Have Knife - Will Travel

Welcome to travelingmohel.com! If you are expecting a boy, or if your son has just been born, and you live in an area without a local mohel (or the local mohel is unavailable, or you are exploring other options), travelingmohel.com is the address for you.

I come highly recommended by happy parents, rabbis and physicians, and have developed the traveling for a bris down to a science so that you have the best experience possible from a traveling mohel, your baby is given the attention he needs and deserves, and we remain in constant contact until your baby is completely healed from his bris (circumcision).

I currently live in South Florida, making me an ideal candidate to fly anywhere in the Caribbean or the United States. I am open to flying just about anywhere in the world!

For more information about me and my thoughts on bris milah/ brit milah/ berit milah, please see my regular blog at http://www.mohelinsouthflorida.com/

Click here to read the inaugural thoughts of this website/blog. This posting is the important first step in understanding what I offer and how my mohel services will best fit your needs.

Monday

Traveling Method WORKS - May Even Be Safer

Sometimes, Jewish newspapers have a bad habit of being critical of Jewish practices. Sometimes the criticism is out of line and unsubstantive, and is particularly meant to make religion and observance look bad. Sometimes the critique is in order, and certain practices need to be changed or modified for the criticism to be removed.

In the case of the article presented here from the Jerusalem Post, they are not saying circumcision is bad, or that circumcision done by a mohel is unsafe. They are saying that when the bandage is on the baby for a long period of time (over 24 hours), chances of a urinary tract infection increases manifold.

Lucky you! When you are serviced by the Traveling Mohel, the baby's bandage often comes off on its own (which is a good thing!), or it is taken off within a few hours after the bris.

Here is the link to the article. In case, over time, the link becomes inactive, the article is reproduced below in its entirety.

The gist is this: Calcium alginate is an effective form of achieving hemostasis (stopping bleeding). Once hemostasis is achieved, the bandage can be removed and the baby will naturally heal on his own.

I have been bandaging this way for years, and (with God's help this will continue) have never had a baby develop any post-operative infections from my brisses.

June 14, 2010 Monday 2 Tammuz 5770



'Traditional Israeli brit mila technique ups infection risk'
By JUDY SIEGEL-ITZKOVICH

J'lem doctors say employing different method to stanch bleeding could reduce complications.

The long-time practice by Israeli ritual circumcisers (mohelim) of using gauze for as long as 26 hours to stop penile bleeding is responsible for the significantly higher rate of urinary tract infections (UTIs) within a few weeks of the Jewish ritual.

According to pediatricians and infectious diseases experts at Shaare Zedek, by adopting a different, yet simple medical technique for stanching the bleeding, many UTIs can be prevented. Drs. Ori Toker, Shepard Schwartz, Gershom Segal, Nadia Godovitch, Yechiel Schlesinger and David Raveh published their findings in the May issue of the Israel Medical Association Journal (IMAJ), along with an editorial by Dr. Jacob Amir, a pediatrician at Schneider Children’s Medical Center in Petah Tikva.

According to standard medical practice, a newborn infant who develops a fever must be hospitalized for observation in case the baby has developed meningitis (an inflammation of the meninges covering the brain) or other serious infection. This requires a painful spinal tap with a needle to remove a sample of cerebrospinal fluid through the baby’s back, and a few days of hospitalization until the fever subsides. This type of hospitalization is costly for the health system, and frightening and exhausting for parents.

Studies conducted abroad have showed that UTIs were infrequent when a physician performed the circumcision, even outside a hospital or clinic, compared to the rate among Israeli males circumcised by a mohel. The difference, the authors suggested, was in the method used to stop the bleeding. While mohalim wrap the penile shaft in gauze, thus raising the risk of urine retention that can lead to infection, physicians stop the bleeding by briefly applying pressure with a gloved hand, using calcium-sodium alginate fiber and adding a “wound cavity dressing” that disintegrates in two to three hours.

In his editorial, Amir urged that Israeli ritual circumcisers – supervised by a joint committee of the Health and Religious Services Ministry – be persuaded to change the way they stop the bleeding (called hemostasis in medical jargon), an aspect of brit mila that is not dictated by Jewish law. If they “adopt the hemostasis technique used by physicians – or at least shorten the duration of the shaft wrapping” – the number of UTIs and resultant hospitalizations could be minimized, he wrote. “The unique phenomenon of the high rate of UTI in male infants in Israel seems to be related to the traditional technique of hemostasis. It is time to improve the practice of traditional circumcision.”

After being asked to comment, the Health Ministry told The Jerusalem Post it would seriously consider the recommendations in the journal articles and decide whether to ask the Religious Services Ministry to direct mohalim to change their hemostasis techniques.

The Shaare Zedek team studied the medical records of 449 newborns up to the age of four weeks who were brought with fever to the hospital’s pediatric emergency room between 1997 and 2006. All underwent urine cultures for UTIs, and the 290 with a positive culture had cultures taken of their cerebrospinal fluid. Their parents were asked if the infants had recently undergone circumcision and, if so, whether it had been performed by a non-physician mohel.

After eight days of life, 24.7% of circumcised boys who had fever were found to have UTIs, compared to 8.4% of girls of the same age. Meningitis was found to be very rare.

Mohalim have already changed some of their methods out of health considerations. For example, they abandoned direct sucking by mouth of the bleeding organ to avoid giving or getting hepatitis B or C, or HIV infections, and instead suck through an hourglass-shaped glass tube in which cotton wool is inserted to prevent transmission of pathogens in either direction.

Tuesday

Isn't it easier - and cheaper - to use a local mohel?

There are certainly benefits to having a local mohel. But there may be cons to having a local mohel too (See here, and here, and here, and here.)

Think of it this way - many people who require a delicate surgery will travel across the country, or even across the globe, to go the "best" specialist in the world.

For your son's bris, the specialist will come to you! (I do not claim to be "the best," which would be presumptuous, but there are things I offer that you won't find elsewhere -- see the end of this posting and here.)

Let's talk about whether it is indeed cheaper to use a local mohel.

If your local mohel does not take a fee or takes whatever you'll give him, then yes, your costs with the local mohel will be lower.

But if your mohel has a flat rate of $500 or more, then you can begin to weigh options.

Here is what I ask for you to cover/arrange.

Travel - flight or fuel (if it is up to a four hour drive, I will consider driving) (we can arrange airport pickup)

Hotel accomodation - in the event I need to come the night before (if I know people in town, I might arrange to stay with them)

Consideration for my time - a minimum of $250 should serve as a base range. As per this blog posting, however, I will leave it up to you - no questions asked.
************************************************

Flights might cost between $200 and $350, depending on the day of the week and the season. In this case, your costs may be the same, or even lower, when you call me.

Obviously, if flights cost $600, I will recommend you use the local mohel, if there is one.

HERE IS THE BOTTOM LINE:

If you are strictly looking at things in terms of dollars and cents, weigh the options and decide which will cost less. Call me - let's see if we can work it out.

If you are weighing other components in your decision, I can help you explore those ideas, to help you discover the best option for you. (go to my other blog, and search "important questions"

Friday

A Busy Month

Ever since Traveling Mohel was launched, this mohel has had the privilege to travel for many brisses.

In this last month alone (April-May 2010), aside from local brisses in between flights, I have averaged more than one bris a week traveling by air.

Many mohels have observed that we never know more than a week in advance where our next jobs will be due to the nature of the business (you are called right when the baby is born and the bris is on the baby's eighth day, which is a week later).

This makes arranging travel a bit of a challenge, but in cases where there is no local mohel, what else can you do?

Simple Steps

The steps have been outlined in other postings. Call me ASAP. If baby is healthy and signs are good, we'll book the most economical flight possible and give enough time so your baby is well cared for.

I feel very strongly about checking the baby after the bris. There is usually no need for me to see the baby beyond one time after the bris, and I make sure to book flights in such a way that I am around for a few hours after the bris in case there are any issues.

By the time I leave, the baby is healing nicely and just needs the requisite days for the circumcision to complete healing on its own.

Email avbillet@gmail.com or call 516 850 9694 (cell).

Looking forward to serving your bris needs.

Sunday

The Search for the Right Mohel

There are many fine mohels in the world. When looking for the one who meets your needs, the questions you should be asking include:

Personality
Can he relate to the way I practice Judaism?
Does he have a good bedside manner?
Will he treat me like a mentsch?
Will he view my baby as I do? Or is my baby "just another feather in the cap?"
Does he have patience?
Does he give me the time of day when I have questions related to the bris that need to be discussed?


Practitioner
Is he an excellent practitioner?
Will the cosmetic results be to my liking?
Do his standards of hygiene and sterility match my sensibilities?
Does he pay attention to detail?
Does he explain things clearly?
Is the baby ever in danger?
What is his track record as far as emergencies and post-op situations?
Does he check the baby after the bris?
Is he in contact to see how the baby is doing a few days along the healing process?


Jewish Law?
Is he familiar with all aspects of Jewish law related to the bris?
Is he familiar with the customs of different Jewish traditions - European, Middle Eastern, North African, etc?
Is he flexible in terms of some of the customs, as they relate to my family situation?
What is his method of circumcision?
Does he use a clamp or the "Jewish shield" to isolate the foreskin?
How does he do metzitzah?


Good luck with your baby! I hope all goes well and your experience is a positively memorable one!


Tuesday

A Traveling Mohel That's Right For You

I met with a woman today who relayed to me an awful experience the son of a friend had in his bris. They brought in a "highly recommended mohel" who, in a manner I think I understand and can explain, amputated either the baby's glans or the tip of his glans. I don't know the rest of the story. I only hope the baby was able to have emergency surgery to correct the new problem he is faced with in life.

Stories like this make me wish mohels like that would be either prosecuted, ostracized, or should at least never work again. It is only arrogance of the highest order (important part is halfway down in the link) which makes some mohels think they need not take necessary precautions to protect the safety of the babies on whom they operate, and attempt to give them the mark of the covenant.

This traveling mohel has an excellent track record, because this traveling mohel takes important precautions to make sure the bris comes out as perfect as possible, every time.

* All materials - bandages and surgical instruments - are brought to the bris packaged and freshly sterilized.
* Gloves are worn every time the baby's open wound is touched.
* A surgical marker is used to pinpoint the exact extremities of the foreskin.
* Irreversible clamps are not used, and safety devices are used (as opposed to old-school free-hand) to unequivocally avoid problematic outcomes such as the one described at the beginning of this posting.
* I check, double check and triple check that the bris looks as perfect as possible before I close his diaper and return him to his parents. In the event the baby, anatomically or through the process of the circumcision, needs an adjustment or touch up, it will be taken care of right away so there will never be a reason to revisit the circumcision.

When you look for a traveling mohel, you want to get a traveling mohel who comes, does the job right the first time, and leaves your baby more than well on his way to a full recovery. With no complications. And with doctors singing the praise of a job well done.

A traveling mohel who will give this to you authors this website. Contact me via email at avbillet@gmail.com

Monday

Making Your Bris Easy and Meaningful

When you live in a place without a local mohel (or in a place where you don't want to use the local mohel), it can be hard, or at least difficult, to find someone who will travel. And who will give you the time of day in doing so.

So you've stumbled across Traveling Mohel. First I will tell you how I will make your bris process easier and meaningful. Then I will tell you about my experiences and why you can be happy with your choice of mohel.

Making Your Bris Process Easier

Here are the things we need to do when we touch base and confirm I will be the mohel.

1. Decide when your bris will take place. This will help determine the travel plans I will make.

If your bris will take place relatively early in the morning, I will have to come the night before.
If your bris will take place late morning or early afternoon, I can fly early in the morning.

2. I will send you an email with all the information you need (or you can access it all here and here )

3. Either you or I will book my flight - I will be in your neighborhood for enough time to do the bris and to check your son's circumcision a few hours later.

4. We will schedule and have a conversation over the phone to assure the bris ceremony will be set up to your liking. Your needs and the needs of your guests will be addressed and I will do my best to make sure you are comfortable with how things will pan out.

5. I promise to give you all the time you need before and after the bris; aside from the conversation (#4), we can either communicate by phone or email to address the details and logistics.

6. It is very important to me that you have the least amount of worry in dealing with your son's care after the bris. After I check your son's progress, he will be left without a bandage, already in the post-raw healing stage.

7. Before I leave, I will review with you what you need to do to properly care for your son. Though I will be sure to go over everything face to face, instructions can be found here in case you need a quick reminder and I am not immediately available to answer the phone.

Making Your Bris Meaningful

1. Our conversation (#4 above) will help me understand your pressing needs and what kind of ceremony will best fit you and the way you experience Judaism.

2. I will do my best to accomodate your particular situation and desire to have different family members involved in the ceremony.

3. I will answer all questions, raise important thoughts to consider, and try my best to make sure you and I are on the same page insofar as what will physically happen to your baby, the religious significance (if that is important to you), and the possible emotional whirlwinds I have seen people experience.

MY EXPERIENCES TRAVELING

I have traveled across the United States to do brisses. Through my travels I have developed an excellent system for giving babies the proper care with appropriate follow-up in a relatively short time.

I am efficient to a fault:
* We start on time
* I give the ceremony and the procedure the time it needs, but I do not belabor the point or draw things out unnecessarily
* The actual circumcision takes a few seconds
* There are no shortcuts - I do not use a clamp. This is a completely kosher, halakhic bris
* Afterwards I double check that the circumcision is perfect, and bandage in such a way that the bandaging will come off easily when I check him later, with minimal, if not zero bleeding.

To toot a small horn, a horn for which I continue to be grateful to God for helping me achieve, parents are consistently telling me afterwards things like "it looks great," "it is healing very quickly," "it is healing very nicely," "the doctor said this was [one of] the finest brisses s/he has seen."

Email me at avbillet@gmail.com. Call and interview me.

Hopefully we will make the bris the experience you want it to be.