The mobile MRI truck in Beer Sheva

Following the unexpected clean bill of health I received from my “shocking” EMG test a few weeks ago, the search for the cause (and cure) of my sciatica continued last week as I underwent an MRI (magnetic resonance imaging) test. My doctor’s suspicion is that I have a problem on the L5 disc of my spine (whatever that means) and only an MRI can determine conclusively the next course of action.

Of course, scheduling an MRI through an Israeli HMO at any time in, say, the same calendar year is a task that even a young David would defer to Goliath. Hadassah Hospital in Jerusalem would be glad to book me an appointment, they told me…for April 17 at 4:00 AM.

My crafty wife, however, has learned – through unfortunate experience (securing a doctor to look at our daughter’s knee) – how to work the system and found an innovative solution: I would do my MRI in Beer Sheva at the “mobile MRI.”

Apparently, there is a trailer truck outfitted with an MRI machine that travels around the southern part of the country, parking itself for a week at a time in Beer Sheva, Dimona and Eilat. They had an opening – just one week away from the day we called – at an entirely reasonable time (1:00 PM) rather than in the middle of the night. We booked it and I psyched myself up for a pleasant drive into the metropolis of the desert.

To be sure, the MRI-on-wheels is a fully functioning piece of equipment. I can’t say as much for the nurse who needled my arm to open the infusion port that would pump radioactive “contrast” dye into my veins during the procedure. I had a feeling she wasn’t the most experienced nurse in the Negev as she repeatedly tapped my veins searching for the best one.

When I got to the MRI machine and lay down on the table, the doctor quietly scolded the nurse before turning to me to say that they’d have to open a new vein in my other arm (“just to be sure,” he assured me).

As for the MRI itself, if you’ve never had one, it’s an entirely alien experience. You place your head into a secure brace, don noise-canceling headphones and then lie perfectly still on your back for, in my case, about 25 minutes. Nothing spins on the MRI (unlike a CT scan) but there are a variety of noises – whirs and clicks and clunks – as the machine uses large magnets to look inside the nuclei of my atoms.

I passed the time by trying to match the sounds with intros to songs. One rhythmic beat sounded deceptively like the Beatles’ “Getting Better All the Time”; another clearly had the low-tech industrial warble of a Brian Eno solo composition; a third reminded me of the Steve Reich piece “Different Trains,” which played in Jerusalem last year.

I was in and out in just over an hour – perhaps because this was a “single task” facility, the mobile MRI staff were highly efficient. I was back in Jerusalem in time for a late lunch.

Now that the MRI was taken care of, I called up my HMO to schedule a follow up appointment with the back specialist. Yes, they would be glad to reserve me a slot with the doc. He has time on May 28. At least it was in the same calendar year.

Maybe I should see a back specialist in Beer Sheva too.

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The new guy

And, like Fischer, Levin also speaks Hebrew, not however, as well as Fischer; not yet, that is.

What Teva is known for...

Of course, it’s a fairly major deal to become the chief executive of Teva, which has become one of the world’s largest drugmakers. But nice to know they also require their chief to be a local.

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NCV shock therapy

I’m not sure what was worse – the over-sized needles stuck into my leg or the electric shocks.

Some background: about six months ago, I developed pain and numbness in my right leg. At first I tried to ignore it, imagining it just some strange runner’s pain, but when it didn’t go away, I stopped my exercise routine and went to my family doctor. He referred me to physical therapy which, when after three months of treatment, nothing helped, referred me to an orthopedist, who in turn referred me to a test called an EMG.

EMG stands for an “electromyogram”; it’s designed to detect abnormal muscle electrical activity. The orthopedist didn’t want to go forward on something major – surgery, cortisone injections – until he ruled out some sort of nerve damage.

An EMG is either a very popular test or they don’t conduct it very often; I had to wait a painful three months for the test which I finally did this morning.

How do they detect that abnormal muscle electrical activity? By sticking needles in the affected area and asking you to push against the doctor’s hand or the table as hard as you can. A machine next to the table translates your efforts into the noise of some alternative universe ultrasound (is my leg having a baby?) The pushing itself isn’t so bad but, dang, that needle felt bigger than the ones they use in acupuncture or to take blood.

For good measure, the orthopedist had also recommended another test call an NCV, for nerve conduction velocity. For this one, they attach metal conductors to your leg and feet and pump a jolt of electricity into the nerve. The first ones were OK; it felt like a strong static electricity shock, not much worse than rubbing a balloon on your head. But the electricity got progressively stronger. My leg jumped and I cried out.

The nurse told me to clench my fist as tight as I could. “Is this part of the test,” I asked. “No,” she replied. “It will take your attention away from the pain.” Super.

“Just three more,” the unsmiling, entirely uncommunicative doctor said.

And then it was over. There appeared to be blood spots on my leg, although on closer inspection, they turned out to be dots of magic marker ink.

“Wait outside while I write up the results,” the doctor barked, in what to him was probably his gentlest voice.

The whole process took less than a half an hour. As I walked out of the hospital and towards the light rail to head home, I opened the envelope with the conclusions that might make or break my case. Everything was entirely fine, the paper said; they’d found nothing.

While that’s normally the kind of answer you’d like to hear, for me it means more tests, more prodding and poking on the way to finding a treatment. My orthopedist said I will be able to run again. I just didn’t realize what he meant was running from doctor to doctor. Shocking, but true, so to speak.

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Duggars on ElAl

Duggars heading into the Kinneret

Outside Yad Sarah

Here’s a clip of their stop in London; the Israel part of the trip isn’t online yet, as it just aired on Sunday.

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FOMO or not, the kids had a great time at the Dead Sea

When I was ten, my parents planned a trip for the family to Disneyland. But a few days before we were set to leave, my father got sick – it was a cold or a flu, nothing serious, but still, the trip was cancelled. I was devastated and, since then, I have tried to never miss out on any kind of experience, big or small. Understandably, this creates a lot of anxiety – I mean, which exciting activity should I choose? What if I choose the wrong one? And if I choose not to go at all, will I be filled with regret?

It turns out there’s a name for this – it’s called “Fear of Missing Out” (or FOMO for short).

Now, citing my missed Disneyland experience is a bit flip – by itself it wouldn’t qualify as the sole cause of my FOMO (for that, I’d need a regular series of dashed expectations that built up over my childhood). But today, the FOMO persists and lately, it’s been causing more distress than the actual missing out.

FOMO was in full bloom this past weekend. Our community was having a Shabbaton at the Ein Gedi Youth Hostel. On the way, we wanted to stop at the Dead Sea. The kids were excited to lather up with Dead Sea mud; I had heard from David Brinn in a post on Israelity about a nature reserve at Einot Tzukim that was supposed to be beautiful. The site also has a number of crystal clear spring-fed swimming pools and mud to boot (or so I thought).

We got a late start leaving Jerusalem. When we called Einot Tzukim, we were told that you can only get into the nature reserve part of the site on a guided tour. The last tour left at noon. We were passing Ma’aleh Adumim and had only 20 minutes to get there. I floored the accelerator and we arrived, miraculously at the gate at exactly 12:00 PM.

I jumped out of the car and cried, “let’s go.” But the kids didn’t want to hike and I hadn’t really considered their needs (mud, of which there turned out to be none) – my FOMO was so much in overdrive. I threw our daughter Merav the car keys and said, “The pools are that way. Imma and I will be back in an hour.” She looked perplexed and not a little bit cross.

As we toured the marshlands (gorgeous, by the way and highly recommended), I kept thinking about how I’d treated the kids and didn’t really enjoy myself. I vowed to make it up.

“Let’s go to the mud!” I announced.

And off we went again, racing towards Mineral Beach (only a few minutes from Einot Tzukim). But it was getting late and Shabbat was coming up quickly. My wife Jody was now the one who was upset. “We’ll only have 45 minutes. It’s not worth the NIS 220 to get into the beach.”

But FOMO raised its ugly head again. And so into the beach it was. The kids were delighted. Me – I couldn’t enjoy myself because, this time, I was disappointing my wife.

I had checked off both experience boxes in order to not succumb to FOMO and yet, I was desperately unhappy. This double whammy, driven home by the negative effect I’d had on the people I love the most, was the proverbial straw that perhaps, finally, would serve to break the FOMO camel’s back (a fitting cliché given our travels through the dromedarian Judean desert). My hope and aim is that, the next time I feel the FOMO rising like some unwelcome bitter bile, I’ll be able to draw on this weekend’s painful memory to keep it at bay.

Or maybe I should keep in mind one person who has it even worse. A friend at the Shabbaton shared with me that, whenever he’s at a buffet meal, he suffers from FOMOFF: “Fear of Missing Out on Free Food.”

Fortunately for him, the limp meat and cold schnitzel served at the Ein Gedi Youth Hostel was a fitting antidote.

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All that efficiency was for routine care, however. When you need to see a specialist, that’s when trouble sets in. And, recently, we’ve run quite afoul of the system.

My daughter, Merav, fell over the summer and hurt her knee. Her family doctor thought it was an inflammation and sent her for physical therapy. But the first appointment she could get through Maccabi, our HMO, wasn’t for two months. And going privately is upwards of $100 a session, so not a good long-term option.

Over the course of the waiting for physical therapy, her knee grew steadily worse. She went back to her family doctor who, this time, gave her a referral to an orthopedist. She got in there pretty quickly – only two weeks this time – and he sent her for a bone scan which determined that she had a torn meniscus which needed surgery.

But first she had to go back to the orthopedist to get a referral to a knee specialist. Problem: he was busy and Merav’s knee was really hurting now and also preventing her from participating in activities at her mechina (see my previous post on what that is).

The next available appointment with a knee specialist at Hadassah Hospital (which works tightly with our HMO): another two months. So we called around and found an appointment sooner at a different hospital. They needed a bunch of paperwork from the HMO, which can only be done by fax (hey – medical institutions: ever hear of the Internet?)

But we did it and arrived at Sha’arei Tzedek Hospital for an 8:20 AM appointment. We figured it was one of the first of the day so we should be out pretty quickly. But the knee doctor wasn’t there yet. “I don’t know why they book these appointments so early,” the secretary said with unsurprisingly Israeli brusqueness. “They always do their rounds at this time.”

But after an hour of waiting, I was getting concerned so I braved the secretary’s scorn and asked again. Turns out that the doctor was called into emergency surgery. They were waiting for a replacement. It would have been nice if they had told us (especially since now the waiting room was now quite full). When would the replacement arrive? No one had any idea.

After two hours, we finally saw the doctor who, in five minutes, confirmed what we already knew: it was a torn meniscus and Merav needed surgery. Duh. “So let’s schedule it,” I said. Not so fast. “First you need a pre-surgery appointment with the anesthesiologist who will take some blood,” he replied. Ensuring that there will be no complications is a good thing. So, when would that appointment be? Another two months. And how long after that until the surgery? He didn’t know. “Ask at the desk.”

We asked at the desk. “Ask the doctor,” a different brusque secretary barked back. “We already did,” Merav told her. “Well, I have no idea,” she replied. I remembered then that the doctor had suggested we could pay privately and that might speed things up. “Can you help us with that?” I asked. “Only Dr. Litvick can do that,” she said. “And he’s the one who’s still in emergency surgery.”

She gave us Dr. Litvick’s secretary’s number (another secretary to sweet talk unsuccessfully) but, given that we had been in the hospital now close to three hours, I figured maybe he was done with the emergency. He had an office on the 7^th floor. Up we trudged.

“He should be back in 15-20 minutes,” his secretary said. “Take a seat.” And there we sat for another 45 minutes. We were both hungry and tired. “Let’s go,” I said finally to Merav. “We can always call him.”

We left and Merav, who had “checked in” on Facebook while we were waiting, ran into three friends who were volunteering at the same hospital. She chatted for a while and then we decided to give Dr. Litvick one more chance.

He was back, but with a patient. We waited another 30 minutes before heading to the door a second time. “Just a second,” the secretary said, and pulled the doctor out to speak with us. His answer was further dispiriting. Our HMO wouldn’t let him take any patients privately in Jerusalem. But he could see us in Tel Aviv. And he could probably get Merav an appointment…in a couple of months.

Total time in the hospital: close to five hours. Success rate: 0.

I wish I could tell you that we have an answer, but we’re kind of back to square one. Jody is picking up the ball now and will try to figure out how to pay privately with a different doctor in a different hospital in Jerusalem. There’s one specialist who comes highly recommended. But when we tried to make a “regular” appointment with him, his first available slot was (wait for it) June 2012.

When, over the summer, the social justice protesters decried the medical system in Israel as “broken,” I scoffed. No more. We will ultimately prevail, I’m sure, although it may take more crook than hook. As always, I’ll keep you posted.

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American TV star Montel Williams, who was diagnosed with multiple sclerosis in 1999 and he has since been an outspoken advocate of medical marijuana to relieve pain caused by the disease, is evidently impressed with our medical usage of the cannabis plant and during a visit to Israel this week, said that he believes the US has something to learn from our policies.

“There are chemicals within that plant,” he told AP, “and some of the leading science on where and how those chemicals work is being done right here in this country,” referring to Israel.

The former host of the popular long-running talk show “The Montel Williams Show” – which rivaled Oprah and Geraldo for popularity – was in Israel meeting with MKs, scientists and physicians about Israel’s medical marijuana practices.

Hundreds of Israelis receive medical marijuana on a regular basis in a government program launched in 1994. I spoke to the program director a couple years ago – Dr. Yehuda Baruch – who said that around 60 more patients applied each month to join the program that enables them to receive free marijuana for their medical problems.
Among the conditions accepted by the program are cancer patients, HIV positive patients, people with Crohn’s Disease or ulcerative colitis, who are being treated by gastroenterologists and MS patients specifically for the spasticity symptoms upon recommendation from an MS center or a neurological specialist. Patients with post stress trauma disorder were being tested with the drug on an experimental basis, Baruch told me.

Montel Williams

Those patients, if they do not get cannabis, they will get morphine-like drugs and other harmful drugs,” said Goor-Aryeh. “I think that in many ways, cannabis is tolerated and is less addictive that morphine-based drugs.”

Williams, who says he uses marijuana daily to alleviate his pain, will surely go back to the US with a different view of Israel.

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A typical Jerusalem co-op

We were on our way home from Kol Nidre services in Jerusalem; me, my boys, sister, brother-in-law and one of my nephews, walking in the middle of the street, reveling in that particular freedom offered by the car-less Yom Kippur stretch. As I walked in the house, the phone rang, which is highly irregular on Yom Kippur, and made me think “emergency.” And it was, as my mother was on the other end, calling from Hadassah Ein Kerem to let me know that she’d fallen and been brought to the ER by an ambulance. I called my sister, whose phone was busy, also unusual. It turned out that she was speaking to “Harry the plumber”, known to many in this area and also my mother’s neighbor.

As we pieced the story together — and got a contingent to the hospital — it transpired that despite being on her own, our mother was taken care of by her neighbors, both near and down the block. She fell in a friend’s stairwell, was helped by her friend’s neighbors who knew her peripherally and who ran to get my mother’s downstairs neighbor, a Shaare Zedek doctor. He checked her out called the ambulance, while Harry let himself into my mother’s apartment to get our contact information. In the meantime, while we were trying to piece together the story, I called Harry who walked down to the doctor’s apartment to help me figure out the order of events.

In the end, everything was okay, and we got Mom home fairly quickly, with neighbors dropping in over the next days to check in on her. It may be just a simple Jerusalem co-op, but it’s great to have good neighbors.

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Yediot Ahronot reported earlier this week that a 24-year-old man walked into an emergency room in central Israel and informed doctors that he was in his seventh month of pregnancy.

No, Israeli scientists are not playing around with some experimental treatment as with the Danny Devito character in Junior. The man in question was born as a woman. He went through a sex change operation several years ago, removing his breasts and taking hormones to create a more male appearance (he apparently was sporting a goatee).

But, in an unusual move, the man (who asked that his identity remain secret) left his sexual organs intact (most transgender men undergo surgery to construct a penis). That enabled his surprising pregnancy.

Yediot reported that in Israel, one out of every 400,000 women seeks to become a man. This, however, is the first reported pregnancy. The doctors in the emergency room, by the way, released the patient, ruling that the pregnancy is proceeding as planned.

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Observers of Ramadan can get to the goodies without debilitating headaches thanks to Israeli researchers.

For an entire month at the height of the oppressive summer heat, the observant Muslim population fasts from dawn to dusk, an effort that goes far past our 24 hour fasts for Yom Kippur, Tisha Be’av and the other lesser Jewish fast days during the annual holiday cycle. So we Jewish Israelis can certainly identify with the trials of our Muslim neighbors, as they abstain from eating for a whole month: so much so, that Israeli researchers have conducted a study on how to help Muslims avoid incapacitating headaches during Ramadan.

According to a study published in the journal Headache, about four of every 10 Ramadan observers get headaches. However, a pill produced by US pharmaceutical giant Merck called Arcoxia, may prevent the headaches from taking shape. The pill, made from the drug etoricoxib, had already been shown to be effective in a study that revealed that Jews fasting for Yom Kippur who took Arcoxia got fewer headaches than those that didn’t take the pill.

Reuters Health reported that in the new study, Michael Drescher, from Hartford Hospital in Connecticut, along with a group of Israeli colleagues, assigned 222 Muslim adults planning to fast in 2010 to either take the drug or an inactive placebo pill just before the start of fasting each day. All participants recorded how often they had a headache, and how severe it was.

After a week they switched treatments. During the first day of fasting, when headaches are thought to be most common, 21 percent of people taking Arcoxia reported having a headache, compared to 46 percent of those who took the placebo pill.

The Arcoxia group also reported fewer total headaches during that first week, the researchers wrote. And when they did have headaches, they rated them as less severe than participants taking the placebo.

Arcoxia isn’t currently approved for use in the US because the FDA decided it was too similar to another Merck drug called Vioxx, which was pulled from the market in 2004 when it was linked to a higher risk of heart attack. But Arcoxia is available in Israel, as well as other countries.

And as far as any Jewish or Muslim religious opposition to taking a pill to prevent headaches during their respective fasts, Drescher told Reuters Health that none of the Muslim participants expressed any objections, and that rabbis who were consulted pointed out that not having a headache could allow people to be “freer spiritually.”

“The religious edict to fast really is not a command to suffer,” Drescher added.

So from one fasting people to another, Ramadan Kareem!

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