Sunday, June 18, 2017

Recent travels

Thank God, some of my recent brisses have taken place out of state. Ever grateful for the traffic from travelingmohel.com and a reputation that is, thank God, growing, these brisses always turn out to be wonderful experiences.  They often include meeting Jews in further-away communities, who are, of course, grateful for the gift of their new baby. But who are also making a go of a Jewish life away from family, and sometimes, away from a mainstream Jewish community.

It's always a marvel how people manage in their own way, their own observance, their own approach to a relationship with God. And how, for all of these people, the question is never "should we do a bris?"

It is always, "Where, and when will the bris take place? And how can we make sure we have a mohel for the proper time?"

Kudos - God bless - and may you raise your children with joy.

Thursday, June 8, 2017

Comics about Bris

I was cleaning out some old files and I came across these - from my New York days when we would get the Jewish Week.

In general I don't like jokes about Bris as they are usually inappropriate and irreverent (as demonstrated in the second one). A colleague of mine likes to say to the person who tells a bris joke, "I have a lot of respect for that joke because it's older than you and me combined."

That said, enjoy?




Sunday, May 28, 2017

Baby Feeling Pain - Myths and Facts

I just came across this article on chabad.org, and thought I'd give a slightly different perspective on the question of whether the baby feels pain at the bris. The main reason for sharing the following perspective is because I prefer to be a realist and share truth, rather than paint a rosy picture, blaming realities on straw-men, and ignoring the facts-of-life.

I do agree with the article in that we've been doing this for a very long time, and when done right, most babies are fine shortly after the procedure is over. And certainly have no memory of it.

I've written about this subject before - you can search "pain" in my website (this link will do it for you if you're not on a computer or laptop) and you'll get my thoughts on this more spelled out.

But here is the brief version.

FACTS
Anything out of the baby's comfort zone causes a baby to cry. This may include: wearing a diaper, not wearing a diaper, being hungry, being handled for a diaper change, having legs pushed out of fetal position, any kind of pain.

MYTH
Babies nerve endings aren't developed so they don't feel pain.

FACT
Babies feel pain. However, they don't have a very long-term memory. When pain sensation ends, and especially if amicably distracted (otherwise comfortable, eating, etc), crying can stop.

MYTH
Babies are at their prime for clotting on day 8, so the 8th day is the best day to have a bris.

FACT
The 8th day is the best day for a bris because God said so. Clotting factor is irrelevant to pain.

MYTH
A bris is really pain-free because it is a mitzvah.

FACT
A bris is often less painful than a hospital circumcision because the hospital variety utilizes clamps that crush the skin and destroy tissue (from the clamping). Some mohels use a clamp too, so let the customer beware (fwiw, I don't use a clamp). The baby cries when being handled, so the longer he is exposed, subject to metal surgical instruments, and with his legs restrained from being in the fetal position, the more he will cry. Saying he doesn't feel the circumcision in a bris ceremony is a lie.

FINAL POINT
While I'll leave the debate of numbing for a different discussion (search for numbing is here), I think the main points to consider are DEGREE of pain-inducing contact, and the amount of TIME during which baby is subject to the same.

A mohel should not use a clamp, and should work neatly, efficiently, and should be done - start (separating membrane) to finish (bandaging) in 30 seconds. Less contact → less discomfort → less crying baby → happier everyone.

Thursday, May 25, 2017

Maybe My Kvatter "Rules" Are Wrong!


I find this depiction of a bris, in particular the description of who served as Kvatter, to be fascinating. And who was the baby? At the time he was the son of a prominent rabbi in Piotrkow. Now that baby is a former Chief Rabbi of Israel. Rabbi Israel Meir Lau. 
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Rabbi Lau
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Naftali Lavie and Rabbi Lau shortly after liberation
The bris story was recorded by Naftali Lau-Lavie in his book, "Balaam's Prophesy"Image result for naphtali lavie

A Bris Milah Roundup

As most of what I've ever wanted to say about Bris Milah has already been recorded in this blog, the challenge is ever present to say something new, to couch something a new way, or to come up with new material that has not yet been addressed. As it happens, there are many sefarim (Hebrew books) written on the subject, so if I would either like to get esoteric, or start discussing out of the ordinary circumstances (such as what happens if the bris is on a pushed off fast day and the baby's father dies before the circumcision), those options are always available.

At the minimum I'm trying to blog once a month, so before May is lost, here goes.

I've gotten two more inquiries from physicians - I mentioned a previous one from two months ago here. And once again a physician (or two, or more?) wants to become a mohel and is having a hard time finding a mohel to train him.

One needs to be consistently busy to train others, and as I'm finding out, babies tend to come in spurts and seasons. I have about 12 babies lined up for brisses at the end of June through early August - and that's just the people who call well in advance! (And some of them may turn out to be girls, which will obviously lower the numbers)

In the news: Europe is going crazy again, couching their anti-Semitism in the guise of liberalism. Save the babies! Save the animals! From those nasty Jews!  (the title is mine, but that is the truth behind this latest assault)

I spoke to a father this week who had two very preemie twin boys. They will need a lot of time before they are ready for a bris. And as I write this I am waiting in an airport for my delayed flight to take me to a bris for another set of twins - though only the brother half will be having his bris.

Life goes on. Babies are born every day, and this blog continues to service people around the globe. Not sure why, but for the first time I know of, the hits from Israel outshine from even the USA - 3929 website visits from Israel in this week alone, compared to a meager 411 in the USA.

Germany, Brazil, UK and Netherlands are the next top visitors. I hope they're mostly Jews looking for information, rather than anti-Semites looking for fodder to fuel their anti-Semitism (see mention of Europe above).

That about does it! Looking forward to the summer and the many anticipated (and unknown to me) births which are coming. May the babies all be healthy, and may the boys have their brisses at the right time.


Friday, April 21, 2017

The Consultant, plus a word on safety precautions

I've had a few conversations this week with new parents who just had their baby circumcised. They are in New York area - I was not the mohel.

They had questions about what had happened in their son's bris. Mind you - this is pretty atypical. Most people have a wonderful, surprise-free experience, and all goes well. But life is sometimes accompanied by surprises and unexpected turns.

While the photos that were sent to me can't be shared on this blog, I will tell you that there's a reason that I pride myself on the circumcision looking as nice as possible hours after bris. There is often swelling, and not much we can do about that. But aside from the natural swelling, to have the circumcision look palatable to any observer is really an important goal. I've had many parents squeamishly look only to discover, "Hey. That actually looks good!"

The natural redness that is exposed through the act of circumcision is not a frightening vision - you just need to know what to expect.

But when things don't go exactly as they should, you need to understand EVERYTHING that has happened in the circumcision and in what direction a proper healing process should go.

Anyway, these parents had questions. In general, when I get these kinds of calls, while in some cases they are in fact talking to their mohel, in other cases, they don't want to talk to him because they either do not want to hurt his feelings or feel they do not have a sympathetic ear for their concerns. This is why I do believe that parents who do not know the mohel they are hiring should at the very least have a phone conversation in advance of the birth, to be sure they are comfortable with their choice of mohel. 

Some previous blog posts addressing these issues are linked here:
http://www.mohelinsouthflorida.com/2010/06/importance-of-trust.html
http://www.mohelinsouthflorida.com/2011/04/consultant.html

And just FYI - I take many precautions to avoid the issues that I have been consulted to share information. I always tell parents that without actually having examined the baby, my opinion is only worth so much (a picture is good, but it isn't the same).

It's hard enough for some people to circumcise. Should the experience be anything other than as smooth as possible? I don't think so. Here are a few precautions every mohel should be taking. If they are not doing these, I honestly think every parent should look elsewhere.

http://www.mohelinsouthflorida.com/2016/02/safety-precautions-what-you-need-to-know.html
http://www.mohelinsouthflorida.com/2015/07/getting-percentages-right.html
http://www.mohelinsouthflorida.com/2011/08/magic-of-marker.html
http://www.mohelinsouthflorida.com/2016/04/tools-of-trade-i-shield.html
http://www.mohelinsouthflorida.com/2016/04/tools-of-trade-ii-metzitzah-tube.html
http://www.mohelinsouthflorida.com/2016/06/tools-of-trade-viii-gloves.html

Monday, March 13, 2017

Perceptions, Perceptions

I should probably learn how to do circumcisions on adults (Rephrase: I know how to do circumcisions on adults. I should learn how to administer local anesthetics and how to suture). What is it about adult men who want to get circumcised, and rather than going the medical route, they seek out a mohel? I've gotten 3 requests this month alone.

Which brings me to the irony of other conversations I've had in the last few weeks. I blogged about one here. And I received another email (from someone out of state who had been in touch with me - no local mohel options available in that town): "we are going to go with a local pediatrician to perform the brit."

And then there was the doctor from a northeastern state who called me today asking if I could advise him on where to train to hone his circumcision skills. Seems he recently watched a bris performed by a certain mohel (he did not identify the mohel) and felt, as a meticulous physician, he could do a better job. And yet, he is turning to mohels to seek that training.

Then there is this article from the Atlantic (goes back to 2015) entitled "Why Non-Jews Are Choosing Jewish Circumcision Ceremonies."

Bottom line: Who is better - a mohel or a physician? A silly question gets a silly answer.

Each mohel - whether medical doctor or simply mohel-specialist - must be judged as a practitioner on his own merit. Either he is good at what he does, or he is not as good as the other guy. Either he works well under pressure or he does not. Either he delivers a beautiful cosmetic result or he does not. Either he is the right person for your family or he is not. Your preference for one type over the other boils down to your perception, but should really boil down to your research.

Make no mistake. Mohels have been doing this for a very long time - much longer than it became "in vogue" for circumcision to be widespread and for doctors to get in to the "circ-service" industry.

Feel VERY comfortable trusting a specialist. Feel free to call me to have a conversation. The doctor I spoke with today was grateful, and I trust you'll find our conversation pleasant and informative as well.

Thursday, March 9, 2017

Metzitzah in the News - Again

Is it a witch hunt? More like "which" as in, "which mohel is responsible for being irresponsible?"

http://nypost.com/2017/03/08/new-case-of-neonatal-herpes-caused-by-jewish-circumcision/

Seriously, this is beyond ridiculous. I have it on high authority that metzitzah is not even required today (Rabbi Herschel Schachter and his reporting on Rabbi Joseph B. Soloveitchik), let alone the permissibility of doing it without a barrier (Rabbi Moshe Dovid Tendler, who has told me it is forbidden to do metzitzah with direct oral contact - not that I was ever doing it that way anyway).

For those of us who are not abandoning the practice of Bris Milah, there is a very simple way to avoid these kinds of stories - completely sterile technique. No exceptions.


Thursday, March 2, 2017

Doing Research Properly

I got an email today from someone with whom I had been in contact for a little while about possibly doing her soon-to-be-born son's bris.

She apologized profusely, saying "my husband wants to try a doctor this time." This was followed by "Hope no hard feelings."

First of all - there are NEVER hard feelings when people are doing research and being open. You must do what you feel is best for your son and your family. And I support that.

However, you must also do RESEARCH and know what you are getting into, no matter who you hire for your son's bris.

This isn't a question of Dr. v. Mohel. A mohel, after all, is a specialist in this field. So being a Doctor doesn't make anyone better at circumcisions than a mohel.

What DOES matter, is how the circumcision is performed.

What METHOD is used

Whether the precaution of a marker is utilized

How much foreskin (see #5 there) and membrane is removed

And, of course, the follow up.

There are MANY fine mohels. There are MANY fine doctor-mohels. The questions every person must ask before hiring either one is, "Have I done my research? Do I know what I want for my son? Have I found the right mohel-specialist for the experience I want my son to have, and the experience I want to have?"

When the answer to all of these questions is YES, then proceed accordingly. Until that time, there is work to be done as a parent. Best of luck!!

Friday, February 10, 2017

Parental Vigilance

Dear Parents,
I can not emphasize this enough. (I've written about this before)

After the bris is over, and I am finished with MY job, YOUR job kicks in.

So let me explain to you what MY job is, so you understand what your job is and why your job is very important.

My job:
1. To get as even and aesthetically pleasing circumcision as possible. To achieve this I use a surgical marker to guide the incision
2. To make sure I take off the correct amount of foreskin, which actually has a small range of flexibility, and not to take off too much.
3. To make sure that beyond removal of foreskin there isn't an excessive amount of membrane left behind, which could give the baby the appearance of being uncircumcised.
4. To control the bleeding and make sure the baby is well on the road to healing and recovery post circumcision
5. To give you information about how things will look over the next few days and weeks
6. To give you instructions for after-care and what your job is over the next few days and weeks

Which leads us, most obviously to YOUR job
1. To follow the instructions for after-care (see 6 above)
2. To be in touch with ANY and ALL questions
3. To keep the diaper area as clean as you can during the healing process
4. Over the next few days, weeks, sometimes months, to avoid the Fusion Concern
5. To be aware of the Chubby Baby Syndrome

It boils down to this.
After circumcision, the body realigns the penis and restructures itself in the absence of the foreskin. Depending on how the circumcision goes, there may be a ring of leftover membrane between the incision spot and the glans, or there may be no membrane there at all. IN EITHER CASE, because the baby spends so much time on his back, and especially if he becomes chubby over time, the glans has a tendency to sink a little back into the membrane or the shaft and stay there, giving the baby a partially (as opposed to completely) circumcised look.

Which is where YOU come in.
Every time you change his diaper, every time you give him a bath, make sure that the glans is free and clear of anything that is below it. It really is a very simple massage every time his diaper is open, until time (could be weeks or even months) indicates that no intervention is required any more.

In simple terms - I met an adult recently whose parents did not take care of this when he was young. After a brief consultation I suggested he speak to a urologist, and he ended up having corrective surgery. This could have been avoided if his parents had been vigilant!