Archives for March 2012

03.28.2012 – ‘Positive stress’ as dangerous as ‘negative’

By JUDY SIEGEL-ITZKOVICH
03/28/2012 21:54

Amid excitement, Ashdod man suffers heart attack shortly after giving a speech at his son’s wedding.

GENNADY FARBER
PHOTO: COURTESY KAPLAN MEDICAL CENTER

Happy excitement can sometimes be as dangerous as nervous excitement when it comes to heart attacks. Gennady Farber learned this recently at his son’s wedding, when after giving his speech the 55- year-old of Ashdod suffered a heart attack and was rushed to Rehovot’s Kaplan Medical Center.Hospital catheterization unit director Dr. Oded Eisenberg said Wednesday that positive emotional experiences can cause heart problems in people at risk.

Farber was attending the wedding of his 26-year-old son Alex – the first of his two children to get married – to Vika, who is studying to be a radiology technician at Kaplan.

The elder Farber was so overcome by excitement at the occasion that he suffered severe chest pain and was taken by ambulance from the wedding hall to the hospital. There, interventional cardiologists opened up a severely clogged coronary artery and introduced a stent to keep it open so oxygen-rich blood could reach the heart muscle.

The pain set in while he was dancing and began to sweat, said Gennady. “I tried not to let on that something was the matter so as not to ruin the wedding.” Then he started to give his speech, but says he could not continue. At the hospital, Farber was found to have a 99 percent blockage and that he had underdone a coronary infraction.

Farber’s wife, Yelena, who works as a nurse in Kaplan’s maternity ward, was by her husband’s side constantly. The married couple postponed their honeymoon to be with Farber during his recovery. About two weeks later, he was discharged to go home.

According to Eisenberg, research shows that emotional stress is similar to physical stress in causing fatty plaque inside coronary arteries to break off and clog the vessels completely or partially. “It doesn’t matter if the stress is positive or negative,” he explained. “It releases factors that can cause the blood vessels to contract, especially if the person has cardiac risk factors or known or hidden heart disease.”

The Kaplan cardiologist urged people with symptoms such as chest pains, sweating, difficulty breathing and/or nausea to call for help immediately.

Eisenberg’s unit performs 2,000 catheterizations, a procedure used to diagnose and treat some heart conditions, a year. Some 60% of patients undergo angioplasty (balloon therapy) immediately after being brought to the hospital, as in Farber’s case.

He advised all people over 40, or those over 35 with risk factors, to undergo scanning to see if their heart is in danger of suffering from clogs.

“There is no doubt that it was an unconventional wedding,” said Alex, an electrical engineer. He thanked the Kaplan staff for saving his father’s life. “The important thing is that Dad gets stronger and lives to see many grandchildren.”

03.27.2012 – Even at 94: Modified coronary bypass surgery

By JUDY SIEGEL-ITZKOVICH
03/27/2012 03:48

Asked for the secret of his longevity, Ganot says: “My wife, the queen of our home, who always took care of me.”

Patient Shimon Ganot
PHOTO: KAPLAN MEDICAL CENTER

It may never be too late to undergo a (modified) coronary heart bypass: A 94-year-old man – one of the oldest Israelis to undergo surgery so far – has successfully had diseased arteries in his heart replaced at Kaplan Medical Center in Rehovot.Dr. Ron Brauner, head of cardiothoracic surgery at the hospital, said on Monday that conventional bypass surgery poses serious risk to nonagenarians, thus an amended technique was used to avoid putting the patient under general anesthesia and attaching him to a respiratory.

Shimon Ganot, who was born in 1918, fought in the pre-state Palmah and was an IDF infantry officer in four wars. Now, the farmer and father of three lives with his family at Moshav Arugot near Kiryat Malachi.

Brauner, a veteran cardiac surgeon, said his patient has lived independently and been mentally sharp. But two weeks ago he arrived at Kaplan’s emergency room suffering from chest pains and shortness of breath. Doctors quickly realized his life was in danger. The diagnosis: cardiac infarction.

Ganot underwent a diagnostic catheterization, which disclosed that several coronary arteries were completely blocked, reducing the blood supply to his heart muscle to a few internal vessels that had naturally created themselves from existing vessels by angiogenesis over the years.

He urgently needed bypass surgery, but that could have caused serious complications in the brain, kidneys and respiratory system.

The modified operation was performed by Kaplan surgeons without using a heart/lung machine that takes over for the pumping of the heart. Instead, a different device was used that significantly shortened the procedure.

When it was over, the anesthesiologists woke the patient up to wean him from the ventilator even before he was transferred to the intensive care unit.

Ganot awakened from the surgery without any pain, and the breathing tube was removed while he lay on the operating table. The next day, he stood on his feet and gradually regained the functioning he enjoyed before.

Ganot, who has cared for fruit orchards for many years, had been complaining recently of shortness of breath. Now, after the surgery, his respiration is much better. He hopes soon to be discharged home.

Asked for the secret of his longevity, Ganot said: “My wife, the queen of our home, who always took care of me. I did everything she said.”

Brauner said that with the ageing of the population, heart disease appears at later ages, but even people over 80 can be helped. The amount of cardiothoracic surgery in this age group has tripled in recent years.

“Proper choice and treatment of suitable patients can make it possible to perform surgery even in patients over 90 like Ganot,” he said.

03.16.2012 – Guest Columnist: How Ashdod is surviving Gaza’s Grads

By ANAV SILVERMAN
03/16/2012 16:56

Ashdod was the target of massive Grad rocket attacks from Gaza, along with close to a million civilians living across the south.

Ashdod blast site
PHOTO: ISRAEL POLICE

Earlier this week a rocket war raged in the south of Israel, as more than 300 rockets were fired at urban areas since last Friday afternoon, following Israel’s killing of the leader of the Popular Resistance Committee, the terrorist group behind the kidnapping of Gilad Schalit.Ashdod was the target of massive Grad rocket attacks from Gaza, along with close to a million civilians living across the south.

As I entered the city around five in the evening, the wail of the siren suddenly sounded and the bus I was traveling on from Jerusalem suddenly stopped. The driver, an elderly man, halted to let the passengers off according to safety protocol. Residents of Ashdod have 45 seconds to find shelter once a rocket has been fired from Gaza.

Some of us lay on the ground with hands over our heads, while others took cover near a cement wall. It’s strange how quickly you find yourself adapting to survival mode. A few seconds later we heard a boom. And then the discussion began: “Did the rocket actually land in the city? Or was it the sound of the Iron Dome intercepting the rocket midair?” We got our answer a couple of seconds later, as we saw a puff of gray smoke in the sky and heard a much louder explosion in midair. The Iron Dome worked wonders during this escalation of rocket attacks against civilians.

According to military officials, the Iron Dome had a 75 percent success rate on Monday, as the system was able to stop 23 of 31 rockets fired at urban areas. And it worked again.

The passengers made their way back to the bus, some slightly hysterical and others more calm. The bus driver checked twice to make sure that everyone was back on. And then the phone calls began.

“It’s been the eighth time today that the siren has gone off!” one woman exclaimed on the phone. Another passenger called her kids to tell them she was on her way home.

The white-haired bus driver told me that there was nothing to be scared of, that this was just another day on the job.

However, a few hours earlier, at around 2:30 p.m., a Grad rocket that the Iron Dome was unable to intercept landed in a residential shopping area, causing extensive damage to businesses, property and vehicles.

Two people were injured, including an elderly woman, who was evacuated to Kaplan Medical Center in Rehovot after being struck by flying glass shards, along with another person. Eight people were treated for shock.

Business owners still looked shocked from the attack a few hours later, as people milled around broken glass and debris that covered the sidewalk. Clothing mannequins lay on the floor in one store, with clothes strewn everywhere and the glass entry doors no longer intact.

Yaniv Araha, part-owner of the Michel Mercier hair salon, showed me a hairspray can pierced by pieces of shrapnel. “We were very lucky,” he said. “One of the stylists had to be hospitalized for injuries, but the rest of us – including our clients who were with us at the time – are fine.”

Araha showed me a protruding wall inside the hair salon where he took cover. “The shrapnel was able to reach all the way to the back kitchen,” he said, “but the wall protected us.”

Across the street, an apartment building was covered in shrapnel holes, close to the crater-like hole in the sidewalk that the Grad rocket left behind.

One resident held in his hand tiny metal balls that had been packed in the rocket, which now lay harmlessly outside the apartment building. “If one of these had struck someone, God forbid…” he said and shook his head. “We experienced a miracle here today. The outcome could have been much worse.”

ADI BEN-HAMU, the spokesman for Ashdod’s municipality, explained that the municipality had worked very hard since the last rocket escalation against Ashdod, during Operation Cast Lead, to prepare residents for the next barrage of Gaza missiles.

“The first time Ashdod residents were targeted by rockets three years ago, we were not prepared,” Ben-Hamu said. “There was a lot of hysteria – almost 800 people experienced shock and had to be treated.”

“This time, not only do residents know how to act and follow safety procedures, but we also have the Iron Dome, which has stopped many of the rockets and has helped boost morale,” he said. “Residents must still enter a protected area in any case, because shrapnel from the rockets can still strike from above.”

“We know how to take care of ourselves,” emphasized Ben-Hamu. “But no civilian can tolerate rockets fired by terrorist groups as a way of life, and no country in the world would allow civilians to suffer like this.”

“The government needs to do whatever it takes to stop these rocket attacks on Ashdod, Beersheba, Kiryat Malachi, Gan Yavne, Ashkelon and smaller communities across the south. In Ashdod alone we have close to 250,000 people, with 55,000 children unable to go to school during these rocket escalations,” added Ben-Hamu.

In regard to school, there was a temporary solution, with teachers assigning homework assignments to students via e-mail and Facebook.

On a more serious note, Ben-Hamu concluded that there was a much greater danger out there than the current Grad rockets being fired. “Everyone here is aware that there could be a much more serious and massive attack of missiles from Iran. This is what we have to prepare for and for an attack of that proportion, we cannot wait till the last minute,” he said.

The writer is an educator at Hebrew University High School and writes for Tazpit News Agency, Sderot Media Center and other news sources. She made aliyah from Maine in 2004.

03.16.2012 – Americans wash dishes to support the South

By JUDY SIEGEL-ITZKOVICH
03/16/2012 01:28

“It is heartwarming that you from America have come to give Israelis support and a hug,” Kaplan Medical Center director says.

US volunteers wash dishes at Kaplan Med. Center
PHOTO: COURTESY KAPLAN MEDICAL CENTER

A delegation of non-Jews from the US – managers, engineers and educators – has arrived during tense times to volunteer at Kaplan Medical Center in Rehovot. Members of the Friends of Israel organization, many of them visiting the country for the first time, volunteered to wash dishes, prepare food and help out with receiving hematology patients.

They were welcomed by hospital director Prof. Ya’acov Yahav, who said that the hospital is ready for any continuing terror attacks in he area.

Beverly Helmut, a resident of Indiana, said she felt “honored to wash windows and help in any way during this tense time. We are happy to be here and give assistance.”

03.14.2012 -15-Year-Old Gaza Boy Given Medical Treatment in Israel

By Elad Benari
First Publish: 3/14/2012, 6:43 AM

A 15-year-old boy was taken tohospital in Israel on Tuesday, after he was injured on Monday morning in the Jabalya area of Gaza, according to a statement by the Coordinator of Government Activities in Judea, Samaria and Gaza.

The boy was taken to the KaplanMedical Center in Rehovot, according to the statement.

The evacuation took place after contacts between the Coordination and Liaison Administration at Erez Crossing and representatives of the Health Ministry.

The statement noted that the boy’s injury is related to the death of another 15-year-old boy, who initially claimed that he was wounded by IDF forces. However, this claim was denied by the IDF Spokesperson, who said that the IDF was not operating in the area.

The evacuation took place despite constant rocket attacks on southern Israel by Gaza terrorists. During four days of hostilities terror groups fired more than 200 rockets at Israeli civilians, while the IAF responded by targeting the cells firing the rockets.

On Monday night it was reported that Egypt had brokered a ceasefire between Israel and the Gaza-based terror groups. The ceasefire went into effect as of 1:00 a.m. (Israel time) Tuesday morning, but terrorists continued to fire rockets and missiles into Israel throughout the day.

Despite the terror presence in Gaza, Israel often helps the residents of the coastal enclave. This assistance includes medical care, and more than once Israeli doctors have been able to save the lives of Gazan children.

Israel allows various goods to enter Gaza and also allows for the exporting of agricultural products, such as strawberries and carnations, from Gaza to Europe, as part of an extensive project financed by the Dutch government.

Gaza recently began exporting tomatoes to Saudi Arabia. The tomatoes were transferred to Israel through the Kerem Shalom crossing on February 8, and a day later were exported abroad via the Allenby Bridge. Several days before that, Gaza exported 31 tons of tomatoes to Jordan.

03.13.2012 – Moms, Babies OK with Low-Dose Warfarin

By Chris Kaiser, Cardiology Editor, MedPage Today
Published: March 13, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

It appears to be safe for young women with new-generation aortic valves to maintain a low dose of warfarin therapy during pregnancy, a small pilot study found.

All 17 women who had a mechanical aortic valve and were on a regimen of 5 mg or less of warfarin a day delivered healthy babies by cesarean section, reported Luca S. De Santo, MD, from the University of Foggia in Naples, Italy, and colleagues.

Three women with bioprostheses (two mitral, one aortic) who were taking more than 5 mg of warfarin a day also delivered healthy babies, and at a mean of 59 months follow-up showed no signs of structural valve degeneration, researchers wrote in the March 20 issue of the Journal of the American College of Cardiology.

Despite the excellent results of this study, the researchers cautioned that the patients were highly selected and closely monitored.

They received extensive pre-pregnancy counseling regarding valve choice and anticoagulation therapeutic options.

The researchers noted that pregnancy induces a natural state of hypercoagulation and that warfarin therapy is associated with adverse fetal effects. However, more recent studies have suggested that the adverse effects are dose-dependent.

In addition, third-generation aortic mechanical valves are less thrombogenic, and thus require less aggressive anticoagulation therapy. But studies demonstrating this did not include pregnant patients.

There are also other things to consider “in the peculiar setting of the heart valve prosthesis patient” who has a desire for future pregnancy.

Pregnancy can result in early and late structural deterioration of bioprosthesis valves, which could mandate re-operation. Mechanical valves, on the other hand, are associated with a high rate of complications for the mother, including valve thrombosis and death.

Warfarin is considered safer for the mother than the fetus, while the opposite is true for heparin (both unfractionated and low-molecular weight), De Santo and colleagues wrote.

However, the newer generation of mechanical valves offers the opportunity to give very low doses of warfarin to this patient population.

Given the uncertainty surrounding best practices for this patient population, it is no wonder that guidelines by the American College of Cardiology/American Heart Association and by the European Society of Cardiology “disagree on many fundamental issues, including … the management of anticoagulation therapy during pregnancy,” the authors wrote.

In an accompanying editorial, Uri Elkayam, MD, from the University of Southern California in Los Angeles, and Sorel Goland, MD, from Kaplan Medical Center in Rehovot, Israel, noted that guidelines from the European Society of Cardiology recommend the consideration of less than 5 mg daily of warfarin throughout pregnancy.

They reiterated that De Santo and colleagues sought a low international normalized ratio (INR) of between 1.5 and 2.5 that was based on studies that did not include pregnant women.

“For this reason, and until more data are available, it seems advisable to follow the American College of Cardiology/American Heart Association guidelines and use a warfarin dose during pregnancy aiming to achieve an INR level of ≥2.5 even in patients with new-generation mechanical prosthesis heart valves in the aortic position,” Elkayam and Goland wrote.

The current study was an attempt to ascertain the benefits of extensive multidisciplinary counseling, as well as to determine maternal and fetal adverse effects associated with low-dose warfarin therapy.

Between 2000 and 2010, 40 women (mean age at pregnancy 27) were referred to the Italian center for valve disease.

Researchers had established a protocol whereby the women who were contemplating future pregnancy would be given a three-month preoperative anticoagulation trial to ascertain whether a low dose of warfarin would result in an acceptable INR (between 1.5 to 2.5). None of the 20 women slated for aortic valve replacement refused the preoperative trial run.

Of the 20, 17 achieved the optimal INR on the low daily dose; three did not and were referred for ≥5 mg of warfarin daily.

All 17 women on the lower dose chose a mechanical valve. Of the three on the higher dose of warfarin, one chose a bioprosthesis and two chose a mechanical valve. One of the women who chose a mechanical valve had the intention to adopt rather than get pregnant, while the other intended to use low-molecular weight heparin for a future pregnancy.

The only pregnancy complication — valve thrombosis — occurred during the 11th week of the woman who chose low-molecular weight heparin. Her dosage was adjusted, she underwent successful reoperation, and she finished her pregnancy successfully under warfarin therapy.

There were no other thromboembolic or bleeding complications in the low-dose cohort of women who had C-sections at the 37th week, including a two-day postpartum warfarin withdrawal. During this withdrawal, the mean INR was 1.39.

De Santo and colleagues concluded that the excellent results were due to the comprehensive pre-pregnancy counseling, advanced expertise of anticoagulation therapy protocols, and close long-term follow-up. Further studies are needed to confirm these results, they said.

The limitations of the study include the small sample size and relatively limited follow-up of patients receiving the bioprosthesis. Also, the findings should apply only to patients receiving third-generation aortic valves, the authors said.

Elkayam and Goland noted that the excellent safety results in this study are not supported by other studies, which have reported fetal complications, and the results should not be considered conclusive.

The authors of the study and the editorialists reported they have no relationships relevant to the contents of this paper to disclose.

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03.12.2012 – Rocket Fire Prompts More School Closures

Numerous southern towns have decided schools will remain closed on Tuesday as rockets continue to rain down from Gaza
By Gabe Kahn.
First Publish: 3/12/2012, 8:08 PM
Rockets land in southern Israel

Rockets land in southern Israel
Reuters

Continued rocket fire on Israel’s south will keep many schools in the south closed for at least another day.

Beer Sheva, Ashkelon, Ashdod, Kiryat Malachi, and Ofakim, all announced their schools will remain closed on Tuesday.

Gan Yavne also announced there would be no school in Tuesday, but noted twelfth graders would learn in fortified rooms and special education children would be sent out of the settlement to schools more than 40 kilometers from Gaza.

However, the Negev Regional Council announced that kindergartens, elementary schools and high schools will be held tomorrow as usual. Middle schools will reportedly conduct classes via the Internet.

In addition, Ben-Gurion University in Beer Sheva announced there will be no classes or exams on Tuesday. University officials said the decision was made after discussions with officers from the IDF Home Front Command.

The university said public university students and employees would be sent safetyguidelines via email, and that that the university Website would update them about changes to the curricula.

The announcements came as no fewer than 40 rockets rained down on Israel’s southern communities. Most rockets were intercepted by Israel’s Iron Dome anti-rocket systems.

However, one rocket injured an 80 year old woman, who sustained light shrapnelinjuries in her leg. She was taken to Kaplan Hospital in Rehovot. An additional 13 people were treated for shock.

Throughout the morning hours terrorists fired volleys of Qassam rockets and mortar shells at communities in the Gaza belt region. Rockets exploded in open areas around Sderot and the Eshkol Regional Council and Hof Ashkelon.

Three mortar shells landed near the Kerem Shalom crossing. One struck a truck transferring aid supplies from Israel to Gaza. Following the attack the crossing was temporarily closed, but the Civil Administration has since ordered it reopened.

The school closures come as the Knesset’s powerful Foreign Affairs and Defense Committee called on the government to declare a “special situation” in Israel’s south.

Doing so would allow the government to provide compensation to local families for costs incurred by the disruption of their daily lives by the escalated rocket fire, including lost pay due to remaining home with children whose schools are closed.

03.12.2012 – Grad rockets cause damage in Ashdod, Gedera

By YAAKOV LAPPIN, JPOST.COM STAFF
LAST UPDATED: 03/12/2012 15:44

Terrorists launch 31 rockets into Israel, causing damages, lightly injuring 2 in Ashdod; Palestinians: 5 killed by IAF.

Damage from Kassam
PHOTO: YAAKOV LAPPIN

A Grad rocket fired from the Gaza Strip landed in the Gedera area on Monday, marking the northern-most point hit by terrorists in the current round of escalation that began Friday and has included the launching of some 200 rockets by terrorists targeting southern Israel. A subsequent blast hit a residential area of Ashdod causing extensive damage to homes and lightly injuring two people.

The Grad, which struck in the Gedera area, was one of 31 rockets fired into Israel on Monday. Some damage was caused to a structure in the attack.

At least eight of the 31 rockets fired on Monday were intercepted by the Iron Dome rocket defense system, including several fired toward Ashdod.

However, one Grad rocket not intercepted by the Iron Dome hit a residential area of Ashdod on Monday afternoon, causing damage to homes. One of the injured, an elderly woman, was evacuated to Kaplan Medical Center in Rehovot after being struck by flying glass shards. One other person was injured from glass and eight people were treated for shock following the attack.

03.01.2012 – Teenage girl donates tresses for cancer patient wig

By JUDY SIEGEL-ITZKOVICH
03/01/2012 04:23

13-year-old says donating hair a great way to ease suffering of women with cancer.

LIRON POLLACK donates hair
PHOTO: COURTESY KAPLAN MEDICAL CENTER

Thirteen-year-old Liron Pollack decided this week that getting her long hair cut short would not only complete a “perfect Purim costume” as a funky teenager with a spiky hairdo, but also ease the suffering of women with cancer.The girl from the Pelech modern Orthodox girls’ school in Kiryat Ekron, who is involved in the Bnei Akiva youth movement, went to Kaplan Medical Center to donate her tresses. For the past two years, the Rehovot hospital has had hairdresser Eli Ben Zikri (a former cancer patient) and Yigal Gott give free haircuts to women and girls (and even long-haired boys) who wanted to donate so that wigs could be made.

The oncology department’s hair salon donates the wigs to women and girls undergoing chemotherapy who had lost their hair.

Hospital director-general Dr. Ya’acov Yahav said that the hairdressing team volunteers to cut the donated hair and make the wigs.

Pollack decided to tour the hospital before Purim.

“I went to the oncology department and saw Eli Ben Zikri making a wig for a woman who became bold. Suddenly, with the wig, she looked radiant,” she said. Now, she needs only gel to create the spikes she needs for her Purim costume.

The teen called on other girls to join her and volunteer for a haircut. Her mother Sarit was very proud, as Pollack has had long hair for so long that she is known for it.

“Her friends couldn’t believe she had it cut short, but apparently this was very important to her!”