24 JanAuthor Profile: Ramin Manshadi, The Wisdom of Heart Health

Why did you decide to write this book?

I have noticed throughout my years of experience that the more educated my patients, then the more likely for the patient to be compliant with their medical advice which can lead to a better health. I put out a questionnaire for my patients to see exactly what would interest them if I were to write a book. These ideas lead to different chapters in my book. I looked for all other heart health books out there, but I did not find any of them to be a type that would be easily readable and understandable. On top of this they lacked the personal touch of a physician.  I knew that I can do better. So far I have heard nothing but positive from my readers. I also wanted to help raise money for my project that is placing AEDs in all of the High Schools in Calif by using the proceeds of this book for this reason.

Do you have any secret writing tips you’d like to share?

Think, and grasp the big picture then write.

Have you ever battled writer’s block? How do you deal with it?

Stop and move on to a different topic then come back.

What’s your favorite quote?

“The Earth is but Once Country and mankind its citizens.”  By Bahaullah the prophet founder for Baha’I Faith

“Knowledge is power”

Who inspires you the most?

In humanitarian acts: Abudlbaha the son of  Bahaullah. He travelled all around United States and promulgated world peace in 1912.
In leadership, Abraham Linclon.
In science, Albert Einstein.
In Cardiology, Dr. Ezra Amsterdam. He is loves his profession and is an excellent teacher.

Dr. Manshadi is a multi-boarded interventional Cardiologist treating patients from prevention to intervention. Because of his dedication to his work and patients he has been awarded Americas Top Doctors Award from U.S. News and World Report, and patient’s Choice Physician award. He complements his private practice with Academic Medicine and currently serves as Associate Clinical Professor at UC Davis Medical Center, Clinical Professor at University of the Pacific, and serves as the Chair of Media Relations for American College of Cardiology, California Chapter.

For more information visit: www.drmanshadi.com

24 JanBook Excerpt: The Wisdom of Heart Health by Dr. Ramin Manshadi

Chapter Eight: CHOLESTEROL

The Good, The Bad and The Ugly

Most of you certainly know about cholesterol. Cholesterol is terrible. Awful for the body. We’d be better off without it! Right?

Wrong.

The truth is, cholesterol is one of the building blocks to our cells. Every cell in our body has cholesterol in it, including those in our brain, heart, muscles, intestines, skin and nerves. Cholesterol is also the backbone of male and female hormones, as well as vitamin D and the bile acids that help digest fat.

In other words, we need cholesterol to be healthy. That’s why our body makes its own cholesterol in the liver. We need only small amounts of cholesterol in our blood to supply these requirements.

But we also take in cholesterol from outside our body – through food. Many people consume too much cholesterol because of the types and amounts of foods they are eating. When that happens, the extra cholesterol in our bloodstream can deposit in our arteries. This is often a prime focus of the cardiologist.

Genetics Can Play a Role

Before we continue, let me point out that too much cholesterol isn’t always because of a bad diet. Some people have genetically high cholesterol. Researchers are not sure yet if this is because they produce it more, absorb it more, or from some other cause. Though rare, some people can exercise and watch their diet, but still have a lot of bad cholesterol. For these people especially, their only method to control their levels is through some kind of medication, which I’ll address in detail in Chapter 39.

On the other hand, though also rare, some people can be obese and not exercise – and their cholesterol is perfect. They’re among the very fortunate, and can thank their genetics for that one.

Why is Too Much Cholesterol a Problem?

Though I will go into further detail later in this book, let’s simply start here by saying that if you have too much of the bad type of cholesterol, it can enter the inner lining of an artery, causing inflammation that may promote plaque formation and lead to blockages.

But truly understanding cholesterol begins with realizing there are three main components to “total cholesterol.” They are what I like to call The Good, The Bad and The Ugly.

The good is HDL cholesterol.

The bad is LDL cholesterol.

The ugly are triglycerides.

Because of this, I do not look at total cholesterol as a marker (indicator) for having high cholesterol. That is how it was done in “the old days” when someone would say, “My cholesterol is 250.” My reasoning is this total cholesterol number is the sum of all your types of cholesterol – including the components of good cholesterol. For example, your total cholesterol could be 250, but your HDL (good cholesterol) could be 80. Your LDL (bad cholesterol) could be 130, and your triglycerides 200.

In general, you want to increase your levels of HDL, to above 40 for men and above 50 for women. Similarly, it’s best to decrease your LDL – generally to below 100.

Fortunately, with new advancements, we can now be even more precise with these measurements.

Going Further – Subclasses of LDL

We now even go beyond dividing cholesterol into its three categories. There are tests today that can examine within the LDL, looking at two subclasses, A or B.

The A subclass is large and buoyant, and is preferred as it will not go through inner linings of vessels to cause blockages. But the B is smaller and denser, and can traverse the inner lining of the vessel and cause fat buildup, which can cause inflammation and then blockage, which can eventually lead to a heart attack.

Just to demonstrate how cardiology is evolving, we’ve also now discovered an offshoot of LDL called LPa. It’s similar to LDL, but can cause more blockages. At this point, the only medication that can lower LPa in our system is niacin, which is a B vitamin (which I’ll address further in Chapter 39).

Personally, I think everyone should be tested for these types of detailed factors. A person could do a regular LDL lipid panel and have it show that everything is good. But you really want to know which subtype you have within your LDL.

The test is called a VAP test. Turns out, this more detailed blood work isn’t really more expensive. It was costly when it first came out, but no longer.

We’ve now found that even HDL has subtypes, some being most beneficial, while others not helping that much. But at this point in time, these HDL different levels are very hard to adjust, so I don’t put too much focus on them. We simply look at the HDL levels. For women, the goal is to be above 50. For men, about 40. If tests were to show less than these numbers, that’s when cardiologists advise taking actions to raise the HDL, such as exercising, or stopping smoking if you are a smoker.

So what about “The Ugly?”

Many have heard of triglycerides, yet most still don’t know they are basically fat. That by itself can lead to more of the bad subclass of LDL cholesterol. Accordingly, cardiologists want to keep patient triglyceride levels low – below 150. If their levels are above this, patients may be advised to alter their diets, eating less of certain foods, and more of others like fish.

Too Little Cholesterol?

Theoretically, someone could have too little cholesterol. We don’t know exactly what might be too little. But we can cite that a little baby’s LDL cholesterol is only 30, and babies experience the highest body growth rate and are in more need of generating cells than anyone. So you would think that even levels down to 30 would be fine.

Educate Your Doctor?

All these new tests really are a blessing. Consider Jim Fixx, an accomplished runner who wrote the best-seller, “The Complete Book of Running.” Everyone assumed he was extraordinarily healthy. Then in 1984, he died of a heart attack.

Why? High cholesterol. Back then, there wasn’t the sophistication that we have today to measure the subtleties of cholesterol. Yet even today, some primary physicians do not know the distinctions of the different types of LDL that should be measured. That’s one of the main reasons I want readers to learn from this book – so they can take an active role in their own health. Sometimes they have to educate their doctors. Sometimes, they have to change their doctors.

Dr. Manshadi is a multi-boarded interventional Cardiologist treating patients from prevention to intervention. Because of his dedication to his work and patients he has been awarded Americas Top Doctors Award from U.S. News and World Report, and patient’s Choice Physician award. He complements his private practice with Academic Medicine and currently serves as Associate Clinical Professor at UC Davis Medical Center, Clinical Professor at University of the Pacific, and serves as the Chair of Media Relations for American College of Cardiology, California Chapter.

For more information visit: www.drmanshadi.com

24 JanMatters of the Heart: Women and Heart Disease

By Guest Blogger Dr. Ramin Manshadi

There is emerging awareness and concern today, as more women now die from coronary disease in this country each year than do men. In fact, when women show up with their first heart attack, 52 percent of them die from sudden cardiac death. Men, 42 percent. This is true even if women don’t have significant blockages in their vessels.

Some of the explanation behind this is that the disease has actually progressed further without a woman necessarily being aware of it. This is partly because women don’t seek out cardiology doctors as much as men do. Plus, when many doctors see female patients, even they don’t treat them as aggressively as they do men. They underutilize the American Heart Association guidelines for treating women, which at the moment are identical for both sexes.

Additionally, there are circumstances linked to heart problems that are unique to women. A recent study showed that the risk of a heart attack for a woman who’s had at least one stillbirth was 3.5 times higher than for women who’d had none. Those who have experienced more than three spontaneous miscarriages had a fivefold increase in their likelihood of having a heart attack.

Furthermore, like men, women are not immune to stress impacting their heart health. A recent 10-year Harvard study found that women with high-stress jobs had a 40 percent higher risk of having some kind of heart disease, along with an 88 percent higher likelihood of experiencing a heart attack.

Women’s predisposition toward heart disease is not only a new perception for many doctors, it also contradicts the expectations of most women, who are generally more concerned about cancer than heart disease. This is despite statistics that show for women, one out of every 2.6 deaths in the U.S. is due to heart disease, while one out of every 4.6 females that dies is because of cancer.

Women have Different Symptoms

Another aspect of the misperception that women are less prone to heart disease than men are the differences in how symptoms show up in women and men. Instead, women get “angina equivalent.” That can be pain in the upper back, fatigue, shortness of breath, or perfused sweating. It’s not as dramatic or clear. And not as well-known.

Additional Dissimilarities

Aside from the already described disparities between women and men in connection to heart disease, women are also distinctly different in terms of:

•    Microvascular Dysfunction
•    Plaque Erosion (and distill microembolization)
•    Abnormal Coronary Reactivity
•    Higher Cholesterol
•    Calcium Scores
•    CIMT Results
•    Framingham Risk Assessment Results
•    Response to Emotional Distress
•    Likelihood of Obesity
•    Vitamin D Deficiency

Let’s take a look at these areas in more detail.

Microvascular Dysfunction

When comparing effects of heart disease on men and women, we have to factor in that women probably have more microvascular dysfunction (sometimes called microvessel disease). It’s one reason that most women don’t exhibit the same warning signs as men – their symptoms and pain are microvascular.

What does this mean?

Heart disease may not necessarily involve a big blockage in a big artery. It can be blockages down in this microvascular system (micro means very small). These microvessels typically control blood supply to the heart tissue during times of high demand, such as exercise or stress. Blockages in these can cause ischemia (decreased oxygen and nutrients to tissue). If lasting long enough while demand is high, a heart attack can result.

This appears to be more of an issue for women than men. One explanation is that the variances in hormone levels throughout a woman’s life (changing during pregnancy to peripartum to menopause), all can raise the risk of more microvascular disease.

So women may not have big blockages in main arteries on top of the heart as much as they have tiny ones inside muscles and organs. These microvascular blockages actually create more symptoms, but doctors can’t figure out why the patient is having them. As a result, many women coming in with this problem will be told they’re not candidates for treatment. But if your doctor isn’t concerned about these symptoms that you bring in, you might bring this possible explanation to their attention.

Plaque Erosion

Fat in the artery is called plaque. It adheres to an artery wall, builds up and slowly erodes into the artery.

Women are more prone to erosion – meaning the plaque that has adhered and built up on the artery walls, eroding off into the bloodstream – creating likelihood that it will lodge somewhere to cause a blood clot and block the blood flow, causing a heart attack.

Another clot-forming tendency with women, aside from plaque erosion, is they may develop smaller clots on the surface of a large vessel, which then separate and flow through the blood to block smaller vessels further down.

Coronary Reactivity

Women can also have what we call abnormal coronary reactivity. It means their vessels react differently than normal under stress. They may not necessarily have a clot or blockage, but because of stress-related issues, they’re more prone to these arterial spasms that cause less blood flow to the heart and possibly chest pains. If severe enough and continuing long enough, these spasms can even cause a heart attack.

Higher Cholesterol

Women also tend to have higher cholesterol than men. Within that cholesterol, they also tend to have lower HDL (the good cholesterol). Additionally, high triglycerides tend to more negatively affect women in terms of causing blockages and heart attacks.

Calcium Score

When you get plaque inside your arteries, it can go under the vessel wall, build up, and become calcified. This is of concern.

Calcium scores vary from zero into the 1000s. Different levels predict the likelihood of developing heart disease over the next 10 years. It’s a good screening test, especially for patients who are borderline risks (like having a positive family history or being diabetic).

It is significant for women if they’re at high risk from the calcium score, as chances for them developing heart disease or heart attacks are consequently 10 percent more than for men.

CIMT

Another difference in women and men is their CIMT results. CIMT measures the thickening of the inside lining of the neck’s carotid artery that goes to the brain. Typically, if that result is normal, we measure the risk at only one percent. But if it turns out higher than what should be for someone of a certain age, the risk of having a blockage and a heart attack in the next 10 years will be much higher than if it was normal. That is generally true equally for men or women.

However, as the thickness increases, the risks are much higher in women than men.

Limits of the Framingham Risk Assessment

There is another reason why women may not be diagnosed as early with heart issues as men.

An evaluation referred to as the Framingham Risk Assessment is commonly used to compare variables such as age, sex, total cholesterol, HDL cholesterol, blood pressure and whether you smoke. It’s designed to determine if you are at low or high risk for developing heart disease or attacks in the future. But it undercuts some of the biomarkers particular to women. This is especially significant, since if the score comes out relatively low, some doctors may not perform further screening tests.

A newer assessment, called Reynolds Risk Score, would be a better choice. This assessment is more male/female specific, and considers the following variables:

•    age
•    gender
•    systolic blood pressure
•    CRP
•    Total Cholesterol
•    HDL
•    Hemoglobin A1C (a marker for diabetes)
•    smoking
•    family history

Utilizing this formula, we’re better able to detect early heart disease in women.

Broken Heart

Not literally tha the heart is “broken.” But there is something referred to as “broken heart syndrome.” As you might imagine, it refers to an emotional sorrow.

It is most often used to describe the condition of an elderly woman with recent emotional distress who has a heart attack.

Everything looks like a heart attack, but there are absolutely no blockages. Yet it’s actually a heart attack. What probably occurred was that the heart wasn’t getting enough oxygen, but then in a few moments the heart goes back to normal. The muscle is acutely damaged, though not bad enough to last an extensive time.

So is there an emotional connection? Does “sadness in the heart” somehow affect it physically? Science is still searching for those answers.

Weighty Subject

Another factor more emphasized in women is weight. The obesity epidemic in this country appears to be striking women more than men. Two-thirds of the female population is obese. Obesity is a risk factor for developing heart disease (as well as diabetes).

Vitamin D Deficiency

It is commonly agreed there is a general deficiency of vitamin D in women today. We know that vitamin D plays a significant role in healthy bones.

A recent study points to vitamin D deficiency in younger women possibly elevating risks of high blood pressure in mid-life. The pre-menopausal women in the study with this vitamin deficiency were three times more likely to have systolic hypertension 15 years later, when contrasted to others with normal vitamin D levels.

Women would be wise to get more vitamin D-producing sunshine, increase the amount of vitamin D-rich foods in their diets, or take supplements, consulting with their doctor as to appropriate amounts.

The myth that women are somehow more immune to coronary disease than men is clearly fading. Women need to be just as conscientious toward their health habits as do men, and similarly consult with a cardiologist when necessary. Their warning signs can be more diverse than the classic indicators, which means that in some cases, women may proactively need to “educate” their own doctors to current information.

Dr. Manshadi is a multi-boarded interventional Cardiologist treating patients from prevention to intervention. Because of his dedication to his work and patients he has been awarded Americas Top Doctors Award from U.S. News and World Report, and patient’s Choice Physician award. He complements his private practice with Academic Medicine and currently serves as Associate Clinical Professor at UC Davis Medical Center, Clinical Professor at University of the Pacific, and serves as the Chair of Media Relations for American College of Cardiology, California Chapter.

For more information visit: www.drmanshadi.com

24 JanHeart Concerns and Erectile Dysfunction

By Guest Blogger Dr. Ramin Manshadi

People with coronary conditions naturally wonder if sex can put a strain on their heart.

It is possible. The general guideline is that walking up two flights of stairs equates to the strain on your heart while having a sexual encounter. If the patient can make that climb without any significant shortness of breath or chest pain, the likelihood of having difficulties from sex to be low. Not zero, but low.

So the healthier your heart, not only is the sex safer (we all want safe sex!), but also more enjoyable as you have increased stamina.

It should be pointed out that this concern doesn’t only apply to older persons, people in their thirties could be experiencing chest pains during sex, which could be a sign they have a very high-grade blockage in their heart.

Erectile Dysfunction

Issues with heart health can create other, seemingly non-related health issues. But a problem you might not expect to be connected is erectile dysfunction. While this exclusively affects men, it in turn has consequences for women as well.

Also called impotence, erectile dysfunction refers to an inability to sufficiently maintain an erection to have sex. Occasional impotence isn’t necessarily something to worry about, but a recurring problem can be another matter. It can negatively affect your sex life, your relationship, and even your self-esteem.

It may also be a sign of underlying medical problems.

While stress, tiredness, depression or relationship issues can also be the reason, there are a number of possible physical causes for impotence. Men with sexual problems of this nature are often smokers, people with high cholesterol or diabetes. All of these affect the inner lining of the arteries. This can cause erectile dysfunction. It is the blood flowing through the arteries that feed the male organ. If you have blockages there, it may be obvious, as that can interfere with its function. But it doesn’t take an actual blockage to affect the quality of your sex. High blood pressure can also impact the area. The sheer force of the pressure of the blood going to the vessels can damage the function of an artery. And if the artery isn’t functioning well, then the organ will run into problems.

Many men have never suspected there’s any correlation. In fact, many believe erectile dysfunction is simply something that often happens as they get older. But in truth, one of the main reasons this dysfunction occurs, is that as men get older, their cholesterol levels have risen, and plaque has built up in the arteries. Testosterone and other hormones also play a role. But the dysfunction for many relates directly to the condition of their vessels.

Men being men, they don’t say anything. They don’t know to ask or are simply too embarrassed. Usually it’s the wife who speaks up and asks, “Is there anything we can do?”

Fortunately…Yes

If you treat your underlying health issues by being active, eating right, not smoking and keeping your cholesterol down (and your sugar intake down if you have diabetes), you’re more likely to have better function. Sure, it will take some effort. But the results are undeniably satisfying.

 L-Arginine

If improving your health behaviors doesn’t solve the problem, there are medications that doctors can prescribe. There is also an over-the-counter supplement that can assist. Called L-Arginine, it is an amino acid that has been shown in studies to improve function of the inner linings of arteries by helping the nitric oxide pathway. Not only can it potentially lower blood pressure, it has also been known to help correct erectile dysfunction. It should be noted that L-Arginine can interact with some other heart medications, including high blood pressure medicines known as ACE inhibitors, as well as nitroglycerin. So check with your doctor.

 VIAGRA

Viagra is a medication commonly prescribed for erectile dysfunction (impotence) in men. While the best known, Viagra isn’t the only one in this class of drugs. There is also Levitra and Cialis, both of which function similarly. All have been “miracle” drugs for many with this ailment. However, they also pose some very real concerns for those with heart conditions.

These types of drugs (phosphodiesterase inhibitors) work by inhibiting a particular enzyme in blood, thereby causing dilation of the vessel. When you have dilation of the vessel, the penis engorges with blood. That is how an erection forms.

Drug Interaction: Passing out and Heart attacks

There is a problem with using Viagra while taking nitrates. Nitrates are used by people who have chest pains. They’re placed under the tongue to relieve the pain. But nitrates also cause vasal dilation, and the Viagra intensifies their effect. When you have too much vasal dilation, your blood pressure drops, you don’t get enough blood flow to the brain and you can pass out.

A different problem can occur as well. If you vasodilate the arteries too much, they open up and the heart muscle itself doesn’t get enough blood. If you already have some kind of blockage there, and suddenly have a supply/demand mismatch (more demand than supply), not enough blood flows to the heart muscle due to the lowered supply. It can precipitate a heart attack. In general, you should not take Viagra within 24 hours of any nitrates.

Other than Drug Interference… is Viagra Safe?

In general, there are two types of patient population: those with known heart disease and those without known heart disease. Of course, people without any known heart disease still might wonder if they can take the drug. To answer that, they can do a simple self-test. If you can go up one flight of stairs without significant chest pain or shortness of breath, you should be fine taking this drug.

On the other hand, if you do have heart disease, your cardiologist should make a recommendation whether you can take the drug, based on the status of your condition. For instance, if you have single vessel disease, meaning you have one blockage that’s been opened up by stenting, then you should be able to use Viagra. But if someone has multiple vessel blockages, or diffused disease in arteries that have not been corrected, then probably best not to use this drug. Once full blood flow has been restored to the heart and the patient has no more symptoms of chest pain or significant shortness of breath, then it should be safe.

Ask your doctor before using this drug, rather than simply rely recollection or understanding about the specifics of your condition. Plus, no two patients are exactly the same. The above are just guidelines. So final advice: consult your physician.

Dr. Manshadi is a multi-boarded interventional Cardiologist treating patients from prevention to intervention. Because of his dedication to his work and patients he has been awarded Americas Top Doctors Award from U.S. News and World Report, and patient’s Choice Physician award. He complements his private practice with Academic Medicine and currently serves as Associate Clinical Professor at UC Davis Medical Center, Clinical Professor at University of the Pacific, and serves as the Chair of Media Relations for American College of Cardiology, California Chapter.

For more information visit: www.drmanshadi.com

24 JanThe Athletic Heart: Sudden Cardiac Death in Athletes

By Guest Blogger Dr. Ramin Manshadi

Sudden Cardiac Death (SCD) is a non-traumatic, nonviolent, unexpected death due to cardiac causes within one hour of the onset of symptoms. Though there is no official registry, research suggests between 200-300 high school athletes die of SCD each year.

What Happens During Sudden Cardiac Death?

Simply, these athletes die of arrhythmias.

A correctly functioning heart has electrical activity going from the top of the heart to the bottom, making the heart squeeze and pump correctly. An arrhythmia is when the entire electrical portion of the heart is firing all at once. The muscle cannot function. The pumping fails. You pass out since you’re not getting enough oxygen to the brain, and in time you die. The most obvious sign of an arrhythmia is blacking out due to lack of blood pressure.

CPR doesn’t really revive you. That can happen, but CPR really just keeps your heart pumping blood through your body by pressing down on the chest. This keeps you alive until paramedics or someone arrives to perform more intensive intervention (like with a defibrillator) to restore heart function. In fact, you should be aware that CPR isn’t even always successful. It really needs to be performed perfectly to keep a patient alive. That’s why staying practiced and updated on its ever-improving protocols is so vital. If you ever have the opportunity to learn or review your CPR skills – take it.

Fortunately, young athletes are generally very healthy. As soon as they’re down, if you shock them with a defibrillator, their heart rhythm can restore. They come back very fast and are just like they were before. It’s pretty astonishing.

Prevention as Solution

If we have a policy in place in which a competent physician evaluates all athletes before they start rigorous exercise activity, we can prevent many young athletes from abruptly collapsing and dying.

Others have already begun doing this. In Northeastern Italy, a simple EKG test has been added to the examination of all athletes. An EKG is a simple exam costing only around $30. With this simple testing, they were able to cut down the risk of sudden cardiac death in their athletes by 85 percent!

We need to adopt using such a test in the United States as well. While there are more expensive tests one can do (like an echocardiogram), an EKG should be able to detect over 95 percent of those with the underlying conditions that could lead to sudden cardiac death.

Athletes should be aware of the possible warning signs of SCD, which include:

•    Chest pain
•    Palpations
•    Dizziness
•    Feelings of passing out
•    Shortness of breath outside of the norm one would expect with exercise

If experiencing these symptoms, a cardiologist knowledgeable about SCD in athletes should evaluate the person.

The Solution on the Field

While prevention is key, something can also be done if an arrhythmia causes an athlete to collapse.

A terrific device called a defibrillator sends a therapeutic dose of electrical current into a person’s body to normalize heart function in various life-threatening situations. It’s what you’ve seen on TV and in movies, where paramedics place paddles on the patient’s chest in a hospital or, and the heart is “shocked” back into beating correctly.

In real life, if someone collapses and you get to him or her within five minutes and shock him or her out of arrhythmia, they will likely survive. But if it takes longer than five minutes to shock them in this manner, the likelihood of survival is almost zero. That’s why these devices need to be at athletic fields everywhere. The time it takes for someone to phone for help, for paramedics to arrive and get to the student, break out the equipment and use it – will most likely exceed those precious five minutes.

Portable Automatic Defibrillators

Fortunately, there are also portable “automatic” defibrillators. Even a person with little training can use one. You simply attach the leads to the chest, press the button, and it performs its own diagnosis and shock. So if someone collapses, you grab it and use it right away before paramedics even get there. If a portable automatic defibrillator is applied within the first minute, the survival rate is 90 percent. But if no such defibrillator is present, then survival drops to five percent, even with CPR. These defibrillators cost about $2000 each, but if one of these can save someone’s life, they’re worth many times that. It is imperative that high schools and colleges possess these life-saving tools.

Most recently, The Sacramento Kings basketball organization realized the importance of schools having portable “automatic” defibrillators, and has been working to create a PSA (public service announcement) to raise awareness of sudden cardiac death in athletes. In fact, once the owners, Gavin and Joe Maloof, originally became aware of this project, they immediately got personally involved. Geoff Petrie, the General Manager, similarly offered to support the cause without hesitation. In addition, their media team has shown a genuine caring attitude in their assistance with this PSA community.

Athletics Offers Terrific Benefits

Athletics has benefits far beyond the exercise and fitness. It has the positive effect of socialization, competitiveness and teamwork, Plus the sense of achieving a goal. Every student-athlete should be involved in some sport. Not necessarily to become a pro and earn money, but to develop these values that will help in their future and daily work lives.

Being competitive, while also being a gentleman or gentlewoman as an athlete, is an example of what can help you to be successful in life.

It is important to relate this because while there are risks in everything, there are distinct benefits as well. It wouldn’t be beneficial for parent or student to shy away from participating in athletics because of anything that has been presented here.

It is important to relay health information like what has been described above, even if it makes some people uncomfortable. Perhaps that discomfort will motivate others to champion their own quest to enhance protections for our young athletes.

Knowledge is Powerful

Bottom line, athletes must simply be informed about their own body and how it functions, not just for their own sake, but for the sake of their team too. If you see a teammate experiencing a medical “event”, everyone else might stand around not knowing what happened (possibly thinking the fallen individual only had the wind knocked out of him). But you, with the knowledge presented here, may jump into action. Start CPR while yelling for someone to call 911, or summon the proper equipment to resuscitate someone. Perhaps an athlete’s life will be saved – simply because someone took the time to read this article.

Dr. Manshadi is a multi-boarded interventional Cardiologist treating patients from prevention to intervention. Because of his dedication to his work and patients he has been awarded Americas Top Doctors Award from U.S. News and World Report, and patient’s Choice Physician award. He complements his private practice with Academic Medicine and currently serves as Associate Clinical Professor at UC Davis Medical Center, Clinical Professor at University of the Pacific, and serves as the Chair of Media Relations for American College of Cardiology, California Chapter.

For more information visit: www.drmanshadi.com

24 JanTen pearls for women to know to help prevent a heart attack or stroke

By Guest Blogger Dr. Ramin Manshadi

1). Try to maintain an excellent health while pregnant and carry through with you pregnancy.

A recent study showed that women who have experienced a stillbirth or repeated miscarriages.

Have a greater chance of having heart attacks later in their lives. The risk of heart attack for a woman who had at least one stillbirth was 3.5 times higher than for women who’d had none.

A deficient prenatal nutrition can potentially cause a weak heart and vascular system since the nutrients are diverted to the fetus’s brain rather than the heart.

2). Avoid and control stress

A recent 10 year Harvard study found that women with high stress jobs had a 40 percent higher risk of having some kind of heart disease, along with an 88 percent higher likelihood of experiencing a heart attack.

3). Women should pay attention to Feeling tired, short of breath, or having diffuse sweating.

Women do not have the classic tell-tale symptoms of blockages that men have. The classic signs of angina or heart attack in men are chest pressure with walking, radiating to the left arm, with nausea. In women, instead, the symptoms can be pain in the upper back, fatigue, shortness of breath, or peruse sweating. If women have these symptoms, then they need to
visit a Cardiologist ASAP.

4). Treat your cholesterol aggressively.

Women tend to have higher cholesterol than men. Within the cholesterol, they tend to have lower HDL( the good cholesterol) . Additionally, high triglycerides ( the high fat content cholesterol) tend to more negatively affect women in terms of causing blockages and heart attacks.

5). Use Reynolds Risk Score (RSS) to asses risk for heart attack rather than Framingham Risk Assessment (FRA)

This is another reason why women do not get diagnosed as early with heart issues as men.

FRA undercuts some of the bio markers particular to women. This is especially significant, since if the score comes out relatively low, some doctors may not perform further screening tests. RSS is more gender specific and consider more variables.

6). Maintain ideal body weight

Another factor more emphasized in women is weight. The obesity epidemic in this country appears to be striking women more than men. Two third of women population fall into the obese category. One of the main reasons for developing diabetes is obesity. Diabetics have an equivalent risk of heart attack as someone who already had a heart attack.

7). Have your Vitamin D checked

Vitamin D deficiency in younger women can possibly elevate the risk of developing high blood pressure in mid- life. High blood pressure is a risk factor for heart attack.

8). Keep Good Thoughts

A recent study showed that women who were optimistic had a lower level of developing heart disease and dying than pessimistic women. Optimistic were nine percent less likely to develop heart disease than pessimistic, with a 14 percent lower likelihood of dying.

9). Moderation in exercise is recommended

Women tend to have a significant micro vascular disease meaning tiny arteries having dysfunctional endothelium ( the inner lining of the artery) which can lead to plaque build up. Exercise in moderation can help improve endothelial function.

10). Quit smoking

Once again, besides all of the known negative effects of smoking on our bodies, smoking can severely damage endothelial function and accelerate heart disease and heart attack.

Dr. Manshadi is a multi-boarded interventional Cardiologist treating patients from prevention to intervention. Because of his dedication to his work and patients he has been awarded Americas Top Doctors Award from U.S. News and World Report, and patient’s Choice Physician award. He complements his private practice with Academic Medicine and currently serves as Associate Clinical Professor at UC Davis Medical Center, Clinical Professor at University of the Pacific, and serves as the Chair of Media Relations for American College of Cardiology, California Chapter.

For more information visit: www.drmanshadi.com

24 JanTransitions

By Guest Blogger Chris Bryant

 

There was a time, a long time ago, when I wasn’t where I am now.  I didn’t used to examine every detail. I didn’t try to explain everything as something else.  The time I refer to is when I was a child.

As a child, I didn’t have a care in the world, other than which toy to play with first.  Life was simple, for the most part.  As it is with most families I’m sure, not everything was perfect.  My little brother and I grew up with my step-dad, who adopted me at a very young age.  We were raised with military precision.  Loud noise was not tolerated, talking back, sitting slouched, a certain level of cleaning, etc.

All of my childhood, I disliked this authoritative figure, even to the point of hate.  It wasn’t until I had grown into the person I am today that I realized how influential he really was and regardless of his methods, he was simply preparing us for the worst.  I am eternally grateful.  Also, from this, at the time, seen negativity, sparked something in me I never knew I had.  A talent.  I still remember the first day.  I asked my step-dad to draw me a picture of a train for school, which he did and did well.  I was impressed.  I had never tried something with such detail before.  So, I decided that afternoon to try myself and was amazed at the quality of the picture I had recreated.  From that day forward, I swore to myself I’d never trace again and I’d strive to draw things with more and more detail.  I’d never settle for less than a challenge.  To this day, I still hold to that.

As a teenager, I began to see the amount of detail I was putting into everything I drew.  I started understanding it, understanding the shadows, the lighting, the angles, and much more.  Thus, another talent was born, writing.  Although, I didn’t fully understand what I was trying to describe and used words that were by far more adolescent than I use these days, I enjoyed what I did.  I still drew, but it became slightly less, mostly due to the young adult lifestyle I lived.  Hanging out with friends, school, and of course homework took precedence.  Yet, through all of that, my mind still soared with the birds and swam with the fish.  I climbed mountains, walked with the indigenous, treasure hunted, battled mummies, and much more.  My artwork grew more detailed as well, surpassing my writing style with ease.  My vocabulary still lacked definition and my words lacked meaning.  It wasn’t until my twenties that I finally saw what I needed to do.

As an adult, now in my early twenties, I began to really expand my vocabulary.  It may sound funny, but this actually worked for me.  I’d watch movies with the subtitles on and when there was a word I didn’t know, I’d write it down and use it in one of my stories to expand my vocabulary.  Subtitles have actually become a great tool and I still continue the process to this day, whether it be to use the words I hear or just to learn the definition.  My art began to form better, my words began to flow more.  It was around this time I really embraced writing.  I began the project that is now my first published work thanks to all that I’ve learned over the years.  I don’t think my writing style would be liked by so many if I hadn’t learned from all the experiences I’ve had over the years.  I’ve included an example from a new chapter of my next book I’m currently working on as an example.  I hope you enjoy it.

“NOOOO!!” Shino screamed, running towards the creature. “FOOL!” The creature bellowed, blasting Shino back six feet on his back. “Do you not know who I am? You insolent little maggot! You cannot fathom the power I possess! How is it you plan to beat me? HAHAHAHA!! You are weak! I am Sephiran. You are dead.” Shino watched in horror as Sephiran gutted his parents first before turning to finish what he had started. Just as Sephiran swung down on Shino, A loud clang rang out just above him. Standing there, covered in sweat and burned from fighting fires, holding a sword blocking the attack was Chingon!

“Creature, you fight me! I am the sanctuary’s hope and no other has the honor of this fight!”

“Hahahaha! You are brave, small one, but you cannot defeat me. Not with darkness in your heart. Yes, I sense it like it’s a sign lit up for the world to see. You are mine!” Sephiran snapped his fingers as he rose to his full height, his dark blue wings folding behind him. At his full height, seven feet, he towered over the two men beneath him. His green robes conformed to his jet black body. The only part of him that hinted at color were the white accents around his eyes, nose, and mouth. His eyes, blood red, glowed like a street light.

At the sound of Sephiran moving, Chingon lunged. As he did, his right arm began to burn. Black seared his whole side before he could yelp a cry of pain. In the short time the rest of his body up to his neck burned, Sephiran approached Shino again. “Let’s see if you can fly, hero!” With that, he threw Shino as hard as he could. Shino flew through the air towards, then past the wall of the sanctuary. He was in a daze as his world began to disappear. He was falling quickly. He didn’t know if he’d survive the fall or not. How could he be a part of that boys life if he was about to die? Could the keeper have been wrong?

Chingon felt a surge of energy rising up in him. The energy felt wrong though. It wasn’t the good he stood for, rather the evil he kept in his heart for so long. How could he be the bad guy? His destiny has become clouded. As the power in him rose, he made a quick decision to do one last good deed. He put his arm out, palm towards the wall, fingers outstretched. He felt for Shino’s falling body.

Just before slamming into the ground, a cushion of cerulean light cushioned the fall. Shino’s sight blurred and he blacked out.

“One final good deed before servitude?” Sephiran laughed. “Yes, I knew what you did. Why would you save such an insignificant insect like that? Your last act and you save someone unimportant. Your decision making skills had better start getting smarter or you won’t be spared again.” He snapped his finger again. The rest of Chingon’s face burned, the agony with it unbearable. Chingon fell to his knees in pain, screaming and clawing at his face. When it finally stopped burning, an unrecognizable Chingon stood and faced Sephiran. Parts of his face were missing from clawing at the burning flesh. “Now for the finishing touches, my general,” Sephiran said, waving his hand at Chingon. The charred remains of his body hardened, his own skin thickening and forming armor, harder than any man made steel. A mask of great evil was shaped around his head and seared in place. The good in Chingon was gone. Chingon was gone. He was now the black knight and he was his master’s general. What were his orders? 

I hope you’ve enjoyed this preview and an insight into what made me the writer, artist, and published author I am today.  I will continue this trend for years to come, I’m certain of it.  My writing can and will get better and better.  Your enthusiasm and support is fuel for me to become the best I can.  I will rise to the challenge of creating something masterful that will blow the minds of the fiction world.  Most importantly, before I go, without you, none of this would be possible.  From the bottom of my heart, thank you.

My name is Chris Bryant.  I’m 26, born and raised in Lexington, Ky.  I love to write.  I have been writing since I was little, always short stories about action or adventures I’d have liked to have been on.  The Sword of Hope is my first of many books to come.  My dream has always been to be able to get one of my stories published.  This is my first full length story.  I can’t wait to see how everyone likes it.

Learn more at: http://theswordofhope.com

24 JanRespect

By Guest Blogger Daniel McNeet

 

Good day, good people.

For devotees of the English language: invidious is an adjective which demonstrates jealousy and hostility.

How to read Harry Potter and the Sorcerer’s Stone? “Why, very quickly, to begin with, and perhaps also to make an end. Why read it? Presumably, if you cannot be persuaded to read anything better, Rowling will have to do.” Harold Bloom in 2000

Is Mr. Bennett engaging in invidious comments? Or, is he just expressing his opinion which he has a right to do?

Give respect, get respect. Book reviewers benefit the authors and the readers. There is no benefit, consideration, good manners or respect in denigrating a reviewer because he or she gave an author’s book a review the writer did not like.

Comics and other live audience performers know better than anyone that you cannot win against hecklers or vitriolists. The same can be said for the same ill-mannered ilk on the Internet. If you are a victim of a heckler or vitriolist on the Internet, what can you do? Should you respond? Can you win by engaging them in the negative interaction? Is the stress worth it? If so, what would you say? What about trying “Received”, “Noted”, “Understood” or other? Can they be effectively ostracized or should they be? After all, one of the many good things about the United States of America is: every person has the right to express their opinion, no matter how ill-founded in fact it may be.

A lack of respect is not new and has nothing to do with the Internet. It only has to do with the human beings who use it in a disrespectful form. But they do have sponsors and role models.

“. . . we saw ‘Midsummer Night’s Dream’, which I had never seen before, nor shall ever again, for it is the most insipid ridiculous play that ever I saw in my life.” Samuel Pepys 1662

Nathaniel Hawthorne said of Edward Bulwer-Lytton in 1851, “Bulwer nauseates me; he is the very pimple of the age’s humbug. There is no hope of the public, so long as he retains an admirer, a reader, or a publisher.”

“About a year ago, from idle curiosity, I picked up ‘The Old Curiosity Shop’, and of all the rotten vulgar un-literary writing . . .! Worse than George Eliot’s. If a novelist can’t write where is the beggar.” Arnold Bennett in 1898 regarding the work of Charles Dickens.

So, much like beauty, respect and disrespect are in the eyes of the beholder. In the four quotes above the eyes of the beholders are the readers Mssrs. Bloom, Hawthorne and Bennett and the eyes of the play watcher, Pepys. Are they being disrespectful and if so why?

What is your thought on handling this Internet ilk, those who engage in jealous, hostile and malicious comments, accuse falsely and pass rumors which injure their targets?

If you have read any of the books above, are they right? What are your thoughts and comments?

Comments and constructive criticisms with honesty, their constant companion, will always be welcome at www.danielmcneet.com.

24 JanAuthor Profile: Batya Casper

Why did you decide to write this book? – I wanted to counteract the black/white sound bytes that the media pick from their computers and convey to their viewers for the most sensational effect.  I wanted to portray the human face of Israel, the extreme moral and existential choices all Israelis face on a daily, often twice daily basis; the pain of the Israeli experience, the earnestness with which Israelis face their problems, make decisions, and live with the consequences of those decisions, cognizant that each decision made will affect their survival and the reactions, if not the well-being, of others. More than anything, I wanted to portray the incredible zest for life that all Israelis manifest in the face of never-ending hostilities.
Do you have any secret writing tips you’d like to share? — I do most of my creative writing in my head, mulling over ideas before falling asleep and then allowing those ideas to ferment through my dreams. My writing flows smoothly the following day, when I do that.
Tell us a quirky or funny story about you! –  It’s been a while since I’ve thought of myself as funny. I believe that my son’s dog (whom I baby-sit while my son is at work) was co-writer of Israela. She sat loyally beneath my desk or beside my chair as I wrote it, never budging from there until I did. I don’t know whether the following counts as quirky but I allow myself to run off on tangents, when I write, following the whims of my characters so I accumulate a great deal of material that needs to be cropped from the final version, but which has provided me with the background and the explanations that I, as a writer, need to know. Often, I sit puzzling over an issue, wanting an answer, when – voila – it falls into my lap. I love the editing process as much as the writing, yet I completely believe in my muse – and my son’s dog – for the real work.
Have you ever battled writer’s block? How do you deal with it? – Once I start on a project, I’m usually okay. However, between projects, I suffer terribly from writers’ block, sure that I have used up all my ideas; that no further thoughts will ever come my way and that the inside of my head will suffer from the draft. I don’t really deal with it. I wait it out – because I have no choice.
What’s your favorite quote? – “Barkis is willing” from Dickens’ David Copperfield. My mother used it often. It reminds me of her. To me, it is quirky and filled with different connotations.
Who inspires you the most? –  Golda Meir. Nelson Mandela. Shakespeare. For this book, Dvorak  – Dvorak’s Nebucco.

Batya Casper PH.D, is a theater teacher, director and actor. Among her previous publications is: Electra: A Gender Sensitive Study of the Plays Based on the Myth, Jefferson, North Carolina: McFarland &Co, Inc. Publisher, 1995. Casper has lived periodically in Israel since early childhood.

Learn more at: www.israelathebook.com.

24 JanBook Excerpt: Israela by Batya Casper

Book One

Ratiba

1966

I had wanted an old time, authentic wedding, with Ibrahim riding through his village on horseback. You can’t get more romantic than that, I thought. Ibrahim laughed at me, claiming I was the only person he’d ever met who’d want such an outmoded ceremony, telling me I was a contradiction of willfulness and sentimentality, sounding like my sister who was always muttering things like that about me. For his part, Ibrahim wanted me to wear the traditional wedding dress that his mother had worn, which was really old-fashioned, that his father had kept for a hundred years and more in a wooden box, specifically for that purpose. Much to our surprise, Kasim wouldn’t let me. “No,” he told Ibrahim. “Your mother’s dress won’t be worn again.” I wanted to ask why not but didn’t. Instead we sent to Haifa for a dress that was fluffy white, that my sister and I embroidered just the same—rows of red and gold stitches down the bodice, making me look like a hybrid.

I begged my father-in-law, “Please,” I said, “don’t hire a hall for the ceremony. Let us marry on the slope of the hill among the trees and the evening breezes at the back of your house.” But Kasim refused. “We’re not poor,” he said. “We need to entertain our friends in style.”

So we congregate in Ibrahim’s village, west of Jerusalem, in the presence of Kasim’s family and friends, in a rented hall where toasters and dishes and sets of silverware grow into a marriage-mountain in their tinsel wrappings on the table near the door, where gobs of blue-and-gold plaster cover the walls, where painted flowers gather dust in the corners, and a crown in the center of the sky-blue ceiling hangs during the ceremony, immediately and ominously, over our heads. When I enter, the women, my sister playing her part among them, vent their excitement in a burst of ululations, scaring a thousand devils out of me, as my mother would have said, because I wasn’t expecting it; then the atmosphere eases, for which I’m more than grateful, as drums and a lone, weeping lute play around us like doves of sound. I clamp onto my sister’s arm, first stifling the need to squeak like a mouse the way I do when I’m excited, then, just as suddenly, repressing the urge to cry, refusing to let go of my sister, to let her move away. This is the defining moment of my life, I tell myself, biting my lip till it hurts. Don’t botch it. We gather for the ceremony.

For the second time in two weeks, Kasim separates me from my sister, draws me to one side.

“You are a good woman,” he says. What’s the matter with him? I’m not even twenty-one. “Tell me now,” he says. “It’s not too late. Would your parents have blessed this union?”

It’s hot. Overcrowded. The hall is way too narrow. Why is he pestering me about parents? About “unions,” as though I was some national entity? Why now, again, at the last minute? If I were to change my mind, would he send everyone home?

“Of course,” I say.

“Good,” says my father-in-law and disappears into the crowd.

Kasim addresses us in front of his guests: “The marriage of a man and a woman,” he says, “is the meeting of two souls. From this day on, you are like the wheels of a carriage. If you work in rhythm with each other, knowing each other’s every thought, anticipating each other’s every move, you and your children will be happy.”

Ibrahim is holding both my hands now, looking only at me. I see nothing, hear nothing, care about nothing but him, my husband, my husband’s orange eyes until, like a bullet shot to heaven, the women pierce the air again with their voices, protecting us from harm.

The women are chanting al zaghareed, congratulating me on my choice of husband and on my decision, from this point on, to tend to his needs. Men are gathered down the center of the room, dancing. Women cluster around, clapping, throwing seeds at us. The singer is wailing way too loudly now, the music pounding in my ears. For a moment, my heart catches as a fishhook in my chest, frozen by the absence of my parents, refusing to beat, refusing to release its flow of blood.

“Raula,” I gasp through the din, “I can’t. I can’t do this.”

“What can’t you do?”

“This. Can’t do it. Can’t breathe.”

She laughs out loud as though I’m joking. Then, in an undertone so I have to read her lips to hear her, “This is no time to panic,” she tells me. “Focus on Ibrahim.” And thrusting me toward him between the two lines of dancing men, my beloved sister spins me around until nothing remains in my mind but my love of my groom and my immediate need to remain upright.

Friends have gathered around Kasim. He looks at my sister and me and tells them, “In the absence of Ratiba’s parents, I felt reassured when I met Raula that my son is marrying into a good Muslim family. Raula’s manner of speech,” he says, “set my mind at ease.” Yes, I think, my stuffy father-in-law has a problem with me.

My sister is mingling with my husband’s family, people she doesn’t even know, handing round glass dishes of dates, of figs, listening attentively, laughing her wonderfully light laugh as they talk, drawing everyone, especially my new brother-in-law and his wife, to her with her charm and her haunting gray eyes. I am trussed up in my self-embroidered wedding dress next to Ibrahim, who is busy being kissed by all the men at our wedding, feeling like a queen bee, Ibrahim looking foreign and adult in his suit. His relatives are circling around me, oohing and aahing, extending their hands, frightened to touch, believing perhaps that I might sting them, wishing us well. My hairpins are digging into my scalp. My new shoes are pinching my toes; I should have worn them in before the wedding. I want to take them off to change back into pants.

A ragged line of mustached men dance al debkeh. Kasim’s neighbor is blatantly inspecting my sister for his son as he moves, his wife joining in his game, nodding, elbowing me, smiling in approval. How are they to know she will disappear after the wedding, abandoning our aspirations, I’ll tell them, for the temptations of the United States? I’ll tell Ibrahim too, on a weekly, monthly basis. For some reason, he’ll never tire of asking, “What happened to Raula?” he’ll ask. “Why doesn’t she write?”

“She does,” I’ll lie, and he’ll ask why I never write back.

We move outside to the patio on the slope of the hill. The patio, it turns out, is larger than the hall. Raula helps the women carry trays of cracked wheat and lamb, the aroma wafting after them as they go, sets them on the sheets that cover the ground.

“See?” Kasim says, leaning into me. I have never seen him smile before. “You have your trees, your evening breezes.” Raula—I just love the way my sister’s name rolls over my tongue—carries the baklava and coffee from guest to guest, and to us, the bride and groom, as we nestle close to each other, immersed now in our own company, responding only peripherally to the good wishes of our guests. Love songs are pumped through a loudspeaker. Under cover of the music, I whisper my question to Ibrahim. “Some day, in the future, if ever you stop feeling this way about me, will you tell me?” Kissing me ever so lightly, like the brush of a butterfly on my neck, then gazing wickedly into my eyes, he says, “I won’t need to. You’ll know.”

Orit

Shuli said I fell into this world, like many of my generation, from the back alley, off the outstretched arm of my mother. That’s the way Shuli said things. Nevertheless, much later as a young adult, I was lucky enough to visit Rome. There, in the center of the magnificent Sistine Chapel ceiling, I saw God’s arm stretched out to man’s, and I recognized those arms as my conduit to life.

*****

Shuli was my mother. She was gentle when you caught her attention. The trouble is that wasn’t such an easy thing to do. Because Shuli was never fully there, was always concentrating on other things—other than me, that is. I was four years old. I trailed after her from room to room, the metal blinds of our apartment pulled down against the heat, sprinkling eyes of light across the floor that winked and watched me, moving the shadow monsters that lived beneath my bed, under the table, behind the chair, in the corner—a giant one in the corner, next to the plant, waiting to pounce. I was clutching Boobie, my comfort blanket, for protection. I’d given Boobie a gender. She smelled like me. I dragged her behind me on the floor, so she collected dust and fluff and little bits of things on the way. Really what I was doing was waiting for Shuli to notice me, to pick me up. But when she finally lifted her head out of the storage chest where she was sorting out clothes and saw me with my arms stretched toward her, she gave a start as though I’d frightened her. When she did that, I jumped too and started to howl.

“I thought you were still sleeping, Ority,” she said “Why didn’t you tell me you were there?” But I’d been whimpering for a while. I knew because I could feel the snot and the tears being smeared round my face by my free hand. She picked me up.

“Yehuda,” she told my aba, “put music on,” and she became my ima again. “Come, babush,” she cooed. “Dance with me.” She wrapped me completely in those long arms of hers that wound around my back and all the way round her too. That’s how long they were. We glided across the room, stepping on the shadow monsters, killing them, her curtain of hair caressing me like wings, I swaying and dipping in the safety of her arms to the strains of Aba’s music; she smelling of the lavender lotion that stood as a permanent fixture on the bathroom sink and never ran out.

There was a gentleness to Shuli that stayed with her, like the bathroom lotion, right up to her last, stubborn, miserable days, way after she’d stopped dancing, when she was lyiing on my dead aba’s bed refusing to walk or talk. But after two minutes of that, she said, “Okay. Orit, sweetness, that’s enough. Go play.” She plopped me down again as though the music had been turned off, as though I was a purse or a scarf she no longer needed. So I sat on the stone floor, in the blinded room, and waited for her to notice me again.

Aba walked in, also on his way to some more important chore. He lifted me, raised the shades so that its tiny eyes raced together back into the ceiling, like those animals that Aba said rush into the sea when it’s their time for the next world, and the day was there. He set me in the corner of the sofa, tied each of my fingers with colored threads and bits of torn handkerchief, drew faces on them with his colored pens.

“This finger is Ima,” he said, hugging me, teaching me also, as always, the Arabic name for mother—ommy. “When you grow up,” he told me, “you’ll speak Arabic just as well as Hebrew.”

Next to Shuli, my aba was my favorite person in the whole world. He stuck a cotton ball on my Ima-finger for hair and gave it her voice. Then, “This one is me,” he, said, adding the Arabic for father—abee—and a thimble. “This one is little Ruti.” He emitted a crying sound like my baby sister, making me laugh. “Play with us. We are at a party, and we have to dance and eat yummy cake. See? See us lick off the crumbs?” When he wanted to leave me to work at his desk, my aba, said, “One of your finger people is sad and lonely, Ority, and the others are trying to make him happy. How would you make him happy?” He covered me with Boobie, my comfort blanket, placed my thumb, like a stopper, in my mouth for me to suck on so I had to pull it out quickly before baby Ruti’s face rubbed off. He put songs on the record player for me to listen to with my family of fingers. I didn’t know that my finger family would develop into my life’s work.

“A woman on a bus gave you to me while I was still in Europe,” Shuli told me, when I was old enough for first grade. “When she sat down next to me, I thought you were a bunch of clothes the woman was clutching to her breast. Later, when I stepped onto the curb with you on my arm, I couldn’t remember what the woman looked like, what she wore, whether her eyes were blue or brown, or even whether she was tall or not. I would never have been able to identify her for the authorities.”

Shuli wouldn’t tell me who “authorities” were, or why she’d need to identify a stranger on the bus for them. Still, I loved this story. Every night, as she’d bend over my bed, I’d spread my Boobie blanket over mother Shuli’s knee and beg her to tell it to me. She always told it the same way.

“World War Two was over,” she’d begin. Then…

“‘My name is Haya,’ the woman whispered. ‘I’m working with an organization trying to trace the families of those who’ve survived and are living in transit camps.’

“‘I’m on my way out of here,’ Shuli said. ‘I’m waiting for papers, and I’m in a hurry.’”

Haya told Shuli that I had no name, that she wanted to find me a temporary home, just for the weekend, because the transit camp was infested with lice, because there was no one in the camp to look after me. Shuli took me. She told me that when she closed the door of the room she was living in and put me down, I scrambled away from her, wouldn’t let her come near me. Two days went by, she told me. I wouldn’t come out from under the table, just stared at her, Shuli said, dirty hair hanging over my “haunted gray eyes.” I wouldn’t let her change me. I puddled on her straw rug, the one she said she loved because it had a star woven into the center. She left food for me in my safe place under the table, but I wouldn’t eat it, she said, until she turned her back. At the end of the weekend, Haya came back; Shuli saw that she wasn’t tall, had curly brown hair and serious eyes beneath a woolen cap. I was still under the table, clutching the blanket that Shuli had thrown over me, that I wouldn’t let her take from me, which was smelly, she said, from my pee. Shuli wouldn’t give me up. “I’m keeping her,” she said. “Her name will be Orit.” Shuli became my ima.

I was three years old, I remember, here, in Israel. I had a white dress like a bride, like Shuli, my mother, exactly like her. Shuli was getting married. We got ready at the same time; I putting on my new socks as she pulled on her stockings. I checked her dress at the back, making sure it looked good. She bent down so I could straighten her veil; she buckled my shoes.

“What color ribbon do you want?” she asked. I couldn’t make up my mind, so she tied my hair up in yellow, pink, and blue, all intertwined. “Stop jumping up and down,” she laughed. But I couldn’t so she gave up on the bow.

“Hurry,” I kept telling her. “We’ll be late.”

She was putting lipstick on for the first time ever. “How does it look?” she asked me. She was so beautiful with the lipstick.

“Can I have some?” She put lipstick on me too. “Hurry,” I said. “He’ll think we’re not coming.”

Shuli was hugging me. She was laughing instead of getting ready.

“He’ll not wait for us,” I told her, jumping up and down. “We’ll miss the wedding.”

People were sitting in rows on either side of us. Shuli was carrying me up the aisle to marry my aba—his name was Yehuda—with me holding the bouquet. A man in a hat and a white scarf read stuff and sang.

“That’s the rabbi,” Shuli whispered, tickling my ear with her breath. “He’s performing the ceremony.” My aba put his arms around Shuli after the ceremony, so I was squashed between them, in the warm lavender smell of their embrace, he kissing me with the side of his mouth while staring into my ima’s dark blue eyes, at the paleness of her skin, at her shiny black hair that she’d curled, just for that day, beneath her veil.

******

I was four and a half when Ruti was born. “Don’t climb into the crib with your shoes on, Ority. It’s new! Don’t pick up the baby!” My parents hovered over me, sure that I meant to hurt my new baby sister. I would have never hurt my sister.

Batya Casper PH.D, is a theater teacher, director and actor. Among her previous publications is: Electra: A Gender Sensitive Study of the Plays Based on the Myth, Jefferson, North Carolina: McFarland &Co, Inc. Publisher, 1995. Casper has lived periodically in Israel since early childhood.

Learn more at: www.israelathebook.com.