Jewish tradition places a strong emphasis on taking care of one’s health. An entire section of Shulchan Aruch, the Code of Jewish Law, is dedicated to guidelines for maintaining one’s health. Many of these laws are based on the writings of Moses Maimonides, one of the most prolific and influential Torah scholars and physicians of the Middle Ages.
In the second volume of his work, Mishneh Torah (Hilchot Deot, 4:1), Maimonides writes, “Since maintaining health and a sound body is among the ways of God, for one cannot understand or have any knowledge of the Creator if he is ill. Therefore, one must avoid that which harms the body and accustom oneself to that which is healthy and helps the body become stronger.” Maimonides sums up his prescription for healthy living in a formula familiar in today’s healthcare discussions: “As long as one exercises, exerts oneself greatly and does not eat to the point of being full…he will not suffer sickness and he will grow in strength.”
With the official launch of the Affordable Care Act, and regardless of one’s politics, health has become a national issue. The U.S. Department of Health and Human Services’ Office on Women’s Health is gearing up for National Women’s Health Week, May 11-17, to help women make health a priority. Over the next few weeks, several community programs throughout Connecticut will examine various aspects of women’s well-being and the steps necessary for a healthier lifestyle. The Ledger spoke with some of the presenters on what’s new in their areas of specialization, and where women can find tools for optimal health.
Step Up to Healthy Living!
Sunday, April 27, 9:30 a.m.
Jewish Federation of Western CT
444 Main St. North, Southbury
Speakers: Karen Sabbath, Registered Dietician and Certified Specialist in Oncology Nutrition, The Leever Cancer Center, Waterbury; Dr. Ellen Polokoff, Board Certified Surgeon, Polokoff Breast Care, Southbury and affiliated with Waterbury Hospital and Saint Mary’s Hospital, Waterbury
Tickets: $10/person, includes healthy refreshments. RSVP by April 23: (203) 267-3177, email@example.com.
Karen Sabbath works with patients throughout all stages of their treatment and teaches healthy cooking classes. She helped develop “Stepping Forward,” a program and cookbook for cancer survivors. Prior to working with cancer patients, Sabbath worked in cardiac rehab and prevention, until a personal encounter with cancer changed the course of her life and career. She became committed to helping people who were going through the process of cancer treatment, and found the work fulfilling.
She decided to change her specialty, shadowing an oncology dietician for a summer at Saint Raphael Hospital in New Haven. While many of the nutrition concepts she already knew were the same, Sabbath found that the circumstances in which they were applied were different. She also had to learn about the cancer process and how the many diagnoses and treatments – surgery, chemotherapy, and radiation – can affect one’s ability to eat and stay as healthy as possible. She worked with cancer patients at the Leever Center in Waterbury for more than a decade, then took and passed a specialty exam offered through the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) to become a Certified Specialist in Oncology Nutrition.
“The ultimate goal for our patients, from a nutritional standpoint, is to help them get through their treatment, maintaining their weight and optimal nutrition despite the many obstacles that can prevent their ability or desire to eat,” Sabbath says. “These can range from debilitating surgery, radiation that affects one’s ability to swallow or digest food properly, side effects of chemotherapy that reduce appetite, alter one’s sense of taste, or cause mouth sores or gastrointestinal problems or debilitating fatigue. Sometimes problems are easy to manage, and other times they can be very complex and challenging. It is essential to work closely with all of the members of the healthcare team, as well as family members. Sometimes ‘it takes a village.’”
Sabbath says that she is often asked whether the “right foods” will cure cancer. “Although I would love to tell people that if you eat this, that, and the other, you will be cancer-free, it would be irresponsible of me to do so. It isn’t that simple,” she says. “What I tell people is that the specific foods you eat may not directly impact the outcome of your cancer, but if you are able to maximize your nutrition given your diagnosis and treatment plan, and maintain your weight and hydration despite the many side effects, it is possible that you will tolerate the treatment better and have fewer treatment breaks, and that can impact the outcome. I work closely with patients to help make that happen.”
Sabbath says that another especially rewarding part of her job is helping people change their diet and lifestyle to be healthier, once their cancer treatment is completed. “Cancer often causes people to reexamine their priorities in life, and frequently motivates them to make the changes they have been meaning to do, but never got around to doing,” she says. “I teach healthy cooking classes and work with many of our patients to help them get on the right track.”
In her April 27 presentation, Sabbath hopes to provide attendees with practical information that will help them make healthy decisions about diet and lifestyle, and discuss some of the many nutrition-related myths and controversies peppering the media. “Most of all, we’d like to have some fun,” she says. “Sometimes it seems that so many things in our lives are beyond our control. What we eat and how we choose to live are two things that we can control, and how we eat really can make us feel better. We hope to focus on the positive and give people the information and tools they need to get started.”
“What’s in Your Genes? BRCA?”
Tuesday, April 29, 7 p.m.,
Beth El Temple
2626 Albany Ave., West Hartford
Presented by Women’s Philanthropy of the Jewish Federation of Greater Hartford in partnership with Jewish Family Services of Greater Hartford. For information: www.jewishhartford.org. This event is free.
Panelists: Dr. Stacy Nerenstone, medical oncologist, Hartford Hospital; Dr. Allan Mayer, gynecologic oncologist, Saint Francis Medical Group (Hartford); Dr. Rochelle Ringer, breast cancer surgeon, Hartford Hospital; Sara Caroll, genetic counselor, Hartford Hospital and Saint Francis Hospital and Medical Center (Hartford); Sue Friedman, founder and Executive Director, FORCE (Facing Our Risk of Cancer Empowered).
Dr. Allan Mayer will present the gynecologic aspects of the care of women at risk for breast cancer and ovarian cancers: gynecologic anatomy, and ovarian cancer risk factors, signs, and symptoms. He will also discuss screening and the most recent approaches to prevention and treatment. The focus of his presentation will be on discussions with family members of affected individuals and their children.
“My goal is to reassure patients that they have many choices and options,” he says. “Hopefully, we will dispel any fears they have regarding cancer screening and treatment.”
Mayer says that the field of cancer genetics changes and improves nearly every month. “We are making strides in diagnosis as well as treatment annually,” he says. “We will present the most recent updates in all aspects of cancer genetics including screening, psychosocial issues, and current community resources.”
This is not the first time Mayer has sat on a panel with Dr. Stacy Nerenstone. The April 29 event is an update on the information the two oncologists presented at a similar community program 10 years ago.
“At that time, genetic testing was somewhat controversial – to patients, not to medical practitioners – because why would people want to find out that, while they may not have cancer, they might get it?” Nerenstone says.
Advances over the last 10 years provide new tools and information to dispel some of the fears and stigmas associated with cancer prevention.
For example, increased surveillance has been shown to work somewhat for breast cancer but fails “abysmally” for ovarian cancer, Nerenstone says. For those women with a risk for ovarian cancer, many oncologists recommend prophylactic surgery to remove the ovaries. “Surveillance is waiting for cancer to happen; prophylactic surgery is making sure it doesn’t,” Nerenstone explains.
The good news is that, even with a mutation, many women can postpone the surgery after they have had children – unless there is family history of early-onset cancer. “A number of studies have shown that taking out the ovaries before age 35 decreases the risk of ovarian cancer,” Nerenstone says. “That’s something we always knew, but now we’ve learned that it also significantly decreases the risk of breast cancer.”
Another advance is the way ovarian cancer survivors are cared for. “In the past, once a woman had ovarian cancer, we wouldn’t think about addressing her risk for breast cancer because most women would die from ovarian cancer – so why put them through breast-cancer treatment?” Nerenstone says. “But now, since many of those women live a long time, we have to pay attention to the risk of breast cancer and consider preventive surgery.”
In terms of treatment, studies show that women who choose a preventive mastectomy at the time of their first breast cancer diagnosis have a higher survival rate than women who wait. In addition, researchers have found that women with the BRCA mutation and cancer are responsive to PARP inhibitors, a new class of drugs being evaluated that target BRCA mutation tumors.
“My mantra is, ‘Biology does not have to be destiny,’” Nerenstone says. “You can carry a mutation that could markedly increase your risk of cancer – but today, we can do something about it.”
Awareness is the watchword and mission of FORCE (Facing Our Risk of Cancer Empowered), a Florida-based national organization founded by breast cancer survivor Dr. Sue Friedman, who also serves as its executive director. (Dr. Friedman is a veterinarian.) She is co-author of the book, Confronting Hereditary Breast and Ovarian Cancer.
Only after completing her own treatment did Friedman learn about the genetic-testing options that she could have accessed. She founded FORCE in 1999 to fill the information void for individuals and families with hereditary cancer, and to help them advocate for themselves.
“It’s really important to know where to go to get the best resources and peer support to allow informed decision-making for the best possible healthcare,” Friedman says. “There are so many different issues that come up that are associated with decision-making: should you find out more about genetic counseling and genetic testing, and if you do test positive, to make sure you’re getting the very best healthcare you’re entitled to if you are at risk.”
“The media loves to focus on issues that raise the most interest and tend to be sensationalized, but this issue has been around since I was diagnosed in 1996, not only since Angelina Jolie decided to have preventive surgery last year,” she says. “This is not about movie stars; these are medical choices like other medical choices, but the patient has to get access to credible, balanced information.”
While testing for the BRCA mutations has been around since the mid-‘90s, most of the related information available was the marketing material put out by the single commercial laboratory with a patent to conduct the testing, Friedman says. As a result, people were not being directed to healthcare experts in genetics.
“Genetic testing is one of a series of healthcare decisions that people have to make in a lifetime,” she says. “This is a test for everybody, and while there is a large group of people for whom it’s not relevant, we have to make it accessible for those for whom it is relevant.”
In addition to printed materials, online resources, and local events, FORCE sponsors the annual conference, Joining FORCEs Against Hereditary Cancer, the largest gathering of BRCA experts from around the world. This year’s event, held in Philadelphia, is in partnership with the Penn Medicine Basser Research Center for BRCA at Abrahamson Cancer Center.
Lisa Cohen, a UK native who made aliyah in 1992, received a scholarship from FORCE to attend the first conference in 2007. The following year, she launched Bracha (bracha.org.il), a non-profit organization that provides BRCA-related information and resources to Israeli women – in Hebrew, Arabic, Spanish, and Russian. Cohen maintains a close partnership with FORCE, returning to the conference every year to learn about the latest developments from experts in the field.
“BRCA mutations are 10 times more common in Eastern European Jewish descendants, but it is found in every ethnicity, so it’s so important for everyone to understand that they can carry the mutation,” Friedman says. In addition, there are other genes aside from the BRCA mutations that can increase risk for cancer. “Any cancer in your family tree is significant, so it’s important to look on both sides of your family, as far out as you can,” she says. “The closer the relative with cancer is to you, the more relevant that is to your own risk.”
To determine the presence of a mutation, the best avenue is to consult with a genetic counselor, Friedman says, because the diagnostic process might involve more than one test.
“People use whatever misinformation they can to avoid testing because they’re not ready,” Friedman says. “That’s understandable, but it’s unfortunate if they elevate false risks above the very real risk of cancer. They say, ‘I don’t want to get testing because I’m not ready to remove my breasts,’ but there are other choices aside from surgery.”
Another myth is that, if your family member has undergone genetic testing, health insurance companies won’t cover your testing or will cancel your policy.
“That fear has reached the level of urban legend but even if it did happen, the incidence was low,” Friedman says. “There are national laws that prevent discrimination by health insurance companies for genetic testing.”
The bottom line, says Friedman: Get balanced information in order to know your options.
EVERY BEAT COUNTS: Hadassah’s Heart Health Program
Heart disease has long been considered a man’s disease. According to the Heart Foundation, women account for just over half of the total heart disease deaths in the U.S. each year – 267,000, six times more than the number of women who die annually from breast cancer. Of the 435,000 American women who have heart attacks annually, 83,000 are younger than 65 and 35,000 are under 55. Under age 50, women’s heart attacks are twice as likely as men’s to be fatal, and 42 percent of women who have heart attacks die within one year, compared with 24 percent of men. Today, eight million women in the U.S. are living with heart disease. Heart disease is the number-one killer of women worldwide, regardless of race or ethnicity.
At the same time, 82 percent of heart disease is preventable. Hadassah has adopted heart health as one of its national advocacy initiatives, partnering with Sister to Sister: The Women’s Heart Health Foundation. “Every Beat Counts: Hadassah’s Heart Health Program” is designed to educate, engage, and empower women to follow a healthy lifestyle by learning symptoms and prevention tips for heart disease.
Sister to Sister recommends four initial steps to begin a heart-health process: identify your needs through screening and assess risk factors; set goals to lower risk; create a support system; and track your success.
Many local Hadassah chapters around the country are involved in the effort, including several in Connecticut. In December, the New Haven chapter hosted cardiologist Lisa Freed, director of the Women’s Heart and Vascular Program at the Yale-New Haven Hospital Heart & Vascular Center. Listed below are two other local programs.
For more information: Every Beat Counts – Hadassah’s Heart Health Program: hadassah.org. FORCE (Facing Our Risk of Cancer Empowered): facingourrisk.org.
National Women’s Health Week: womenshealth.gov/nwhw.
Red Dress Luncheon & Fundraiser, Westport
Friday, May 2, 11 a.m. – 2 p.m.
at the Westport Inn, 1595 Post Road East
For information and registration: Liz Kaner, (917) 597-1834, Lizkaner@gmail.com
The Westport Chapter of Hadassah will host a Red Dress Luncheon & Fundraiser, featuring guest speakers Linda Casale, MD, clinical cardiologist at Bridgeport Hospital on “Latest Advances in Women’s Heart Health;” and Paul Epstein, ND, Mind-Body Integrative Medicine, Westport on “Treating the Whole Person and Meditation as Medication.”
“Every Beat Counts: Race to Jerusalem,”
Sunday, May 4
For information: qucheshirehadassah.weebly.com
Coinciding with Israel Independence Day, the Cheshire chapter will conclude a four-month “Every Beat Counts: Race to Jerusalem” exercise program and fundraiser.
Chapter president Alyssa Budkofsky thought up the idea in December, inspired by the typical seasonal talk of New Year’s health resolutions. As a way to participate in Every Beat Counts with an Israeli twist, Budkofsky and fellow board members calculated the 5,615 miles between Cheshire and Jerusalem. For every 15 minutes of exercise (or a donation to Hadassah), a participant earns one mile. Nineteen chapter members signed up. Budkofsky keeps track of everyone’s progress and motivates them with regular emails about cardiac health and nutrition. The May 4 celebration in Bartlem Park in Cheshire will include prizes for those with the most miles.