You want to live, don’t you?
I am just back from surgery, having been sidelined for several weeks. As a rabbi, an attorney, and as a person who endeavors to grow more knowledgeable over time, I have learned a great deal from congregants, from clients, and from life about issues involved in staying alive and well. Most of us keep our personal medical information and subsequent health education private, but there is value in sharing when it can save a life. So I share.
Back in 2006, I was rabbi at the one nightmare congregation I have encountered during my 37-year rabbinical career. It was the worst place a rabbi ever could be. It was even worse than that. I found solace in friendships with several Christian pastors, good friends of mine, who shared that they also had experienced such church ministries. They even introduced me to a book that helped me through that period: Clergy Killers by G. Lloyd Rediger.
As rabbi at the Nightmare Congregation I lived the life of Donald Trump — only without the money and the extracurricular activity or the importance. (But my wife is as beautiful as is Melania — and, yes, my wife will be reading this column.) There was a vicious small coterie of noxious Klingons who spent day and night plotting and fantasizing, cooking up allegations, charges, and rumors aimed at undermining my rabbinic work and spiritual ministry. Every day there was a new false allegation and lie, very much like what President Trump encounters daily from the despicable Seedier Media and their endless stream of concocted Fake News. I even had to deal with my own Bob Mueller investigations. Like the President, my every day was sidetracked with one to three hours needing to be devoted to overcoming slander and libel, as I endeavored to spread the truth and, frankly, to let my deeds and comportment speak for me because I had no Mike Pence, Sarah Huckabee Sanders, Kellyanne Conway, or Sean Hannity otherwise accessible to defend me. In the end, I reverted to my other professional background and training, moved towards full-blown litigation, negotiated a separation deal on my terms, and started my new congregation that now is marking our Tenth Anniversary.
Appendectomy and Meniscus Surgery as Prelude to Life-Saving Procedure
During that nightmare period, in 2006 I became quite ill one night. Started retching and regurgitating. My wife dragged me to the hospital emergency room over my protests, and it turned out that she saved my life because my appendix already had begun leaking and was about to burst. I was raced into an emergency appendectomy; enough had leaked that I remained hospitalized for five days. The bill was close to $30,000 — and I had not even been able to eat many of the foods because of kosher laws — but, in those halcyon days before Obama was anything but a part-time law professor who never had published a law review article anywhere, I had my insurance plan that I liked and my doctors that I liked, and the insurance paid everything after my first $3,000 payment. It was early in the calendar year, and now that I had met my Year 2006 “Stop Loss” limit, it meant that all my legitimate medical costs for the next ten months would be covered 100% by the health plan.
I long had needed meniscus surgery to deal with an athletic injury stemming from my days crouching long innings as a catcher. I got it done. No Obamacare — so I got to use the doctor I wanted, and G-d guided his surgical hands marvelously. Then I checked the menu to see what else they had for dessert since my Year 2006 medical meal had become an all-you-can-eat buffet. I knew I was long overdue for a first colonoscopy, so I figured: yeah, may as well. Let’s see how that comes out.
Colonoscopy Can Save Your Life
I picked my doctor, did the delightful prep, had my colonoscopy, and called a few days later for the result. As is my wont, I joked in slightly light-hearted tones, but the doctor responded with gravity. He was not humored. “Rabbi,” he said tersely, “we are waiting for the biopsy results. Let’s talk again next week.” I tried again to be jokey, but he again sounded deeply concerned. So now I became concerned. The thing is, I had no symptoms. I had undergone the diagnostic only because my general practitioner had been pestering me for years to get a colonoscopy, and this one was on the house, so why not?
The following week, the doctor called. He sounded much lighter: “Rabbi, you are America’s Year 2006 Poster Boy for Colonoscopies.” My mind’s eye was not too keen as it envisioned the image on billboards across the prairies. He continued: “We found a huge polyp inside, one of the biggest I have seen in my decades. Usually, those turn out bad. Yours, however, turned out to be benign. But even though the technology nowadays empowers us to zap into oblivion any polyps we find — and I zapped that one — I need you to come in for another colonoscopy in two months, when the area will have recovered, so that I can be sure that I excised all of it. It was that huge.”
He taught me about colon cancer. He explained that, at least as I now understand it, no person ever should get colon cancer and, more so, no person ever should die of colon cancer. It is not like other cancers. If a person gets a colonoscopy on a schedule as recommended, either the finding will be clear, or there will be a polyp or more. If there are polyps, they always begin as benign and non-cancerous and can be zapped at the spot when found. Only if the polyps are permitted to remain and grow, undetected year after year, do they sometimes become malignant and result in colon cancer. But every time we read in the news about a famous person dying of colon cancer, the unspoken and unstated sentence in the news story is that the deceased failed to go in for a timely colonoscopy.
Publicly Sharing a Private Medical Discovery From My Pulpit to Save Lives
That Shabbat (Saturday Sabbath), I decided to devote my sermon to educating everyone in shul (synagogue) as to what I had learned, urging friend and hater alike to be sure to get colonoscopies if so advised by their medical providers. Predictably, the Noxious Klingons went to overdrive against me for that sermon. “That’s what our rabbi talks about in synagogue?” They were fast and furious. Another Special Counsel investigation. More Board meetings and explaining myself. But two things happened: one of the lead haters decided that he hates the rabbi so much that he is not going to get a colonoscopy. (Fine with me.) And, unknown to me at the time, not only did several congregants schedule their first-ever colonoscopies shortly thereafter, but one of them told me two years later that the sermon had saved his life because his doctor found the beginnings of a malignancy during his exam, and they miraculously caught it in time. To this day, he says I saved his life. If you are reading this, perhaps yours, too.
Dealing Timely With Especially Severe GERD Can Save Your Esophagus, Your Lungs, and Your Life
Next: GERD. We see the TV ads for the purple pill, and the pharmaceutical shelves have the generic proton pump inhibitors (PPIs) like omeprazole alongside. They are taken for gastroenterological reflux disease (GERD). When you take them as prescribed — or, as it emerges, they commonly are taken under medical supervision daily for a lifetime — they can play a major first-defense role in reducing reflux and its symptoms. However, it emerges that even with those medicines, people suffering from GERD often may have more serious underlying ailments that, masked by the initial symptomatic relief afforded by the PPI meds, get worse and even life-threatening. An example: A study in Texas conducted on the removed and diseased lungs of people who had undergone lung transplants found that a huge percentage of the hopelessly diseased lungs had been damaged perilously by the bile and acid seeping from undetected and out-of-control GERD. If a person sustains a hiatal hernia (not the same as the weight-lifting-associated inguinal hernia for which men are tested in that sketchy “make-a-cough” exam at the doctor’s office), there can be a real chance that the stomach, whose top is attached to the esophagus (“food pipe”) will rise upward towards and pressing into the growing tear. The tight slot at the diaphragm through which the esophagus enters to connect with the top of the stomach (the fundus) at the lower esophageal sphincter can become loosened and tear increasingly wider. In time, digestive acid — and, even more perilously, bile — can seep upward from the stomach, through the expanding tear at the hiatal hernia, and possibly work its way into the esophagus and even into the lungs. The long-term impact can be severe, resulting in severe diseases ranging from Barrett’s Esophagus to a next-step esophageal cancer, and it likewise can severely damage the lungs. Some diseases can be reversed; lung-scarring, by contrast, is irreversible.
It now is more possible for skilled gastroenterologists to determine the degree to which a patient’s GERD truly is being controlled by over-the-counter PPIs or is especially severe. In the extraordinary medical laboratory for life-saving inventions that is known as the “Country of Israel” — it is amazing how many Jew-haters and Israel boycotters are alive solely because they live each day off Israeli medical advances and inventions that they selectively choose not to boycott — technicians created a device called “Bravo,” a small wafer that a doctor can attach internally to a person’s esophagus while doing an endoscopy. The patient wears a recording device on an external belt attachment for a day or two, and the recording device identifies the degree to which a person’s GERD puts him or her at severe risk. If bad enough, indicating extensive and potentially perilous seepage of bile and digestive acid, suitably trained surgeons can attack the problem in one of two primary ways. One surgery approach is a fundoplication — wrapping or folding (plicating) the fundus (top of the stomach) around the lower esophagus. That can seal off the bile and acid seepage from the stomach to the esophagus. On the other hand, it also presents a bit of a challenge in terms of food traveling downward. If a person has strong downward esophageal motility (what we called “peristalsis” in elementary school back in the days when they taught subjects like that, reading, math, history, and writing), then the patient may get a complete 360-wrap-around (a “nissenfundoplication,” named for Rudolf Nissen, the German Jewish doctor who figured that out). Alternatively, if a doctor-ordered barium swallow test and a subsequent videoesophagram reveal lack of esophageal motility, meaning that the esophagus has lost its force to push food down, and your food enters your stomach only because the California Democrats have not yet regulated and taxed Gravity, then you cannot sustain a full “nissen” wrap-around. Instead, then, the surgeon will do a “toupet fundoplication” which is a partial wrap, sewing the fundus some 180-270 degrees around the lower esophagus while still leaving an unsewn portion a bit of a gap so ingested food can reach its intended destination.
When the fundoplication surgery is done along with a repair of the hiatal hernia, the result can be a complete end to all bile and acid seepage from the stomach or, at least, such a profound reduction of seepage that at least it no longer enters into the esophagus and lungs. The success of the surgery is confirmed through post-op follow-ups, diagnostics, and ultimately with another Bravo wafer inserted a year later. If pursued timely when medically indicated, it can save a life from Barrett’s Esophagus, from certain severe lung diseases, and can help eliminate an important and oft-overlooked potential cause of esophageal or lung cancer. An even newer medical approach now in service, but only for those who have good esophageal motility, is the Linx procedure. The Linx is a small ring that is inserted at the junction of the fundus and lower esophagus. It is comprised of several small metal magnets that hold the circle together, effectively creating a ring-lock barrier blocking bile and digestive acid from seeping upward out of the stomach, but releasing the magnetic pull and thereby loosening the ring to make room when food comes down the esophagus and is forced forward to the stomach by peristalsis and esophageal motility. Thereafter, when the food has passed and the downward force relents, the magnets re-tighten. However, the Linx cannot be offered to patients who lack the esophageal motility to push the magnets apart when food approaches.
I had been taking over-the-counter omeprazole for years, and more recently had moved to prescription Pantoprazole (also known as Protonix). However, in time, I underwent a Bravo endoscopy, and that led me to learn that I could have enhanced my health much sooner and much better had someone written an article like this one a few years earlier.
Urological Monitoring Can Save Your Life
Which brings me to the last one: male urology and the PSA test that assesses protein-specific antigens. There is no certainty of correlation between PSA results and possible prostate cancer, but urologists who encourage PSA testing look hopefully for results below 4. A PSA score between 4 and 10 causes increasing concern, and a score above 10 generates extreme concern. Beyond the numerical score, the urologist looks for velocity — has the PSA score changed all that dramatically since the last test six or twelve months ago? Some people have scores above 4 that reflect merely increased age and an enlarged prostate, inherent in growing wiser in years. As the prostate grows larger, it obviously will be inclined to contain a higher quantity of the protein-specific antigen (PSA) being measured. Some have “saw-tooth” PSA scores that inexplicably go up at one blood test, down the next, up the next, down again… like a saw tooth. Inasmuch as PSA alone is not always an authoritative gauge of possible prostate cancer, new tests also have emerged, including the PCA 3 test and the even-newer 4K-Score test. The important thing is for men, as they age a bit, to find a reliable and skilled urologist to monitor their prostate health. My urologist told me recently of a new patient who had come to him with symptoms of concern. He ordered a PSA test, and the score was not under 4. Nor was it within 4 and 10. Nor was it even somewhat over 10. Rather, the score was …three hundred and eighty. “Rabbi,” the urologist said to me, “I so much wanted to yell at him and say: ‘Didn’t you get the memo?’” To be sure, most prostate cancers progress so slowly that, only after death, is it found that men had been living with it for years; therefore, many health professionals discourage overly aggressive treatments, and many even question the value nowadays of PSA testing, which can result in heightened stress and perhaps unnecessary treatments that can cause worse situations (sexual impact, incontinence) than the disease. But every man at a certain age should be including a urologist in his annual medical visits.
You now have the memo. Take good care of yourself. Get the best insurance coverage you can. Carefully select the best medical doctors, medical group, or medical provider you can. Be an advocate for your own health. Don’t allow a mediocre or sub-par doctor to gaslight you. As an Orthodox rabbi, I truly believe that all medical results are in G-d’s hands, not those of a physician, but G-d helps those who help themselves. He guides us to people skilled in healing, even as He guides their hands. Indeed, He guides us perhaps even to read an article like this.
Remember — and never forget — the noun we use in the English language for the medical school student who graduates last in his or her class: We call such a person “Doctor.” So pick your doctor carefully when you have a choice. Ask your pastor or priest or rabbi for leads because, over the course of years, they learn from their congregants in confidence whom to trust and whom to avoid. Ask close family and friends. Seek referrals from a doctor whom you trust. Do not be scared off by a few bitterly negative Yelp reviews for a highly recommended doctor. People have all kinds of reasons for getting their bile and acid into their keyboards and “getting even,” sometimes because of their own issues. If a matter is severe or complex enough, try consulting with a second skilled specialist, too — get a second opinion. (You know about the guy whose doctor gives him bad news, and he asks the doctor whether he would mind if asks for a second opinion… and the doctor responds, “You want a second opinion? OK, you’re ugly also.”)
And if you learn that you have something wrong, tell your grown kids because they are comprised in part of your DNA, so if you have learned that something runs in the family, do them a favor and let them know in advance to watch for it, and you might save their lives, too.
Unless they voted for Hillary or Bernie. In such case, they obviously are much smarter than we are, so they can figure it out much better on their own.
Eduardo Montes-Bradley/Creative Commons