Because we live in an increasingly depressing world, there are things that I must do and that I cannot do in order to maintain that my interest in this field (bris milah) is solely for the mitzvah - helping parents fulfill their biblically mandated requirement to have their sons circumcised to bear the mark of the Covenant.
This is why, as much as I want to share before and after photos so parents can know what to expect, I am resigned to explain it in words, leaving photos out.
This is why my care for most children ends one or two days after the bris, when things are healing nicely and I know that as long as post bris care follows my instructions, everything will be fine.
I have a colleague who likes to offer the change the baby's diaper if he bumps into the parents weeks down the road - it's his way of checking his handiwork to assure that all is healing as it should.
I am not so bold, and I don't ask parents for such opportunities. However, every now and then a parent will have a question or wants me to assure that all is good (especially if we left things as "let's keep in touch to see how things heal") and I get a chance to see how things have healed. This happened twice this week, and I am happy to report wonderful healing processes.
It is always flattering to see such beautiful results from one's handiwork. I hope they all turn out this way.
God bless!
Showing posts with label how it looks. Show all posts
Showing posts with label how it looks. Show all posts
Monday, December 1, 2014
Monday, October 3, 2011
A Wonderful Compliment
The baby nurse from yesterday's bris said to me "You cut a perfect diamond. I have never seen a circumcision like this. No blood - nothing! Amazing job, Rabbi!"
I am not sure about the precious stone reference, but I'll take the rest of it to the bank.
I am not sure about the precious stone reference, but I'll take the rest of it to the bank.
Monday, August 8, 2011
The Fusion Challenge
This is a topic which seems to come up every now and then, but since I've dealt with it twice in the past week, I write about it again. [Here is the original posting on this subject]
The two cases I dealt with in the past week were on babies who were circumcised by physicians, one two weeks ago and one 2 years ago. In both cases, the babies' parents were unaware of "why" the baby did not look circumcised. With no need to re-invent the wheel, I refer you to the post I linked before, where I explain how parents should deal with this to avoid it being a long-term problem.
When the skin on the shaft (especially since it may be a little more loose after the circumcision) is looking to settle down and get comfortable, it can easily sort-of-kind-of fuse itself to the edge of the glans, or even climb up on the edge of the glans.
THE GLANS SHOULD BE DISTINCT. YOU SHOULD SEE THE OUTER EDGE OF THE GLANS, AND IT SHOULD NOT BE FLUSH WITH ANY SKIN OF THE SHAFT.
As some babies develop, their body fat is deposited most heavily in the groin area. So it is not uncommon for the penis to seem as if it sinks in to itself. It is constantly being constricted inside the diaper, and the baby fat likes to swallow whatever might appear "extra."
In this case, the glans' rim sometimes appears to fall back into the shaft, but you can still see that there is a glans and a shaft.
There is a more extreme case, where the glans and shaft disappear entirely into the hole from which they may otherwise seem to emerge, and when you open the diaper, you only see a scrotum and a hole where the shaft should be.
Not surprisingly, this condition is called "The Disappearing Penis."
To avoid boring you with details (it is apparently a little more common, just people don't talk about it), I refer you to Dr Greene, where he more than adequately deals with all the possible scenarios.
The two cases I dealt with in the past week were on babies who were circumcised by physicians, one two weeks ago and one 2 years ago. In both cases, the babies' parents were unaware of "why" the baby did not look circumcised. With no need to re-invent the wheel, I refer you to the post I linked before, where I explain how parents should deal with this to avoid it being a long-term problem.
When the skin on the shaft (especially since it may be a little more loose after the circumcision) is looking to settle down and get comfortable, it can easily sort-of-kind-of fuse itself to the edge of the glans, or even climb up on the edge of the glans.
THE GLANS SHOULD BE DISTINCT. YOU SHOULD SEE THE OUTER EDGE OF THE GLANS, AND IT SHOULD NOT BE FLUSH WITH ANY SKIN OF THE SHAFT.
As some babies develop, their body fat is deposited most heavily in the groin area. So it is not uncommon for the penis to seem as if it sinks in to itself. It is constantly being constricted inside the diaper, and the baby fat likes to swallow whatever might appear "extra."
In this case, the glans' rim sometimes appears to fall back into the shaft, but you can still see that there is a glans and a shaft.
There is a more extreme case, where the glans and shaft disappear entirely into the hole from which they may otherwise seem to emerge, and when you open the diaper, you only see a scrotum and a hole where the shaft should be.
Not surprisingly, this condition is called "The Disappearing Penis."
To avoid boring you with details (it is apparently a little more common, just people don't talk about it), I refer you to Dr Greene, where he more than adequately deals with all the possible scenarios.
Tuesday, August 2, 2011
Don't Let Finances Deter You!
Every now and then I either hear a story about someone or hear from someone directly that they either chose not to circumcise or to have a doctor do it instead of a mohel (which usually means when the baby is 1 or 2 days old, instead of on the eighth day - the correct day for the bris), on account of financial reasons.
Often, they never even spoke with a mohel: they chose to go that route without even consulting with anyone.
This is very unfortunate, for a few reasons.
1. Any real mohel would prefer your child have a bris than a hospital-circumcision
2. Any real mohel will "work something out" if that is your circumstance
3. A circumcision before day 8, as well as almost any hospital circumcisions are not considered brisses
4. A routine hospital circumcision has a different definition than a bris circumcision. Significantly (and statistically) more often than with a mohel, the hospital cosmetic result will have a child who has not had enough skin tissue removed, who requires another procedure.
5. Anecdotal evidence (from physicians and pediatric surgeons I know) suggests that more "touch-ups" come from work done by doctors than by mohels. This is not to say mohels are perfect, or that doctors never do a good job. Just that mohels (generally speaking) have a better track record than doctors when it comes to the cosmetic results of their circumcisions. [Of course, the doctors who do the cosmetic touch-up work usually do a great job!]
Your research is a great first step. Now pick up the phone, and let's work something out!
Often, they never even spoke with a mohel: they chose to go that route without even consulting with anyone.
This is very unfortunate, for a few reasons.
1. Any real mohel would prefer your child have a bris than a hospital-circumcision
2. Any real mohel will "work something out" if that is your circumstance
3. A circumcision before day 8, as well as almost any hospital circumcisions are not considered brisses
4. A routine hospital circumcision has a different definition than a bris circumcision. Significantly (and statistically) more often than with a mohel, the hospital cosmetic result will have a child who has not had enough skin tissue removed, who requires another procedure.
5. Anecdotal evidence (from physicians and pediatric surgeons I know) suggests that more "touch-ups" come from work done by doctors than by mohels. This is not to say mohels are perfect, or that doctors never do a good job. Just that mohels (generally speaking) have a better track record than doctors when it comes to the cosmetic results of their circumcisions. [Of course, the doctors who do the cosmetic touch-up work usually do a great job!]
Your research is a great first step. Now pick up the phone, and let's work something out!
Thursday, March 17, 2011
A Long-Term Care Reminder
One question that comes up a lot, particularly when a baby boy is 4-12 months of age is, "Why doesn't it look circumcized?" (I get this a lot more often when I wasn't the mohel, but every now and then if I was)
In most cases, "it" actually does look circumcised, except that a minor issue needs to be tweaked.
Before I continue, let me be clear that this may be difficult to understand without the visual image, but I will do my best!
Clench your fist, and look at the profile of your arm. Imagine the fist is the glans, and your arm is the penile shaft, and you understand what the penis should look like from the side. The glans should sit above the shaft, and its outer rim should be completely separate and distinct from the shaft.
UNFORTUNATELY, not all parents realize this should be the case, until it is slightly too late.
What do I mean by slightly too late? I mean
In most cases, "it" actually does look circumcised, except that a minor issue needs to be tweaked.
Before I continue, let me be clear that this may be difficult to understand without the visual image, but I will do my best!
Clench your fist, and look at the profile of your arm. Imagine the fist is the glans, and your arm is the penile shaft, and you understand what the penis should look like from the side. The glans should sit above the shaft, and its outer rim should be completely separate and distinct from the shaft.
UNFORTUNATELY, not all parents realize this should be the case, until it is slightly too late.
What do I mean by slightly too late? I mean
Wednesday, January 26, 2011
Knowing What To Expect Afterwards
[For much more detail on this subject, click here. The short version follows.]
When your child is circumcised, it is a good idea to get a good feel for how long the healing process takes.
In most cases, I need to see the baby only once after the bris, often enough to remove a bandage, but even when the bandage comes off on its own, just to see that everything is healing nicely. This has changed the time frame of my care for the baby - I used to see the baby, in some cases, two whole days after the bris. Now I see him within a few hours.
I FIND SEEING THE BABY A FEW HOURS AFTER THE BRIS TO BE MUCH BETTER: FOR THE BABY, FOR HIS PARENTS, AND YES, EVEN FOR THE MOHEL
There are mohels who like to see the baby a few days later, or even to see how things are looking a few weeks later. This is admirable.
At the same time, in the event that something is not OK at that two week period, there is really nothing that a mohel could/should do at that point. Any "correction" should be taken care of right away, which would perhaps necessitate an additional follow-up visit.
In simple terms:
* The glans (tip of penis) should be a dark red, and the extent of its outline - like a helmet on a head - should be visible all around
* There will or will not be remains of a membrane below the glans (also a dark red, though a slightly different hue). It is often swollen, though to what degree depends on how much membrane is present.
* The skin where the incision took place should be identifiable below the glans or membrance, and should be as close to even in its circumference around the shaft. Depending on the baby's anatomy, in some cases, the mohel might cut at more of an angle, to compensate for a differently angled glans.
If this is what things look like after the bandage comes off (with the caveat of the possibility of some swelling below the glans), all your baby needs is "time." Some colors may emerge (white, yellow, green) that are just the way the area scabs. But even all this goes away within a couple of days, and certainly very quickly once ointments (vaseline or similar product) are no longer applied to the area.
For instructions on how to care for baby, see here
When your child is circumcised, it is a good idea to get a good feel for how long the healing process takes.
In most cases, I need to see the baby only once after the bris, often enough to remove a bandage, but even when the bandage comes off on its own, just to see that everything is healing nicely. This has changed the time frame of my care for the baby - I used to see the baby, in some cases, two whole days after the bris. Now I see him within a few hours.
I FIND SEEING THE BABY A FEW HOURS AFTER THE BRIS TO BE MUCH BETTER: FOR THE BABY, FOR HIS PARENTS, AND YES, EVEN FOR THE MOHEL
There are mohels who like to see the baby a few days later, or even to see how things are looking a few weeks later. This is admirable.
At the same time, in the event that something is not OK at that two week period, there is really nothing that a mohel could/should do at that point. Any "correction" should be taken care of right away, which would perhaps necessitate an additional follow-up visit.
In simple terms:
* The glans (tip of penis) should be a dark red, and the extent of its outline - like a helmet on a head - should be visible all around
* There will or will not be remains of a membrane below the glans (also a dark red, though a slightly different hue). It is often swollen, though to what degree depends on how much membrane is present.
* The skin where the incision took place should be identifiable below the glans or membrance, and should be as close to even in its circumference around the shaft. Depending on the baby's anatomy, in some cases, the mohel might cut at more of an angle, to compensate for a differently angled glans.
If this is what things look like after the bandage comes off (with the caveat of the possibility of some swelling below the glans), all your baby needs is "time." Some colors may emerge (white, yellow, green) that are just the way the area scabs. But even all this goes away within a couple of days, and certainly very quickly once ointments (vaseline or similar product) are no longer applied to the area.
For instructions on how to care for baby, see here
Sunday, January 31, 2010
What Will It Look Like Before and Afterwards?
I try to leave graphic images out of this blog, so I will do my best to explain here what the penis looks like before and after the bris.
BEFORE
Take a look at your baby! Now you know how it looks before the bris!
Just kidding.
The uncircumcised shaft of the penis looks like an inverted hourglass. It is thinner as it hits the scrotum, and thinner at the tip, but significantly fatter in the middle. The reason for this is because the glans, the part of the penis which is revealed after the circumcision, is hidden underneath the foreskin. Were you to slowly (and gently) pinch the tip of the penis, you'd see the "bump" in the middle of the shaft move it's way towards the scrotum. Let go of the tip of the penis, and the bump will slide back to its natural position. That bump is the outer edge of the glans - usually the 1/3 or midway point of a baby's penis.
THE FORESKIN
The foreskin (a.k.a. "prepuce") is an outer coating which covers the glans. It covers around half of the shaft. As only the foreskin is removed during circumcision, when the glans is revealed, one can easily see (contrary to popular culture's 'complaint') that the penis is not "smaller" - it just looks different.
[While I won't put the photo in the actual blog - I believe you can get the idea of what this all means when you look at this photo of a circumcised banana.]
AFTER
Before you read this section, understand that most circumcisions do not necessarily turn out exactly the same. All babies are different, and may have different "surprises" under their foreskins, which are not usually detected until after the circumcision itself.
For example, every baby has a differently shaped glans. Thus the first thing you see will look different from child to child.
Secondly, some babies have a minimal mucosal membrane underneath the foreskin, which might completely come off as well during the circumcision. Others have much more membrane with a significant amount left over after the bris, even if it is no longer coating the glans. Still others have significant tissue webbing, which would be undetected until the foreskin is removed. Depending on the extent of the webbing, it may need to be removed separately after the circumcision.
THREE SECTIONS
After the circumcision, one can usually identify three distinct sections on the circumcised penis.
SECTION #1: THE GLANS is the first things you see. It is the tip of the penis, and it almost looks like an army helmet - were the shaft to be standing upright.
A kosher bris consists of the farther rim of the glans being completely revealed, visible, and distinct, with no skin tags attached to it, and nothing hampering its distinct view.
It is usually a very deep, dark, raw RED COLOR (though it is sometimes PURPLE).
SECTION #2: THE MEMBRANE may or may not be completely removed in the bris process. If some of it remains, it may be slightly swollen, and may seem a little puffy below the glans.
Like the glans, it is typically a dark RED COLOR, though it does not usually have the same deep color of the glans. It will also look raw.
If the Membrane is completely removed, the area below the glans will look empty, but there will usually be a gap of a couple of millimeters between the glans and...
SECTION #3: The SPOT OF THE INCISION. This is the spot on the skin itself where the foreskin ended - or at least where the mohel estimated the foreskin ended. Ideally, the incision mark will be fairly close to the glans - but depending on the size of the baby's shaft, the mohel may have found the need to remove more or less skin in order to avoid future problems which may come from the glans falling back into the shaft and/or scrotum.
Dr. Neil Pollock - a very busy circumciser in Vancouver, has detailed information about this on his website. Feel free to read through the information he has - it can be found here [Start with the "Parents Guide to Circumcision" and move on from there!]
WHAT YOU WILL SEE
Aside from the dark red colors and the swelling, the scab tissue which sometimes develops in the area will typically be of a yellowish/ greenish hue. This is normal.
It is not advisable to pick at this, or to rub it as it will only cause the penis to bleed. A warm bath is good and promotes healing. Otherwise, like any scab, it is best to put bacitracin on it for a few days and then stop using ointments when the danger of infection is gone and it just needs to continue healing on its own.
BEFORE
Take a look at your baby! Now you know how it looks before the bris!
Just kidding.
The uncircumcised shaft of the penis looks like an inverted hourglass. It is thinner as it hits the scrotum, and thinner at the tip, but significantly fatter in the middle. The reason for this is because the glans, the part of the penis which is revealed after the circumcision, is hidden underneath the foreskin. Were you to slowly (and gently) pinch the tip of the penis, you'd see the "bump" in the middle of the shaft move it's way towards the scrotum. Let go of the tip of the penis, and the bump will slide back to its natural position. That bump is the outer edge of the glans - usually the 1/3 or midway point of a baby's penis.
THE FORESKIN
The foreskin (a.k.a. "prepuce") is an outer coating which covers the glans. It covers around half of the shaft. As only the foreskin is removed during circumcision, when the glans is revealed, one can easily see (contrary to popular culture's 'complaint') that the penis is not "smaller" - it just looks different.
[While I won't put the photo in the actual blog - I believe you can get the idea of what this all means when you look at this photo of a circumcised banana.]
AFTER
Before you read this section, understand that most circumcisions do not necessarily turn out exactly the same. All babies are different, and may have different "surprises" under their foreskins, which are not usually detected until after the circumcision itself.
For example, every baby has a differently shaped glans. Thus the first thing you see will look different from child to child.
Secondly, some babies have a minimal mucosal membrane underneath the foreskin, which might completely come off as well during the circumcision. Others have much more membrane with a significant amount left over after the bris, even if it is no longer coating the glans. Still others have significant tissue webbing, which would be undetected until the foreskin is removed. Depending on the extent of the webbing, it may need to be removed separately after the circumcision.
THREE SECTIONS
After the circumcision, one can usually identify three distinct sections on the circumcised penis.
SECTION #1: THE GLANS is the first things you see. It is the tip of the penis, and it almost looks like an army helmet - were the shaft to be standing upright.
A kosher bris consists of the farther rim of the glans being completely revealed, visible, and distinct, with no skin tags attached to it, and nothing hampering its distinct view.
It is usually a very deep, dark, raw RED COLOR (though it is sometimes PURPLE).
SECTION #2: THE MEMBRANE may or may not be completely removed in the bris process. If some of it remains, it may be slightly swollen, and may seem a little puffy below the glans.
Like the glans, it is typically a dark RED COLOR, though it does not usually have the same deep color of the glans. It will also look raw.
If the Membrane is completely removed, the area below the glans will look empty, but there will usually be a gap of a couple of millimeters between the glans and...
SECTION #3: The SPOT OF THE INCISION. This is the spot on the skin itself where the foreskin ended - or at least where the mohel estimated the foreskin ended. Ideally, the incision mark will be fairly close to the glans - but depending on the size of the baby's shaft, the mohel may have found the need to remove more or less skin in order to avoid future problems which may come from the glans falling back into the shaft and/or scrotum.
Dr. Neil Pollock - a very busy circumciser in Vancouver, has detailed information about this on his website. Feel free to read through the information he has - it can be found here [Start with the "Parents Guide to Circumcision" and move on from there!]
WHAT YOU WILL SEE
Aside from the dark red colors and the swelling, the scab tissue which sometimes develops in the area will typically be of a yellowish/ greenish hue. This is normal.
It is not advisable to pick at this, or to rub it as it will only cause the penis to bleed. A warm bath is good and promotes healing. Otherwise, like any scab, it is best to put bacitracin on it for a few days and then stop using ointments when the danger of infection is gone and it just needs to continue healing on its own.
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