fear, their hopelessness, their ‘why me?’

“When they would be ready to hear me, I would tell them that there is a G-d, master of the universe, who loves you more than anyone else loves you in the whole wide world. Everything G-d does is for the good, even though I know it doesn’t feel that way right now. This is a test that G-d knows you can pass; otherwise, He wouldn’t have given it to you…. This is an opportunity for you to grow and to bring out your hidden potential and strengths that you never knew existed within you. Through this test, you can create miracles. Through this test, you can bring good and G-d into the world. Depending on your attitude and perspective, you will be able to help and change other people’s lives. This test is bringing you farther along to fulfilling the potential that only you can do.”

Life with inherited trauma

Dr. Gita Arian Baack, author of The Inheritors: Moving Forward from Generational Trauma. (photo from Gita Arian Baack)

Dr. Gita Arian Baack, author of The Inheritors: Moving Forward from Generational Trauma, was in town earlier this month to speak at the Cherie Smith JCC Jewish Book Festival and hold a three-day experiential workshop with the Second Generation Group in Vancouver.

The Ottawa-based counselor began her festival presentation with a quote from the late Israeli novelist Amos Oz, who wrote, “Our past belongs to us, but we do not belong to it.” For Baack, the quote underscores her message to inheritors of the Shoah – that “we were given life and an obligation to bear witness and honour the martyrs and heroes of the Holocaust. And that we also have the right to live full and joyful lives.”

“Generational trauma stems from devastating events which transpired before we were born,” Baack told the Independent. “In the case of the Holocaust, we have experienced it from birth; it is as if we were there. We carry an unrelenting sadness, sense of absence and betrayal.”

The ultimate question her book explores is: “How can we live a full life despite the difficult trauma we inherited?”

Prior to writing The Inheritors, Baack conducted doctoral research into the subject of intergenerational trauma and resilience, yet what she uncovered did not fit or go deeply enough into either. Often, resilience is described as bouncing back with support from others. But, she said, “You don’t bounce back from the Holocaust!”

She was resolved to unravel answers to these and other questions, such as why are so many of us resilient and compassionate despite our inherited trauma? Do we carry memory from one generation to another? How do we move forward, when the usual therapies for trauma have proven not to work for us?

“We are also faced with the difficulty of piecing together our family stories,” said Baack. “Much of our family stories are full of holes, unknowns and even secrets, our roots destroyed. Understandably, we have strong emotions but don’t know how to deal with them; for example, excessive sadness, fear of authority, worry, lack of trust, lack of safety, etc.”

Further, inherited trauma is often frozen, embedded in the brain stem, also known as the primitive brain – accessing it is difficult, but it can be done, she said.

Baack noted that ancient wisdom, the Bible and new epigenetic scientific research explain that trauma is passed onto generations in the DNA, and even the cells, for as many as seven generations. She strongly believes that this is the case if it is acknowledged and processed; if it is not, then it can take longer than seven generations.

Though Baack’s own experience is being a child of Holocaust survivors, The Inheritors encompasses others who have been victimized: Canada’s indigenous population, survivors of the Rwandan genocide and of several other horrible episodes of recent history. The book also looks at trauma on a personal level, from those who have suffered as a result of natural disaster, an accident, economic hardship, the justice or education system, illness or loss of a loved one.

The intent of The Inheritors is to serve as a tool for moving forward, said Baack. The book is filled with dialogues, poetry and stories from people of different backgrounds. Readers are invited to explore their story, and there are questions at the end of each chapter to help them process that story and, in so doing, transform their pain. At the least, in the end, they will have a written story as a legacy to their descendants.

The Inheritors has had other, unexpected, impacts. For example, the conductor of the North Carolina State University orchestra commissioned composer and flutist Allison Loggins-Hull to write a piece for an upcoming performance and she has chosen to write a work inspired by the book – Inheritors Overture will première on April 5 in Raleigh, N.C.

The group dialogues that Baack conducts offer a means of validation through other people with similar experiences and various experiential tools that can help further a deeper exploration of their trauma stories, the “undiscussables” and the unknowns. Group participants, she said, are often surprised by the creativity, laughter and camaraderie that arise.

The Inheritors is dedicated to (and inspired by) Baack’s two half-siblings. “From my earliest beginnings, I remember carrying a great sadness for my siblings, Henush and Halina Arian, who were only 4 and 3 years old, respectively, when they were killed,” she writes. There was no information about the circumstances of their death or burials, “But their existence was real and has mattered to me in an extraordinary way. And so I don’t fight the sadness; I embrace it. It has a special place. I am the carrier of their memory. This burden is the most cherished of all my burdens.”

At the age of 4 or 5, Baack had what she describes as a “knowing” or “inherited memory.” A “felt sense” told her, even at that young age, that her siblings, two of 1.5 million children killed by the Nazis, had both been shot in the back. When she asked her father how her half-siblings died, he said he didn’t know. Nonetheless, the memory (and feeling) she had inherited persisted, and could be placed on a spot in the middle of her back, with a knowing that her half siblings had been shot in that place.

Her research revealed that the timing of their deaths was before gas chambers had been built, and children under 5 were regularly shot. In 2019, a tour guide in Krakow pointed to the very street where the children and their mother were shot. To Baack, it was a stunning confirmation of her lifelong memory.

Baack has been consulting and coaching individuals and organizations for more than 30 years. She recently founded the Centre for Transformational Dialogue to help individuals and communities that have inherited devastating legacies. She also has written a book of verse, Poems of Angst and Awe, published in 2017.

For more information, visit gitabaack.com. Baack continues to research inherited memory and wishes to hear from others on the subject. She can be reached at [email protected].

Sam Margolis has written for the Globe and Mail, the National Post, UPI and MSNBC.

Using apps and robots – coronavirus

One high-tech solution for patients possibly infected with the coronavirus is a robot that can enter the patient’s room and be controlled by medical staff from the outside. (photo from IMP)

Before the coronavirus arrived in Israel – there were two reported cases at press time – Sheba Medical Centre was preparing for it with different high-tech means: a telemedicine app that enables patients to receive care in the isolation, but comfort, of their own home; and robots that can treat in-hospital patients in order to minimize contact with staff.

Sheba’s Datos Health-In is a telemedicine app that enables patients to remain at home. In the event of an epidemic, with more patients than isolation rooms available, the app can be a viable tool for patients who are not severely ill. With the app, patients can enter vital signs and other information, which is directly accessed by their doctor. Patients can also establish contact with their physicians at any time of day or night.

The program was launched on Feb. 9 and tested on Israelis who had been in China and who, according to Health Ministry instructions, had to be in quarantine for 14 days, the incubation period of the virus. Doctors initialized contact with the patients twice a day.

photo - Sheba Medical Centre’s Dr. Galia Barkai — Sheba Medical Centre’s Dr. Galia Barkai *(photo from IMP)*

“This is one instance where telemedicine protects staff as well as other patients, by minimizing direct contact with those infected with the coronavirus,” explained Dr. Galia Barkai, head of telemedicine services at Sheba.

Another high-tech solution for patients possibly infected with the coronavirus is a robot that can enter the patient’s room and be controlled by medical staff from the outside. Designed by California-based virtual healthcare company Intouch Health, the robots are already in use in other departments, such as in the intensive care unit of pediatric cardiology, and the trauma unit.

“This technology is the perfect solution to provide care for in-patients infected with coronavirus, while protecting staff from contagion,” said Barkai.

Screening for the virus produces results in just a few hours but, with symptoms that are not very dramatic and that are reminiscent of the flu, including fever, cough and shortness of breath, Israel’s Health Ministry is only allowing those who have returned from China and a few other countries in the Far East to be tested.

– Courtesy International Marketing and Promotion (IMP)

Treating children’s asthma

Dr. Allan Becker has devoted much of his life’s work to the study of asthma and how it affects children who have it. (photo from Allan Becker)

As Jewish community member Dr. Allan Becker was starting his career as a general practitioner, his daughter was diagnosed with asthma. As a result, he has devoted much of his life’s work to the study of the condition.

“My interest really started when my oldest daughter began having a wheezing episode at about two years of age,” Becker told the Independent. “It was pretty obvious that this was an infection – something we call bronchiolitis, which is fairly common in young children.”

Becker was working in Dauphin, Man., at the time of his daughter’s diagnosis, in the 1970s, and was beginning to see more and more kids with asthma coming into the emergency room.

“Since 1980, when I returned to academics, I’ve been trying to understand why the epidemic started – what the developmental origins of asthma and allergies are,” said Becker, who is now based in Winnipeg. “And, really, they’re the canary in the coal mine when you think about the increase in chronic diseases.

“Asthma is by far the most common chronic disease in children and it’s the earliest to start,” he said, “but we’re seeing parallel increases of other chronic diseases, like diabetes, inflammatory bowel diseases, various forms of arthritis, and others.”

Over the course of a five-decade career, so far, Becker has seen chronic diseases become more prominent. And, while the reasons for this change remain elusive, it seems clear that it involves genes and the environment.

In the early 1990s, Becker and Vancouver-based Dr. Moira Chan-Yeung embarked on a study of ways to potentially prevent the development of asthma.

“Think about the environment in terms of things we breathe and eat … and things like pets in the home, like tobacco smoke exposure, like pollution, like bad nutrition, Western-style diets, etc.,” said Becker. “We started a multifaceted prevention of asthma program in 1994.”

While that study did not reap substantial results, it did eventually lead to a current study examining the environmental impact on expectant mothers in all areas, including the benefits of decreasing stress, which Becker feels may be the most important factor.

Information about the study, called Canadian Healthy Infant Longitudinal Development (CHILD), can be found at childstudy.ca.

“CHILD started in 2008 and is an observation study, because we don’t believe we know enough to prevent the disease as yet,” said Becker. “We’re now seeing the children at 8 and 9 years of age, and we’re looking way more broadly at the environment. We’re looking at stress very specifically, both for parents and children.

“We’re looking much more in terms of diet, but also at the microbiota, the bacteria and other organisms that live in us, with us and on us, and which are likely extremely important – maybe critical – in helping to shape children’s immune responses in early life.”

According to Becker, there are more bacteria in our gut than there are cells in our body, and microbiota are now being considered as the cause of and potential cure for all sorts of illnesses.

One of the biggest hurdles is trying to determine if a young child who is wheezing has asthma and should be treated as such, or if the child has a respiratory infection that causes wheezing. Becker said part of the problem is how to more accurately define wheezing, which is described as a whistling noise coming from the chest.

“The key thing is that it’s not just the whistling noise in the chest,” said Becker. “It’s also that tugging in, particularly tugging in under the ribs, with the tummy pulling in when breathing. That’s a very good indication that those airways are narrowed and that the child has to work hard at moving air, particularly moving air both in and out. That’s what we teach our trainees to work on with the families they see.

“And, obviously, any time a child is distressed – if they’re looking distressed, particularly if there’s a change in colour of the lips – those are urgent issues. And, some children have such severe narrowing of the airways that you don’t hear wheezing, because they’re not moving enough air, but they will be struggling to breathe. You’ll see them pulling in their tummy and you’ll see their shoulders heaving,” he said. “And you’ll often see toddlers and older kids with their hands braced on their knees, hunched forward, trying to get air in. That type of tripoding is really a worrisome sign, as is a change in lip colour – that’s an emergency. Those children need to be brought to emergency quickly.”

If it gets to the point that the child is given inhalers, Becker pointed out that blue puffers are for particularly bad episodes, while orange or red puffers are for management.

For a bad episode, he said, two inhales from the blue puffer should be taken. “An inhalation and a bit of a pause, and then a second puff and inhalation … in many cases, that will be enough to help control things,” said Becker. “If it doesn’t help make things better, then, in five to10 minutes, it should be repeated. If the child is still distressed, that’s an indication they need to be brought to a hospital.”

The blue puffer should not be used for asthma management, he warned, as the body will develop resistance to it. So, if the controller medications are not providing enough control, he said parents should talk to the doctor who prescribed the puffer to determine a solution.

“If people are needing to use the blue puffer on an ongoing basis, even once or twice a week, week after week, that’s really telling you that you don’t have control of what’s going on and is very worrisome,” said Becker. “There should never be a death from asthma. But, sadly, every year there are some. And, these deaths are – rather surprisingly – not necessarily in kids with the most severe, persistent asthma; they’re in kids who are thought to have mild asthma. But, in fact, when you look at it, if you are using the blue puffer and need to get a new one every month or two, that’s a big red flag … needing to use the blue puffer in the middle of the night, that’s a big red flag. Nighttime symptoms are really a worry – those are kids who need to be seen and properly assessed and, in most cases, they need to be using controller medication.”

Becker is proud of having led the development of a national certification for asthma educators in Canada – Canada was the first country to provide this type of certification.

“We have a children’s allergy and asthma education centre in Winnipeg attached to our children’s hospital,” he said. “It’s one of the only real free-standing ones in North America. The website is asthma-education.com.”

Rebeca Kuropatwa is a Winnipeg freelance writer.

Camp helps lift spirits

A moment of levity during the taking of Justine and Stewart Silver’s wedding photos. (photo from Justin Silver)

The late Stewart Silver was born and raised in Montreal. He had worked as a standup comedian, and moved to Toronto in hopes of furthering his career. Justine Silver grew up in a Houston suburb. In late 1990, she followed her sister, who had moved to Toronto, and, there, she joined Jewish online dating site Jdate. So had Stewart.

“There was a thing where you had to describe your perfect date,” recalled Justine. “Profile after profile included long romantic dinners and were all gushy and gross … but his said, ‘Yeah, after we grab a drink, we step out of the restaurant and trip over a big bag of money.’ I was like, ‘Oh my gosh … that’s the perfect date!”

The couple took their time getting to know each other and, after a year and a half, got married.

To all appearances, Stewart was a healthy 44-year-old. He had biked up hills in Christie Pits Park the day before he had a fatal heart attack while the couple was having a conversation on Nov. 16, 2011.

Left shocked and widowed, Justine embarked on a healing path, including taking a hiatus from her event-planning business.

“It’s been quite some time since then and there’s been grief bursts,” said Silver. “In the early days, there was a lot of therapy and some peer support groups. Then, I found Camp Widow and have been to a few of those. I was pleased it wasn’t at all associated with any religion and was welcoming…. There was one in Tampa, and so a couple of widow friends that I had met up with, here, in Toronto, in a peer support group for young people who’d lost their spouses under the age of 55 … decided to make a whole trip of it. We went to the beach, museum, and then to Camp Widow. It’s a very transformational experience when you feel that you’re surrounded by people who understand the topsy-turvy world that you’re starting to barely understand yourself.”

The first camp Silver went to, in Tampa, was in the spring of 2018. Then, in November 2018 and November 2019, she attended the camps in Toronto. She and her friends have already signed up for the next November 2020 camp in Toronto.

While it’s called a “camp,” the weekend is more like a conference, with people coming together for sessions on various topics.

“One of the neat things I like at Camp Widow is that the name tags, everyone has one, but there are a couple features to it,” said Silver. “One of them, there’s a ribbon at the bottom. For example, in my work as an event planner, if you’re a presenter, your ribbon will say ‘presenter,’ or, if you’re on the organizing committee, it will say ‘organizing committee’ or ‘volunteer.’

“But, these [also] have the number of years ago that your loss occurred. So, for me, that was six years. So, let’s say it’s a teal ribbon. All of a sudden, you notice the six-year people … and there’s a bond, because you’re in a different place than, say, the six-month people. Everyone is compassionate to everyone else, but it’s just a really interesting way to bond with people.”

As far as the camp schedule, there are some group meals, as well as meals on your own. There are various types of sessions offered.

“There are tracks, like for people who are five years out, one year, or one to five,” said Silver. “I can’t remember the exact breakdown, but you can decide to go to everything along a certain track, or you can decide in the moment what you’ll do, which sessions you’ll go to. Then, there are some networking evening events, different ways of getting to know people.”

One is designed like speed-dating, but not for that purpose. You get the chance to talk to someone for a certain amount of time, and then you move on to the next person and chat with them. “It’s really interesting to see where the commonalities fall,” said Silver.

On Saturday night, there is a banquet with a theme and people dress up – some participants may not have gone out since their loss. After dinner, each person says the name of their loved one out loud, while some 200 others quietly listen. Then, there is a dance, which gives the opportunity to destress and socialize. The DJ doesn’t play any music that could potentially trigger anyone’s grief, like slow songs.

At the camp, there are people from their mid-20s to people in their 70s and 80s; people from all religions, cultures and political leanings.

For Silver, Camp Widow “creates community and support amongst widows and widowers…. Sometimes, when you’ve lost someone, it can be very isolating, which can be in different and unexpected ways. I wouldn’t say never, but it doesn’t go away. The intensity definitely lessens and you find new ways to live with grief. And there are plenty of people who, we say, are ‘re-partnered.’ When you’ve been widowed and then you meet someone else and you have a boyfriend/girlfriend, wife/husband or partner, we say you’re ‘re-partnered,’ because we don’t think that means you’re not still widowed.”

The camp provides tools and connections that widows and widowers may not otherwise find on their own.

“I feel camaraderie in sharing my story and being heard, or hearing someone else’s story and being helpful to them,” said Silver. “At this past Camp Widow, I did an art thing. I can do crafty things OK, but I’m not really an artist. But, one of the workshops I went to was all about healing through art and it was just a whole different facet. We all had paint and they set it up so well…. We had a white piece of paper and I got white paint and I painted a white heart. Then, I put a line through it – a squiggly line, like it was broken – and you could barely see it … like you couldn’t see that my husband had a heart problem…. Then, everyone shared in the room what theirs was about. When you do that, it’s like opening up a wound, and then the scar heals better next time.”

Six months ago – eight years into her healing journey – Silver and her older sister, Eileen Jadd, who is a social worker, started the charity Good Grief Bereavement Healing Services.

“We have a roster of counselors in different parts of Toronto for bereaved people,” said Silver. “We’re also offering workshops on eye movement desensitization, which is a thing for trauma victims. It really helps you compartmentalize the trauma, so you can talk about it without being retraumatized. So, we’re doing a workshop on that.

“We’re starting a group on sibling loss and, eventually, will have a physical building. We want to have a centre, so people who’ve lost someone, it’s like a snap of the fingers and they’ll know where to go. When you know there’s an accident, you know to dial 911. We want it to be, ‘Wow, you’re in need, you’ve lost someone, and you know exactly where to go.

“I think widows and widowers need their person’s name to be said. People are so afraid of saying it, because they don’t want to bring it up in fear. But, they want their names to be said, so that’s a big part of it. I happen to talk about Stewart all the time, but a lot of people don’t have those opportunities in their own lives.”

In addition to talking about him when memories arise, Silver said, “Every year, I go to shul and I say his name and a prayer for him, and commemorate it that way. I remind people that we got married in that synagogue, and I remind people that he was a person that existed and stood in that space with me, and that his influence is still there. Just because he’s not standing next to me in that moment … he’s still there. In those ways, we talk about him.”

Camp Widow is put on by Soaring Spirits International. For more information, visit soaringspirits.org, campwidow.org, widowedresilience.org and goodgriefhealing.ca.

Rebeca Kuropatwa is a Winnipeg freelance writer.

Predicting diabetes risk

A new computer algorithm can predict in the early stages of pregnancy, or even before pregnancy has occurred, which women are at a high risk of gestational diabetes. (photo from Weizmann Institute)

A new computer algorithm can predict in the early stages of pregnancy, or even before pregnancy has occurred, which women are at a high risk of gestational diabetes, according to a study by researchers at the Weizmann Institute of Science.

The study, reported recently in Nature Medicine, analyzed data on nearly 600,000 pregnancies available from Israel’s largest health organization, Clalit Health Services.

“Our ultimate goal has been to help the health system take measures so as to prevent diabetes from occurring in pregnancy,” said senior author Prof. Eran Segal of the institute’s computer science and applied mathematics, and molecular cell biology departments.

Gestational diabetes is characterized by high blood sugar levels that develop during pregnancy in women who did not previously have diabetes. It occurs in three to nine percent of all pregnancies and is fraught with risks for both mother and baby. Typically, gestational diabetes is diagnosed between the 24th and 28th weeks of pregnancy, with the help of a glucose tolerance test in which the woman drinks a glucose solution and then undergoes a blood test to see how quickly the glucose is cleared from her blood.

In the new study, Segal and colleagues started out by applying a machine learning method to Clalit’s health records on some 450,000 pregnancies in women who gave birth between 2010 and 2017. Gestational diabetes had been diagnosed by glucose tolerance testing in about four percent of these pregnancies. After processing the dataset – made up of more than 2,000 parameters for each pregnancy, including the woman’s blood test results and her and her family’s medical histories – the scientists’ algorithm revealed that nine of the parameters were sufficient to accurately identify the women who were at a high risk of developing gestational diabetes. The nine parameters included the woman’s age, body mass index, family history of diabetes and results of her glucose tests during previous pregnancies (if any).

Next, to make sure that the nine parameters could indeed accurately predict the risk of gestational diabetes, the researchers applied them to Clalit’s health records on about 140,000 additional pregnancies that had not been part of the initial analysis. The results validated the study’s findings: the nine parameters helped accurately identify the women who ultimately developed gestational diabetes.

These findings suggest that, by having a woman answer just nine questions, it should be possible to tell in advance whether she is at a high risk of developing gestational diabetes. If this information is available early on – in the early stages of pregnancy or even before the woman has gotten pregnant – it might be possible to reduce her risk of diabetes through lifestyle measures such as exercise and diet. On the other hand, women identified by the questionnaire as being at a low risk of gestational diabetes may be spared the cost and inconvenience of the glucose testing. (Visit weizmann.ac.il/sites/gd-predictor to access the self-assessment questionnaire.)

In more general terms, this study has demonstrated the usefulness of large human-based datasets, specifically electronic health records, for deriving personalized disease predictions that can lead to preventive and therapeutic measures.

The work was led by graduate students Nitzan Shalom Artzi, Dr. Smadar Shilo and Hagai Rossman from Segal’s lab at the Weizmann Institute of Science, who collaborated with Prof. Eran Hadar, Dr. Shiri Barbash-Hazan, Prof. Avi Ben-Haroush and Prof. Arnon Wiznitzer of the Rabin Medical Centre in Petach Tikvah; and Prof. Ran D. Balicer and Dr. Becca Feldman of Clalit Health Services.