The “benefits” of cancer in Israel

by Brian on February 18, 2019

in Cancer

While no one ever wants to get cancer, there are a few “benefits” to having the disease.

In Israel, they fall into several buckets: financial (discounts on taxes), bureaucratic (my HMO assigned me a medical representative to help expedite drug approvals and shepherd paperwork), pharmaceutical (it was easy-peasy to get a medical cannabis license), spiritual (our “healing holiday” at the Ritz Carlton through the Refanah organization) and physical.

The latter is perhaps best exemplified by the Yuri Shtern Holistic Care Center, which provides inexpensive touch and alternative therapies for both cancer patients and their caregivers.

Yuri Shtern was a member of Knesset who made aliyah in 1981 from Moscow. He initially joined Natan Sharansky’s Yisrael B’Aliyah party and later moved to Yisrael Beitenu. Shtern was actively involved in bringing thousands of Refuseniks to the Jewish State and founded the Knesset Christian Allies Caucus in 2004.

Shtern died of cancer in 2007. During the last year of his life, Shtern’s wife Lena organized a variety of holistic treatments which she says significantly helped improve the quality of her husband’s life.

Lena Shtern

Lena wanted to bring the same benefits to others suffering from cancer. She established the center in her husband’s name later that year, first at Sha’arei Tzedek Medical Center and later adding a clinic in Jerusalem’s German Colony.

More than a decade later, the Yuri Shtern center now draws on the experience of 142 therapists, all of whom are volunteers (they give 3 hours a week of their time). That adds up to about 900 treatments a month – or nearly 11,000 treatments a year in total. 

There’s also a 40-hour training program so the therapists can understand the unique needs of cancer patients

Treatment at Sha’arei Tzedek is free. At the clinic, there’s a nominal fee of NIS 65 per treatment. At 40 minutes each, sessions are relatively short, but that’s still a fraction of the going price in Israel for such therapy of NIS 250 and up.

Those suffering from cancer get up to two treatments a week for five years. Lena Shtern understood that caregivers need care too; they can receive two treatments a month. 

I started going to the German Colony clinic about two weeks after my chemotherapy started and took a smorgasbord approach to what’s on tap, trying out a different therapist each time. I’ve done all manner of massage (shiatsu, Swedish and Thai), reflexology (a focused foot massage with medical intent), and a kind of energy healing called craniosacral therapy. 

Also available: yoga, Chi Gong, focusing, Breema, Reiki, Feldenkrais, acupuncture and traditional talk therapy.

While I’m not a professional massage connoisseur, I have had body work all over the world. On a trip to Bali a few years ago, my wife Jody and I had a massage a day – at $7 for an hour treatment, how could we not? We even had a full day at a spa for under $50 – including lunch. 

In Bangkok, we sought out the famous massage school on the grounds of the Wat Po temple. My masseur was excellent but a bit too chatty. I think he was trying to improve his English. 

In Nepal, after hiking 11 days in the Himalayas, we treated ourselves to a massage in Kathmandu. The idea was sound but the masseuse went to town on my back and I left there achier than when I arrived. 

A massage at a 5-star hotel in India found me completely naked on a hard wooden table. No soft mattress, no pillow for my head, no towel (and no relief from pain when he dug into my shoulders). 

So how do the treatments at Yuri Shtern compare? It of course depends on the therapist, but I’ve been very pleased. When you’re feeling as rotten as I sometimes did after chemo, any touch is welcome. 

As has been getting to know the therapists. 

Some are professionals who work in the field when they’re not volunteering. Others are on second careers. For example, Ruth was a speech therapist who now does medical and Thai massage.

“No one ever said to me, ‘Wow that was amazing, I loved it’ after a speech therapy session,” Ruth told me. But that’s exactly how I reacted after her massage.

For the past few months, I’ve been returning to my favorite masseuse who specializes in deep tissue massage. One day, the appointment after me canceled at the last minute and I was offered a double session. It was hands down the best massage I’ve ever received.

The Yuri Shtern clinic is the only one of its kind in Israel. There are other organizations offering medical massage, but not with volunteers and not at such discounted prices. 

There’s certainly the need. According to the Israel Cancer Association, there are 250,000 cancer patients in the country with more than 30,000 new cases of cancer being diagnosed every year.

Sha’arei Tzedek oncologist Dr. Nathan Cherny summed up the benefit Lena Shtern has brought to the cancer world in Israel. In a video made when the clinic was getting started, he pointed out that, “Quite often patients tell us ‘we thought we were coming to the oncology department but we feel as if we came to a spa.’”

While the price to gain access to this wonderful world is steeper than anyone ought to pay, it’s been a relief to know that a break from my day-to-day cancer experience is just down the street.

I first wrote about the Yuri Shtern clinic at The Jerusalem Post.

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The SUV was right on my tail, flashing his lights and frantically marking his territory like a mean dog without a muzzle. While I’ve never been a fan of playing “chicken” under any circumstances, doing it at 100 kilometers an hour on Israel’s Highway 1 is decidedly dangerous. 

I tried to speed up, but the SUV matched my every move, getting even closer (if that was possible). I felt my pulse quicken, my skin flush, lips tighten. If I hadn’t been alone in the car, I would have let loose a string of choice curses at whomever was in the passenger seat, if only to demonstrate that I would be no freier (Yiddish for “sucker”).

Instead, I pulled over to the adjoining lane. The SUV zoomed past me, but then, in a too typical example of bad behavior, abruptly switched into my new lane and jammed on his brakes. He was going to show me who was the boss. I did the same – fortunately there was no one behind me – before the SUV sped up and was gone. 

The whole incident lasted less than a minute. But the feeling of anger, frustration and a desire to “get back” at my multi-ton vehicular bully remained with me for the rest of the trip home.

I was annoyed but not afraid of the SUV driver. Aggressive behavior behind the wheel, while sadly de rigueur in Israel, rarely ends in the kind of road rage that made headlines in 1987 Los Angeles, when five people were killed by angry drivers packing heat on the city’s freeways in the course of several months that summer.

“People are calling up from other states wondering if it’s safe to travel to Disneyland!” lamented California Highway Patrol Chief Edward Gomez at the time.

Incidents around road rage seem to fall squarely in the category of “unnecessary and avoidable.” If only drivers would tamp down their anger, our highways would be secure.

But rage in general is not only inevitable, it appears to be evolutionarily selected, says Robert Wright, author of The Moral Animal.

While “crazy things like road rage don’t seem to make a lot of sense,” Wright explained during an interview on WYNC radio, the same emotion carried a certain logic in a hunter-gatherer environment. “Rage demonstrates that you cannot be taken advantage of. Someone tries to steal a possession, a mate or whatever, you show you’re willing to fight.”

You don’t have to win, Wright added. “Even if you lose the fight, you’ve demonstrated that there’s a cost.” 

The problem is, when you take your rage out on the highway, you’re not sending a signal to anyone you’ll likely ever meet again. “They’re not living right next door to you, you won’t see them around the campfire that night,” Wright explained. 

Which is why rage has the propensity to “misfire in the modern environment,” Wright said. We try our hardest to be good mannered in our face-to-face dealings, only to see it blow up with a speeding stranger.

But if rage is an integral part of our prehistoric psyche, is there a way to “use” it in more productive ways – far from the Jerusalem-Tel Aviv highway? In the right context, can a little rage improve our relationships? Make us more productive?

Roey Tzezana thinks so. The Israeli futurist, nanotechnologist and author of The Guide to the Future, says that rage channeled correctly can fuel creativity. 

“We need to create a culture and a society where people aren’t afraid to disagree,” Tzezana says

And which country has the highest percentage of people with such chutzpah? Hello Startup Nation.

Tzezana has been doing impromptu “field research” on the role of rage while living in the U.S. for the past few years, where his wife is pursuing her doctorate. 

Tzezana recalls a party where “one Israeli got into a fight with another Israeli. It was a real shouting match. The Americans were starting to bite their fingernails. ‘Those guys will pull out their knives,’ they feared.” 

At the end, though, the two Israelis agreed to disagree. They demonstrated their rage, signaled their passions, then “shook hands and had a drink,” Tzezana remembers.

As an immigrant to Israel, it can be hard to stomach the degree of aggressiveness in everyday life here – whether that’s in the supermarket, at a concert or dealing with know-it-all bureaucrats. 

What Tzezana is saying is that the same aggression that makes me sometimes want to flee to a more “polite” country could be regarded in a more positive light. We all need to “argue more like Israelis,” Tzezana quips.

How might we get there? Tzezana has a simple way to start: ban suits and ties at conferences, he says. 

“Ties constrict our creativity. They enforce thinking in old ways, of acknowledging hierarchy. If you want to be a truly innovative society, people must be able to argue and shout at each other – without ties.”

The perpetrators of road rage don’t generally wear ties, and it can be a fine line between discomfort and ingenuity. But perhaps with a little creative rage of our own, we’ll come up with new ways to disincentive counterproductive signaling to strangers.

Rage is not an emotion we can simply will away. Nor should we want to. 

So here’s a challenge: what should we get angry about next?

I first got out my road rage at The Jerusalem Post.

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Husband: self-regulate!

by Brian on January 21, 2019

in Cancer,Mindfulness

At Hadassah Hospital in Jerusalem

My long-suffering wife has earned that sobriquet. I was a kvetcher long before my cancer diagnosis, ruminating and over-sharing my concerns. 

But now after 30 years of marriage putting up with my vocalized emotional turmoil, exacerbated by a year with the greatest health challenge of my life, Jody’s had it with the suffering. 

No, we’re not splitting up or anything drastic. But I’ve been read the riot act: “You’ve got to self-regulate, husband.”

Jody’s change in attitude started around the time I went into remission last year. 

I was already worried that sharing my “good news” would lead to a flurry of “congratulations” and “way to go” messages that didn’t address the fact that I’m just in the first part of a long treatment protocol, that I’m far from being side effect free and, as someone with a chronic and incurable cancer, I didn’t deserve any accolades about “beating” the disease. 

What I didn’t realize is how the remission would also affect Jody.

“I’m ready for this cancer to be done,” Jody said one night as I was too fatigued from my most recent immunotherapy session to get up from the couch and walk the dog.

“Yeah, me too,” I replied. 

“Maybe you can, you know, complain a little less about it?” Jody said. “It’s like your fears about the future have created this constant background music. I’m not saying you have to hide where you’re at. I know you feel crappy some times. I just wonder if you could turn down the volume a bit?”

That’s where self-regulation comes in. 

Self-regulation is the ability to keep your emotions in check, explains psychotherapist Andrea Bell on the GoodTherapy website. Someone with strong self-regulation skills “can resist impulsive behaviors that might worsen their situation and they can cheer themselves up when they’re feeling down.”

Put another way, as Arlin Cunic writes on the website VeryWell, it’s about “thinking before acting.” Or in my case, considering whether I really need to express a particular gripe out loud or if I’d be better off keeping it to myself.

Words and phrases like “postpone,” “pace yourself” and “choose what to say” can help one cultivate a more self-regulatory approach to life.

Self-regulation sounds self-evident – of course this is how we should be in the world. But it’s not something we’re necessarily born with. We have to learn it. 

Usually that happens in childhood. Toddlers who throw tantrums eventually figure out how to tolerate uncomfortable feelings without flying into a rage. However, children who don’t feel safe and secure or who are unsure whether their needs will be met, may have trouble soothing themselves and self-regulating.

I don’t know if I fit into that category as a kid, but I retain a strong impulse to verbally vent as an adult. That’s the crux of the crisis with my wife. 

I brought up the topic with my therapist.

“Any feelings you’re having are OK,” she reassured me. “It all depends on what actions you take around those feelings. Can you find other people to talk to, not only Jody?”

“You mean, like … friends?” I said in return. “Yeah, I’ve tried that in the past. It didn’t work out so well.”

I remembered how, when I used to work in Tel Aviv, I had a boss who I didn’t get along with so well. He bullied me and I was miserable most of the 3 years I worked at the company. On the long commute home to Jerusalem each night, I would call a couple of confidants on my car’s speaker phone and proceed to growl for an hour. 

Eventually my friends got burned out, as Jody was now.

“It’s not black or white,” my therapist added. “You can still share your distress with Jody. Just not all day long. Maybe delay the desire to grumble in real time and limit it to an evening check-in. Or avoid being together in the same room when you’re in a particularly vulnerable and vocal state.”

Offloading some of my anxiety to friends who also care about me could help with the balance, she suggested.

“Can they be virtual friends? On Facebook?” I asked.

“Better to get together for coffee in person,” she said. 

Such an old school approach to relationships!

The truth is, friends havebeen calling me but I’ve mostly rebuffed them, not wanting to be a burden like I was with my Tel Aviv commute buddies. Instead, I turned Jody into my safe place.

“You’re like my personal human Evernote,” I once joked to Jody. As with my favorite note taking app, I reasoned that if Jody could hold my worries, then I could let go of them for a while myself. 

I love my wife dearly, of course, and the last thing I want to do is cause her pain. So I’ll give it a try. I’ll meet up with friends. I’ll try to keep the volume down. I’ll think before I act or speak. I’ll postpone and pace.

People who are adept at self-regulating tend to “view challenges as opportunities,” writes Cuncic. They “are clear about their intentions, act in accordance with their values, put forth their best effort [and] keep going through difficult times.”

Those are all attributes worth aspiring to. Maybe getting cancer will be the trigger that helps my wife to no longer be so “long-suffering.” 

Perhaps the same will be true for me. 

Jody first read me the riot act at The Jerusalem Post.

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Correction: “Waiter, there’s a fly in my soup.” “Sshh, don’t say anything or everyone will want one!” That’s meant to be funny, of course, but my misrepresentation of Rabbi Aaron Leibowitz’s fly-in-the-soup story in “Judaism’s honesty problem” was serious business. As several readers have pointed out, a fly floating on the surface wouldn’t have made the soup treif once removed. In his talk, Leibowitz spoke of a fly lost in the pot. I apologize for the error.

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Judaism has a fundamental problem with honesty and it’s driving the Jewish world apart.

That was the take-away from a challenging talk by Rabbi Aaron Leibowitz, the conclusion of a six-part series on “Jewish Life, Halacha and our Changing Reality” held at the Pardes Institute of Jewish Studies in Jerusalem.

Leibowitz is an Orthodox activist and provocateur. He started the private kosher certification organization Hashgacha Pratit to break the Israeli rabbinate’s monopoly on kashrut in 2013 and is now heading up a new initiative called Chuppot that marries couples according to Jewish Law but outside the auspices of the rabbinate.

It’s not surprising, then, that to illustrate the extent of Judaism’s honesty obstacle, Leibowitz brought two examples from his own confrontations with Israel’s ultra-Orthodox-controlled rabbinic establishment.

Story #1: A restaurant under kosher supervision has a special soup on its menu. Just before the evening rush, a very large fly makes an ill-advised dive into the big soup pot in the kitchen, where it is incapacitated, sinking deep into the creamy broth.

Once he is made aware of his bug bogey, the restaurant owner faces a dilemma. If he throws the soup out, as it is may no longer kosher, he risks losing hundreds of shekels of business. Leibowitz explained. But if he serves the soup, he could be causing kosher patrons to unwittingly sin.

The restaurant has a kashrut supervisor, but he mainly stops by once a month to pick up his check, providing no real inspection or guidance. This situation annoys the owner who doesn’t understand why he has to pay so much for a service he isn’t really receiving.

The relationship became even more antagonistic in the previous few months when the supervisor demanded a pay hike without any corresponding increase in visits. Kashrut supervisors in Israel are paid directly by the restaurants, not the rabbinate, creating a clear conflict of interest.

The owner doesn’t have any incentive to reach out to his never-there inspector, and the supervisor doesn’t really want to know, as it would entail more work on his part or – heaven forbid – the restaurant might be shut down, jeopardizing his easy money job.

Story #2: When someone decides to get married in Israel, the rabbinate requires proof of his or her Jewishness. Conversion is sometimes required.

Leibowitz shared the saga of a bride who needed to convert but was assured by the rabbinate that, in her case, it was just a formality and she didn’t have to take the lengthy conversion course required of other brides and grooms.

The day of the wedding was fast approaching, but the rabbinate still hadn’t set a time for the bride to immerse in the mikveh. Finally, just two days before the chuppah, this final step in the conversion process was scheduled.

At the mikveh, one of the conversion rabbis asked the bride if she intends to keep all of Jewish Law. She answered truthfully: “no.”

The rabbi looked puzzled and asked again. “Will you keep the halacha?” The bride responded “no” a second time.

“Well, we cannot convert you until you take the full conversion course,” the rabbi told her. “You can apply again in a year.”

What did the rabbi want to hear? That, yes, the bride would keep all 613 commandments, even if she knew – and everyone else knew, too – that she wouldn’t.

“They wanted her to lie!” Leibowitz cried, pounding his fist on the lectern.

How did we get to a situation where dishonesty is baked into the relationship between “client” and “service provider?” Why don’t the bride and the restaurant owner have a rabbinic ally to whom they can turn to solve problems, rather than cover them up with a wink and a nod?

It stems from economics, Leibowitz explained. The rabbinate has, for most of its existence, had no competition. And when clients can’t take their business elsewhere, there’s no impetus to improve.

Leibowitz is passionate about breaking what he described as a government-sponsored religious services monopoly. He did it first with Hashgacha Pratit, which created the first real alternative for standalone kashrut certification.

The program, which started with just a couple of restaurants in Jerusalem, was so successful that it was taken over earlier this year by the Orthodox but liberal Tzohar organization, which now supervises 110 restaurants, pubs, hotels and catering businesses and, significantly, flips the business model so that it’s Tzohar, not the restaurants, paying for supervision.

Leibowitz’s newest initiative, Chuppot, is technically illegal: a law passed in 2013 imposes potential jail time on both the couple and the officiating rabbi if a marriage ceremony is conducted outside of the rabbinate – although Leibowitz says the law’s language is so vague, he’s doubtful it could ever be enforced.

In the meantime, Chuppot, which is headed by Rabbi Chuck Davidson, has already conducted 89 weddings since it was established in July 2018, and is on track, Leibowitz said, to perform 200 ceremonies in its first year.

Since the rabbinate lost their monopoly on kashrut and with the pressure Chuppot is putting on them with weddings, “they’ve become 100 times more user-friendly to the public,” Leibowitz said.

Will that mean fewer tearful brides driven to despair two days before their weddings? No more flies surreptitiously skimming our kosher soups?

“I think we’re going to win,” Leibowitz said at the conclusion of his talk.

In the competitive marketplace of ideas, creating a climate for honesty to flourish really is the best policy.

I first wrote about Rabbi Aaron Leibowitz’s rabble rousing at The Jerusalem Post.

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Defining Courage

by Brian on December 24, 2018

in A Parent in Israel,Cancer,Science

The Merriam-Webster dictionary describes courage as “the ability to do something that frightens one.” I’d give it a slightly different definition.

Courage for me, as I’ve discovered over the past year coping with chronic cancer, is not about choosing to jump out of an airplane or bungie jump off a bridge near Katmandu. Rather, it’s doing something you really don’t want to do but know you have to.

It was courage I needed when my next immunotherapy appointment came close.

I finished four months of chemotherapy for my follicular lymphoma earlier this year and am officially in remission. Now I need to go in every other month for an IV of biologic “maintenance” treatment to keep the cancer at bay for as long as possible. I’m supposed to do this for two years. It’s not as bad as chemo, but it still comes with side effects.

As the day approached, I became acutely aware of my resistance to going back under the needle. Part of that was just not wanting to feel uncomfortable – not so much the hospital visit but the fatigue and aches and pains that come after. Part was that each trip to the hematology daycare ward reminds me that I have a chronic, incurable cancer that will be with me for the rest of my life.

But there’s also a lingering uncertainty about whether maintenance treatment is worth it.

According to Dr. John Leonard, a lymphoma specialist at Weill Cornell Medicine in New York, only 16 out of 100 patients will see an improvement in PFS (that’s “progression free survival,” the number of years before the disease returns) as a result of the kind of maintenance immunotherapy I’m supposed to be getting.

“Moreover, it makes no difference in overall survival,” Leonard adds. He advises most of his patients these days to skip maintenance and simply “re-treat” when necessary – even if that’s sooner than it might have been if you’re in the lucky 16 percent group.

Dr. Jonathan Friedberg, chief of hematology-oncology at the University of Rochester Medical Center in Rochester, New York, puts it more plainly. “Maintenance therapy is probably over-treatment.”

I asked my own doctor at Hadassah in Jerusalem. She admitted that “we really don’t know what maintenance therapy does or how,” but she still recommended it. “Sixteen percent is not insignificant.”

As my appointment became imminent, I tried to think of other examples of courage that fit my definition, to see whether any of those might provide clarity for the decision in front of me.

The first thing that came to mind was perhaps the complete opposite of healing: war. No sane person ever wants to go to war, but sometimes you have to do it for the health and survival of your nation.

Divorce also is a form of courage. Resistance to this kind of major life change can be overwhelming, but if you’re in the wrong relationship, you know deep down that sometimes the only way to get healthy again is to get out.

Making aliyah takes courage, as well. My wife, Jody, and I planned our immigration to Israel for seven years. Making a life in the Holy Land was part of the shared values we brought to our marriage.

But when the time finally came to move, I kept delaying. My career was in full swing: I had a great job at a software company, I was teaching at San Francisco State University, I’d just finished a term as president of an international professional association. We had friends, community, two cars and savings.

I knew that aliyah would be the healthy thing for our relationship, for our children, for the Jewish people.

“Making these kinds of monumental decisions takes a special kind of faith,” a friend once told me.

“Faith is not something I’m big on,” I joked in return.

“Then call it a ‘leap of faith’ – making an important choice with imperfect information. Gather data then reevaluate. If it doesn’t work out, you can always go back.”

Melanie Greenberg writes in Psychology Today about six kinds of courage: feeling fear yet choosing to act, following your heart, persevering in the face of adversity, standing up for what is right, letting go of the familiar, and facing suffering with dignity or faith.

At least four of those six are part of my personal definition of courage. (You guess which four.)

In the end, though, it was not my cognitive deliberations, an appeal to faith or a pithy article in a pop psychology journal that shone a light on how I should decide.

It was an episode of the TV show “This is Us.”

One of the main plot points of the popular NBC series is that the father of the family dies when his kids are teenagers. The harrowing experience of losing their father at such a young age impacts much of how they live as adults.

My own kids are all in their 20s but that’s still young enough that I wouldn’t want to bequeath to them any avoidable trauma.

Sixteen percent may not sound like a lot statistically, but I owe it to my family to do whatever I can to stick around as long as possible.

I might feel like crap, temporarily at least, but I know, too, that my long-term health and the health of everyone around me depends on me mustering up that courage – however I define it.

I first defined courage at The Jerusalem Post.

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My problem with Maoz Tzur

December 9, 2018

Do those who live their lives according to a strict reading of the biblical narrative have a greater propensity to seek revenge?

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Surprise me, Moshe Lion

November 26, 2018

Jerusalem has a new mayor. I desperately want to see the good in Moshe Lion. But I’m up against “the negativity bias.” Can I be surprised?

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The best-laid plans

November 11, 2018

“Let’s plan a party,” she said. “I’m not out of the woods just yet,” I replied. But my forest is looking healthy overall – even if some of the trees need extra care.

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“You look good”

October 28, 2018

What do you do when the way you look on the outside doesn’t match how you feel on the inside? It comes up all the time with chronic cancer.

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Religion as complementary medicine

October 15, 2018

I’ve been looking at religion all wrong. Does religion need to make sense rationally? Or is it more like complementary medicine – a cultural placebo?

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