Being a traveling mohel has its perks and downsides. Every time I travel, the opportunity to see a new community and to be introduced to a slightly different Jewish culture presents itself. I love seeing how people react to my unique methods of sterility, cleanliness and the efficient manner in which I preside over a bris ceremony and circumcision.
The downside is that I don't stick around that long. Traveling does take its toll on the body, but the appreciation for my efforts in coming is always worth the trip. And, in some cases, I do revisit after an absence of several months of even years.
Someone called me today from Puerto Rico, expecting a baby in next couple of months. I remember my last visit there fondly, and look forward to the arrival of this baby and a-now-anticipated trip.
Why did I say percentages going up? Because of the brisses I've done in the last couple of months, between 30-40% of them were traveling cases beyond my local area.
I look forward to coming to your area soon, and giving you the travelingmohel experience!
Tuesday
Number One Concern About Traveling Mohel Laid to Rest
Many parents are concerned that with a traveling mohel, you don't have the flexibility of having the mohel come back a few days later to see that everything is OK. I understand the concern.
Here is why it shouldn't be.
I have become a much better mohel since I began to travel. While I used to leave the baby's bandage on for 24+ hours, I now either take it off or have it fall off within 4-5 hours of the bris.
It is the bandaging at the bris itself which is the critical moment, to the point that my taking the bandage off a few hours later is either a mere formality to speed up the healing process (because the baby doesn't need the bandage anymore or it might have fallen off on its own), or it is because I want to see how things look.
The way I leave the baby at the end of my time with him at the bris is the way he will be. A few days down the road, I can assure you over the telephone, or you can send me a photo via email and I'll tell you what you are seeing.
Any concerns at that point (three days later) are concerns you'd prefer to address with a physician anyway. But in my experience, these haven't come up in a very very long time.
It's always worth the call in the first place. If it doesn't work for you (or for me), we'll figure that out quickly, no harm done.
But if the services I provide (which are unique) are the kind you want, which you will not get from a different mohel, wouldn't you want to at least explore the option?
See the mistakes parents make and what makes me a different mohel
Here is why it shouldn't be.
I have become a much better mohel since I began to travel. While I used to leave the baby's bandage on for 24+ hours, I now either take it off or have it fall off within 4-5 hours of the bris.
It is the bandaging at the bris itself which is the critical moment, to the point that my taking the bandage off a few hours later is either a mere formality to speed up the healing process (because the baby doesn't need the bandage anymore or it might have fallen off on its own), or it is because I want to see how things look.
The way I leave the baby at the end of my time with him at the bris is the way he will be. A few days down the road, I can assure you over the telephone, or you can send me a photo via email and I'll tell you what you are seeing.
Any concerns at that point (three days later) are concerns you'd prefer to address with a physician anyway. But in my experience, these haven't come up in a very very long time.
It's always worth the call in the first place. If it doesn't work for you (or for me), we'll figure that out quickly, no harm done.
But if the services I provide (which are unique) are the kind you want, which you will not get from a different mohel, wouldn't you want to at least explore the option?
See the mistakes parents make and what makes me a different mohel
Sunday
It's All About Being There
When my friend called me to do his new son's bris in NY last shabbos, I jumped at the opportunity. It's always an honor, but even moreso when I have a relationship with the baby's parents.
Flights were booked, and once fears of Hurricane Irene grounding me were put to rest, I was on my way on Friday. No delays - a perfect trip.
The bris took place on Shabbos morning, on time, as it should be. Over shabbos, the grandfather of a newborn, whose bris was supposed to take place the following morning, approached me. He told me they had hired a mohel to come the following morning, but as Hurricane Irene was scheduled to come that night, and no one knew what damage it might bring, they would like me to be on call in the event that the other mohel could not make it.
That evening I received confirmation that the other mohel was not going to be available, so I served as the pinch-hitting mohel.
The following morning, though the storm was over, the damage in the local neighborhood was thankfully minimal (some lost power, some had flooded basements). The bris took place in a house where power had not been lost, and though the lights flickered once or twice, they stayed on full blast during the bris itself.
It was an honor to serve as mohel for both families.
Traveling always carries with it a story - and this one is for the books.
Flights were booked, and once fears of Hurricane Irene grounding me were put to rest, I was on my way on Friday. No delays - a perfect trip.
The bris took place on Shabbos morning, on time, as it should be. Over shabbos, the grandfather of a newborn, whose bris was supposed to take place the following morning, approached me. He told me they had hired a mohel to come the following morning, but as Hurricane Irene was scheduled to come that night, and no one knew what damage it might bring, they would like me to be on call in the event that the other mohel could not make it.
That evening I received confirmation that the other mohel was not going to be available, so I served as the pinch-hitting mohel.
The following morning, though the storm was over, the damage in the local neighborhood was thankfully minimal (some lost power, some had flooded basements). The bris took place in a house where power had not been lost, and though the lights flickered once or twice, they stayed on full blast during the bris itself.
It was an honor to serve as mohel for both families.
Traveling always carries with it a story - and this one is for the books.
Monday
Still not convinced?
When I travel for a bris, my care for your son begins shortly before the bris, and ends (typically) a couple of hours after the bris. After the last time I see him, his bandage has been removed, he is healing nicely, and his body is doing its job to move everything right along, unimpeded by a no-longer-necessary dressing.
I find I typically change the baby's first diaper (before his parents do) because the process I utilize works so efficiently - I am back to check by the time his nap ends and he is ready for a changing..
I always see the baby after the bris. I usually leave him without a bandage, and you with complete instructions how to care for him. Sometimes I have to leave a bandage on the baby for precautionary reasons, but the bandage will come off on its own without you having to deal with it.
It's that simple! 100% attention. Total care. Complete instructions. And my time dedicated only to you.
What other mohel can guarantee you that?
I find I typically change the baby's first diaper (before his parents do) because the process I utilize works so efficiently - I am back to check by the time his nap ends and he is ready for a changing..
I always see the baby after the bris. I usually leave him without a bandage, and you with complete instructions how to care for him. Sometimes I have to leave a bandage on the baby for precautionary reasons, but the bandage will come off on its own without you having to deal with it.
It's that simple! 100% attention. Total care. Complete instructions. And my time dedicated only to you.
What other mohel can guarantee you that?
Tuesday
Busy Busy Busy
This week I will be in New York again for the fourth time in a month. I am honored that despite the inordinate number of mohels in New York, there are people who would prefer to bring the travelingmohel to their son's bris.
In the end, it's not such a big deal for the parents - and, frankly, the traveling has made me into a better mohel
Looking forward to hearing from you too!
In the end, it's not such a big deal for the parents - and, frankly, the traveling has made me into a better mohel
Looking forward to hearing from you too!
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.
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.
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.)
If you are strictly looking at things in terms of dollars and cents, that will guide your decision. It never hurts to call - 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")
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