War is hell, not just on the battlefield but in the bedroom.

The ongoing hostilities between Israel and its jihadist neighbors are forcing couples to rethink familiar patterns of intimacy. When partners are consumed or paralyzed by the news, it’s hard to keep one’s mind clear for romance. 

It gets even more complicated when lovers have different ways of relating to said news. One partner may be proactive, fast to get out of the house and volunteer, while the other curls up on the couch, avoiding anything that might be traumatizing.

“We didn’t have sex at all during the first week of the war,” Sigal from Ramat Gan told Dana Spector in an article for Ynet. “It was all such a shock. We’d sit there from morning until 3:00 am, each of us glued to our own phones. We couldn’t even talk to each other.” On the outside, she says, “I was the same woman, but I was completely disconnected. I couldn’t feel anything at all. My libido dropped to zero.” 

Indeed, with the war still raging and the remaining hostages unaccounted for, “Sex is the first thing to give up on,” Michal Nir, who coordinates the sex therapy program at Bar-Ilan University, told Haaretz. “You have to eat, sleep and breathe. You don’t have to have sex.”

“There’s also ‘survivors’ guilt’ – people taking on the guilt of what happened to women who’ve been kidnapped and punishing themselves as a form of ‘moral duty,’” comments Keren Gilat, who heads the School for Holistic Psychotherapy at Reidman College. “If they can’t experience pleasure, how can I?”

But there’s also the risk that the emotional distancing will translate into long-term issues with intimacy.

Sigal knows this, too. “It’s not healthy going so long without,” she laments. 

Survival mode doesn’t necessarily mean sex is off the table entirely. People had sex in the concentration camps. People with cancer still desire sex.

For women, the impact has been particularly difficult. 

A senior high-tech manager, who finds she suddenly has to hold down her job while simultaneously handling all the household and childcare responsibilities as her husband is away fighting, told Ynet, “I pray that he’ll get hit by shrapnel and that he’ll come home. These past weeks have broken us.”

That brokenness stems in part from what nearly all Israelis are suffering from today: “secondary trauma.” 

Secondary trauma, or “compassion fatigue,” refers to distress that’s experienced indirectly by hearing details,or witnessing the aftermath, of trauma experienced by another person. 

Secondary trauma shares many of the same symptoms as full-on PTSD: intrusive thoughts, avoidance of everyday activities (going to the supermarket, taking kids to the park), irritability and mood swings, negative thoughts (“what is there to live for, anyway?”).

“In reserve duty, I saw some very disturbing videos,” explains a soldier in the Ynet article. “True, I wasn’t there, but I’m inside it. I’ve been traumatized ever since.”

Secondary trauma has entered my household, too. 

A few nights ago, I found myself yelling at my wife, Jody, for something ridiculous: She hadn’t read a WhatsApp I’d sent to her. We defused the situation quickly, but that’s not me – I don’t scream at my spouse. 

Secondary trauma in the bedroom means that getting into a sexy situation can be scary because there might be a siren. That kind of excessive arousal (and I don’t mean the “good” kind) makes it “hard to be in a pleasant, intimate situation,” notes clinical psychologist Gilad Horowitz.

Talli Rosenbaum, cohost of the Intimate Judaism podcast and coauthor of a new research paper on intimacy in times of war, points out that “we are now wired in a way that’s not meant to be the default way of being in life. We’re wired in a hyper-aroused or hypo-aroused state, as if we’re numb.” 

This state of hypervigilance, she explains, is “dissonant with intimacy.”

Rosenbaum wants us to remember that “one of the most important tools for maintaining marital harmony is self-awareness. ‘Am I going into a stress response?’ ‘How do I calm that stress response?’ ‘How do I regulate myself emotionally so that I can go into my more cognitive, logical, rational space?’”

The study Rosenbaum helped compile revealed that nearly half of respondents reported watching disturbing videos from the Hamas attacks several hours per day. “They were almost addicted to watching war-oriented content,” notes Aryeh Lazar, who coauthored the study with Rosenbaum and Ateret Gewirtz-Meydan, an associate professor in the school of Social Work at the University of Haifa. “The amount of viewing time correlated with a self-reported decrease in sexual desire, arousal and orgasm.”

For those who do want to restore intimacy, even in the midst of war, what can they do to make things better? 

It might seem obvious, but patience is the new state of play. “You mustn’t pressure someone who just can’t think about sex right now,” says sex therapist Shelly Varod. “You need to let them heal emotionally.”

Now is the time for baby steps. Look for something small – bird song outside your window or some favorite music playing in the background – to ground you in the reality that existed before Oct. 7. Crack open a bottle of wine. Watch TV together with your partner – just not the news.

Finally, “don’t give up on your grief – not for a moment,” stresses psychologist Ruth Ben-Asher. “It doesn’t mean that you’ve forgotten or you’re abandoning all those who lost loved ones or were actually hurt. [But when] you renew your connection with your spouse and make yourself stronger, you can get on with your grief much better…and not from a place of trauma.”

I first explored intimacy during war for The Jerusalem Post.

Photo by Womanizer Toys on Unsplash

We’ve all seen that person. The one who feels unwell at a concert or a public event. As he or she lies on the ground, a crowd of gawkers assembles. Eventually a doctor materializes, and the stricken person is whisked away by ambulance. 

On a recent Shabbat, I was the guy on the floor. 

My wife, Jody, and I were invited to a kiddush at a local synagogue when I started to feel faint. I sat on a bench but soon needed to lie down, too. I was nauseous and thought I might throw up, but when I tried to get to the bathroom, my vision blurred, and the outdoor space spun around me. 

I lay down again, this time on the hard pavement, aware of the spectacle I was creating but with no real option to sit up, lest I wanted to pass out.

This being a shul full of Jews, it was inevitable that there would be a doctor in the house. My pulse was dangerously low, he warned. He asked me to count from one to ten. No confusion but he still felt I needed to get to the ER.

“I don’t want to go,” I whispered to Jody. “I don’t want to spend the whole of Shabbat in the hospital.”

But it was too late. The ambulance had already been called. My blood pressure was a paltry 80/40. Hoisted onto a gurney, I was whisked off to Hadassah Ein Kerem.

The Emergency Room was efficient – they hooked me up to an IV, checked my heart with an EKG, did a chest X-ray and took blood and urine. Everything came out normal.

“It’s probably dehydration,” the doctor pronounced, as he hooked me up to a saline drip.

That didn’t make sense to me. I’ve had plenty of times where I haven’t drunk enough but nothing like this had ever happened. I had a couple of sips of Scotch at the kiddush – could it have been that?

My own diagnosis: I was having a panic attack. The symptoms were consistent: dizziness, shortness of breath, low blood pressure (although to the doctor’s cautious credit, those same symptoms could indicate a heart attack).

Anxiety has been my watchword since the October 7 “Black Sabbath” attack on Israel’s south. The minute-by-minute reports of fighting in Gaza that fill my WhatsApp feed, the deep depression over the fate of the Israeli hostages in Hamas’s hands, the escalation in the north, has everyone on edge.

Now, add to all that some unexpected health news and maybe it’s not so surprising that I collapsed.

Remember the “boom-boom” radiation I received over the summer? It, unfortunately, didn’t work. At first, the tumor we zapped shrunk, and I was optimistic. 

But a follow-up PET CT was shocking: The tumor had grown back – and then some. New tumor sites appeared, as well. 

My doctor recommended that we start treatment again. 

Follicular lymphoma is a chronic cancer. For most people, it won’t kill you, but it nearly always comes back, requiring more treatment. I had chemo and immunotherapy in 2018 and went into remission – but just for six months before I relapsed. If there’s a silver lining, I went treatment free for five years since, with follicular lymphoma, you don’t treat until the tumors get large enough or if you’re having “B” symptoms. 

Was my near-fainting in shul a “B” symptom? My hematologist didn’t think so. But the disease is now clearly progressing and treatment in 2024 has become unavoidable.

That’s where I am now – at the beginning of months of cancer treatment which will, hopefully, knock out the lymphoma for a good many years.

Part of what gives me confidence is a new kind of treatment that has emerged that will, in the coming years, likely become the standard of care for blood cancers like mine. No more chemo. The new drug of choice is known as a “bispecific antibody,” a form of immunotherapy. Mine in particular is called Mosunetuzumab.

A quick primer: Antibodies are a protein component of the immune system that circulates in the blood, recognizes foreign substances like viruses and bacteria, and neutralizes them. Immunotherapy, unlike chemo, which indiscriminately kills both cancer and healthy innocent bystander cells, harnesses the body’s immune system to fight any malignancies. Scientists do this by engineering antibodies in a lab and then injecting them into the patient.

Antibodies tend to have a “Y” shape. Most engineered antibodies are “monocolonal” – they have the same function on each “arm” of the Y. For lymphoma, they seek out a protein called CD20 that’s expressed by the tumor cells. 

For bispecifics, the two arms have different functions. One still searches for CD20 proteins, but the other binds with CD3 proteins which are expressed by T-cells in the immune system. 

Because the two arms of the Y are tethered to the same stem, they pack a powerful punch. Unlike with monoclonal antibodies, where the T-cells have to search somewhat randomly throughout the body to find the cancer cells that the monoclonal antibody has marked, with bispecifics, the antibody basically says, “Hey, T-cells, I found a tumor. Here it is. Go get it.”

The result can be dramatic, with tumors obliterated sometimes as fast as a matter of minutes. We don’t know how long the remissions will last – bispecifics are so new there’s no long-term follow-up date on them – but the prognosis is encouraging.

By this time next year, I should be done with IVs and meds. I can only pray that our country will be in a similar remission from the war and the divisiveness that preceded it, and that we will have eradicated our enemies – both internal and external.

I first shared my latest health news at The Jerusalem Post.

For a good overview on how bispecifics work, this video from the Lymphoma Research Foundation is excellent.

I’m circumcised. So are all the men in my family. We’re Jews. That’s what we do.

But have we made a terrible mistake?

There is a growing movement around the world for “foreskin regeneration.” An online survey conducted by foreskin “intactavist” Brendon Marotta asked 10,000 circumcised men if they’d be willing to have their circumcision reversed and how much they’d be ready to pay.

Some 40% of circumcised respondents said they wanted their foreskins back. Of these, 22.6% said they would be willing to pay over $20,000 for the procedure. 

Why would men be clamoring for a procedure in such a sensitive area? 

In a word: pleasure. 

The foreskin comprises a third of the skin of the penis – that’s an awful lot of satisfaction being lopped off.

But how would we know? Since most men are circumcised as infants, we don’t have any way to compare before and after. 

Unless you’re a Russian immigrant to Israel.

Circumcision was not as de rigueur in the Former Soviet Union as it is in Israel, where brit milah is a clear Torah commandment. But Russian immigrants who want to convert to Judaism will sometimes get circumcised later in life. 

An article in Haaretz quoted an immigrant named Yuri who was already sexually active before deciding to get circumcised.

“The feeling in the sexual contact was affected, it was wrecked,” Yuri laments. “There was a great deal less sensitivity and I needed a higher level of stimulation. I was 16 and I was an idiot.”

Haaretz’s Hilo Glazer interviewed 50 immigrants who were circumcised only as adults. 

“Seventy percent of them reported that their enjoyment of sexual relations had been adversely affected,” Glazer writes. “Twenty-two percent said there had been a significant decline, 10% said it was medium, and 38% characterized it as a minor drop.”

A survey published in Israel Hayom and conducted by Rosh Yehudi, the NGO that was at the center of controversy on Yom Kippur when it tried to hold gender-segregated prayer in Tel Aviv’s Dizengoff Square, found that, while 47.8% of respondents said it was “imperative” to them that their children be circumcised, and an additional 25% said they considered it “important,” 8.4% said it was only “somewhat important” for their children to be circumcised, 11.5% said it “wasn’t important” to them, and 7.3% said they were “opposed” to circumcision.

For Jews considering non-circumcision, an organization called Bruchim promotes an alternative – the brit shalom – which focuses on the ceremony but without the cut. There’s also the website, Beyond the Bris; the 2005 book A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision by Richard Darby; Brendon Marotta’s documentary, American Circumcision; and Rabbi Haviva Ner-David’s novel, To Die in Secret, which highlights as a pivotal plot point a woman debating whether to circumcise her son.

Brit milah has not remained static over the years.

According to the Oxford Dictionary of the Jewish Religion, the version of brit milah practiced today is quite different than what was originally delineated in the Bible. Rather, it is a response to the Greeks, who loathed circumcision.

To participate in Hellenistic sporting tournaments, one had to compete naked. Jews wanted to be a part of the games, too. Some Jewish athletes would systematically weigh their foreskins down with stones so they would appear still intact.

The rabbis, who were against assimilation of any kind, responded by mandating the removal of much more of the foreskin than the Torah originally intended. 

If brit milah was originally the ultimate impossible-to-fake “signal” of belonging to the Jewish tribe, circumcision later became more of a moral imperative. Maimonides wrote, for example, that the purpose of brit milah was to “reduce the pleasure of the sex act.”

The 19^th century Victorian- and Edwardian-era English-speaking world concurred, believing circumcision would lessen sexual desire and, as Darby points out, lead to a reduction in masturbation. 

John Harvey Kellogg, the inventor of Corn Flakes, sadistically claimed that circumcision would make a “good punishment” for boys who play with themselves, and advocated operating without anesthesia.

Circumcision is far from pain-free, regardless of the recipient’s age or state of stupor.

Dr. Daniel Shinhar runs a clinic in Tel Aviv that performs circumcision on infants under sedation. He notes that “the pain of circumcision is equal to that of having a tooth pulled without an anesthetic.” 

On the plus side, circumcision appears to reduce the risk of urinary tract infections, prostate cancer and sexually-transmitted diseases such as genital herpes, syphilis and HIV.

While the idea of more pleasure is enticing, I’m not considering reversing my own circumcision. Interested men, however, can turn to a startup called Foregen, which is running clinical trials to re-establish a fully-functioning foreskin.

Foregen creates an extra-cellular matrix – a kind of “scaffolding” made of proteins, carbohydrates, collagen, hyaluronic acid and other biological material formed from donated foreskin tissue.

Foregen then applies different growth factors “to get the tissue revascularized,” Ryan Jones, Foregen’s chief operating officer, told me. 

“If the Israel Hayom-reported data is accurate – that more than 18% of secular Israelis feel circumcision isn’t important or are outright opposed – it shows a surprising lack of support for circumcision among secular Israelis,” Rebecca Wald, executive director of Bruchim, told me. “There’s still widespread endorsement of circumcision, but this definitely indicates the tide is turning.”

While I wouldn’t go so far as to call circumcision a “terrible mistake,” perhaps there’s a middle ground for the Jewish baby boys yet to be born.

Could we return to the Biblical, more minimally-invasive method of brit milah that existed before the rabbis and Greeks messed things up? Would that enable greater stimulation without turning non-circumcised males into Israeli locker room oddities? 

Or should we just not touch the whole sensitive topic?

I first wrote about foreskins for The Jerusalem Post.

“Foreskin’s Lament” is the title of a wonderful memoir by Shalom Auslander.

“Are you ready to ‘boom-boom?’” the radiation-oncologist asked me. 

This is not where I expected to be this summer.

My non-Hodgkin’s follicular lymphoma has been growing slowly but steadily over the past four years since I relapsed following chemo and immunotherapy.

I had hoped the cancer would continue at a snail’s pace and this period of “watch and wait” would last for long enough that researchers could come up with a cure – or at least an attractive alternative with minimal side effects. 

“Watch and wait” describes the limbo that sufferers of a chronic cancer like mine must navigate. You only treat when the tumors get large enough or you notice unpleasant “B” symptoms. Otherwise, you monitor with regular scans and checkups.

It was that unexplained edema that developed in my left leg while my wife, Jody, and I were on vacation in the Amazon that tipped me off that something had changed. (See From Bother to Benefit, May 5, 2023.)

I met with my hematologist upon returning to Israel. She saw that my lower extremities were still swollen and swiftly ordered a PET CT.

When the results came back, the reason for the swelling was finally clear: It was my cancer.

My main tumor, which is located in the pelvis region, had grown – not a lot, mind you, but just enough to press on a blood vessel that controls the flow of fluid on my left side. If drainage from a part of the body is blocked, fluid can back up.

This was a serious development, my hematologist intoned, eschewing her usual reassuring banter. If left untreated, I could develop a fatal blood clot.

She prescribed anticoagulants to lessen the chance of a thrombosis.

Unfortunately, the anticoagulant medicine was not a pill, but a shot. Yes, I had to inject myself every morning. Ouch.

Rather than recommend more IVs, pills or immunotherapy, my hematologist had an idea: Maybe we could knock out the offending growth with radiation.

That’s how I wound up sitting across from the radiation-oncologist – who, in that weird way that everything overlaps in Israel, is also my downstairs neighbor.

The radiation-oncologist looked at my scans. Radiation could indeed work, he said. The usual course is 12 to 14 treatments, but follicular lymphoma was particularly responsive to just two quick sessions.

“After five years, if you do a dozen treatments, you’ll have a 90% control rate,” my neighbor/doctor explained. 

“Control,” in this case, means the tumor hasn’t come back or isn’t growing.

“But if you do just two treatments, you’ll have a 70% control rate. That’s an excellent response with much less radiation. You probably won’t even have any side effects. It’s called the ‘boom-boom’ protocol.”

“’Boom-boom’ sounds good to me!” I replied enthusiastically.

The next step was to get a tatoo.

Now, I’ve never had a desire to get inked. But as I lay on the bed after being scanned in a CT machine for the pre-radiation “simulation,” I felt a brief but sharp pain on my left side, then another on my right. 

“This is so we know where to direct the radiation beam,” the technician said.

“It will come off when I shower, right?” I asked, alarmed at this unbidden affectation of my body.

“No, it’s a permanent tattoo,” she said. “But you’ll barely notice it.

Who knew cancer would finally give me hipster cred?

A week after the simulation, I arrived for the real deal. 

The waiting room in the radiation-oncology department at Hadassah Medical Center was renovated a year ago. It now has calming pastel-colored chairs and couches, with paintings of pleasant landscapes on the ceiling. The lighting in the treatment rooms is bright and they’ll even let you play your own music while being radiated.

I lay down on the bed attached to the radiation/CT unit, which rolled me into the belly of its beast. There was a slight buzzing sound, almost like an epilator – or was that another tattoo needle? The machine repositioned me a couple of times. There was more buzzing. And then, ten minutes after we started, it was over. 

I didn’t feel any pain while it was going on. Afterward, though, I was hit by an intense wave of nausea. My brain was foggy, and I was loopy and tired for most of the day. 

So much for “no side effects!”

On my second day of “boom-boom,” I popped in my AirPods. Steven Wilson’s “Hand Cannot Erase” was my album choice. 

I got through all of two songs before I was done. 

Six weeks later, I did another PET CT. The results were encouraging but not conclusive. The “boom-boom” gave me a partial response, meaning the tumor shrank, but it was still there. It could continue shrinking. Or I might require more radiation. 

“We’ll be smarter after we do the next PET CT in the fall,” my hematologist told me.

I had almost not mentioned the edema to my hematologist during that checkup. I simply didn’t connect the two: What would my leg have to do with my cancer? But when I showed my doctor my then-slightly-but-still-swollen foot, she suspected the two could be related.

That’s an important lesson. I sometimes worry I should hold back more when meeting with my doctors; that I should just stick to the basics, the most immediate concerns, rather than review a laundry list of aches and pains.

In this case, though, sharing that information could very well have saved my life. To paraphrase Tony Soprano from The Sopranos (and Sonny Corleone in The Godfather before that), “Bada boom, bada bing” – that’s some good “boom-boom,” indeed.

I first wrote about my :boom-boom” summer for The Jerusalem Post.

“You have to put up with some bother in order to reap the benefits,” my therapist cautioned me just prior to our two-week excursion in Ecuador.

What he meant was that everything involves some “bother” – annoyances you simply can’t avoid. The key is to put the bothers in perspective, so you don’t lose sight of the big picture – in this case, the fun we were planning to have on the vacation.

Bothers while traveling abound.

Standing in lines at the airport is no one’s idea of a good time. 

Tight seats that don’t recline with no leg room are a pain. But you have to go through it in order to get to your destination.

Your hotel room might be facing a bright streetlight. Should it ruin your enjoyment of all the daytime activities you’ve got lined up? 

You went to a fancy restaurant, but you didn’t love what you ordered. Frustrating, yes, but it’s not the end of the world. 

Bothers have a psychological term: reactants – “an unpleasant motivational arousal to the loss of freedom.” 

“I’m sorry, your carry-on can’t go there.” 

“It’s not time for your group to board yet.” 

Even “Please buckle your seatbelt” can be a reactant. 

This mantra became incredibly helpful during our time in South America. 

When the passport control line wriggled and wound its way in crazy-eights for more than an hour, my wife, Jody, and I simply repeated the “bother to benefit” message and, before you knew it, we were in Quito.

But what happens when the bother is bigger than a long line or a mediocre meal?

A few days after we arrived in Quito, Jody noticed something odd going on with my left foot: It had turned black and blue and swollen to twice its normal size. 

Not just the foot – my whole leg was retaining fluid. And it hurt like crazy to walk. I could barely pull on my hiking boots – not the best situation when you’re about to start a holiday that is primarily about trekking.

I’ve never been someone who slows down. My fear-of-missing-out on seeing a penguin or giant tortoise is too pronounced to skip a day of snorkeling or climbing to the top of that volcano.

But I was concerned. We were about to fly to the Galapagos. I needed to be sure this unexpected edema was not a thrombosis. If a blood clot traveled from the leg to the heart or lungs and I was on a flight over an ocean, that could be bad.

I called a doctor. 

Within an hour, an emergency medicine physician and nurse arrived at my hotel room where they did a full assessment. They took blood and brought in a portable ultrasound unit to image my leg. 

Everything came out negative: I was clear to fly. The doctor prescribed some painkillers, compression socks for the flight, and blood thinners to take prior to boarding.

“Did you really need to see a doctor in Ecuador?” my therapist asked upon my return. “Maybe it wasn’t necessary?”

“I could have died if I didn’t get this diagnosed correctly,” I exclaimed. 

Still, I understood his point, even as it frustrated me. 

I do tend to run to doctors more than the average person. I have been zealously monitoring my body – my therapist would say “over monitoring – since I was a teenager with Crohn’s disease and needed to report to my gastroenterologist all the bloody details.

Since then, my monitoring has bordered on obsessive. 

Is that dry cough turning wet? Is another round of pneumonia coming on? 

Am I feverish? I just took my temperature 20 minutes ago. Should I do it again?

Is that sudden flurry of floaters a sign of retinal detachment? My ophthalmologist sent me to the ER, and I dutifully complied. 

My eyes were fine.

“Do you feel that all your monitoring might be getting in the way of you focusing on what’s important?” my therapist asked.

“Sometimes yes,” I said ruefully, not wanting to admit that a change in behavior might increase my overall engagement with life.

Don’t get me wrong: The trip was wonderful despite the physical challenges. But upon our return, I was so unable to walk that I stayed in bed for 36 hours with my leg elevated.

The edema miraculously resolved nearly entirely.

Meanwhile, Jody and I began to explore some tough questions.

Were we getting too old for this kind of adventurous travel? I’ve tried to ignore the role my cancer might be playing in all this, but maybe that’s no longer prudent.

Should I just accept that, after these kinds of trips, I’ll be laid up for a few days – or longer – and that’s the price of seeing the world for someone like me?

Going forward, should we eschew the challenging treks in favor of more relaxing beach holidays? 

Meanwhile, my therapist had started to come around. 

“There’s a difference between a ‘bother’ like getting stuck in traffic and a potentially life-threatening condition. You were right to call the doctor in Quito.”

Now back in Israel, I still need to figure out what caused my foot to swell so much that it looked more like a tree trunk or an animated golf putter than an actual human appendage. 

Was it the high altitude? (Quito’s elevation is 3,000 meters.) 

The 25,000 steps a day we were logging? 

The plane ride itself?

My doctor scheduled more tests.

Until then, I’m finding myself monitoring my foot from time to time, an over precaution to be sure, but changing old habits is hard. 

It’s a fine line. The goal now is to learn how to thread it.  

I first wrote about bothers and benefits in The Jerusalem Post.

Large tech conferences are ideal for networking with colleagues you may only see once a year.

You know what else likes to network at large conferences? Viruses. 

If February’s OurCrowd Global Summit had been held in the last couple of years (it was canceled in 2021 and 2022 due to Covid restrictions), it would have been dubbed a super-spreader event. With 9,000 attendees crammed into packed hallways and lecture halls in Jerusalem’s International Convention Center, there’s no doubt that at least some of the participants must have been sick – if not with Covid then with the flu or common cold.

I apparently wasn’t the only one concerned about picking up a bug at the Summit.

Israeli-Canadian startup SaNOtize set up a booth to test its antiviral spray, enovid. The company’s cofounder and chief science officer, Chris Miller, told me this was “the world’s first double-blind clinical trial launched at a convention.”

SaNOtize cites studies claiming that by using nitric oxide (NO) and the company’s proprietary NORS (Nitric Oxide Releasing Solution), enovid can kill 99% of virus particles in two minutes. A 2022 study published in The Lancet found that, if you do catch Covid, treatment with enovid cut the duration of disease by 50% compared with a control group. 

In another double-blind controlled study, enovid reduced the viral RNA load in infected Covid patients by more than 95% within 24 hours of treatment. 

“We have known that NO is an antiviral for over a decade,” Gilly Regev, SaNOtize’s Israeli CEO, told me. “NO is a naturally occurring molecule with documented antiviral, antibiotic and antifungal properties. We have used it on ourselves while traveling for years.” 

“I haven’t gotten the flu for ten years,” Miller added. “And I’ve never caught Covid.”

Enovid works by creating both a physical and chemical barrier in the nose. 

First, “the gelling agent creates a mechanical barrier that traps viruses within the nasal cavity and prevents them from further entry into the respiratory tract causing infection,” Regev said. 

A chemical barrier is also established by the NO, as it destroys the shape of the spikes/protrusions of any viruses present – Covid, the flu, rhinoviruses and RSV – rendering as useless the part of the virus that’s evolved to penetrate the body’s cells and replicate.

The SaNOtize clinical trial at the OurCrowd Summit enrolled around 450 people. Half the participants received the real thing and half a “sham” – a neutral saline solution. Daily reminders to spray and test (five home antigen kits were included in the trial kit) were sent by email and SMS. Participants who completed the full 10-day process and filled in all the forms received a $100 Amazon gift certificate.

“What happens if you get the sham and you wind up getting Covid or the flu?” I asked Miller.

“We stop the trial and immediately send you the real spray,” Miller replied. 

What if you were in close proximity to a known Covid or flu carrier?

“You have a three- to four-hour window when exposed to the virus before it penetrates the host cell and starts replicating and shredding into the nasal passages,” Miller told me.

You can buy enovid in Israel, Europe and parts of Southeast Asia, but not in North America yet where NO is only approved as a prescription drug to help with “blue baby syndrome” (persistent pulmonary hypertension in newborns). Phase III trials are starting now. In Israel, enovid is sold over-the-counter for NIS 139.

When NO was first being tested in the early 1990s, it was delivered through pressurized gas cylinders. Part of SaNOtize’s innovation is to deliver NO as a spray to use at home, rather than requiring expensive tanks. 

SaNOtize has 20 employees and has raised over $40 million. Miller, a respiratory therapist, completed a PhD in 2004 on the antimicrobial properties of NO. Regev has a doctorate in biochemistry from the Hebrew University.

“Can’t you still get sick by breathing in a virus through the mouth?” I inquired. While that certainly can happen, “the major route of entry, and specifically the incubation location, for respiratory viruses is in the nasal cavity,” Miller explained. 

Now that Covid is becoming less of a concern, will this harm SaNOtize’s sales of enovid? 

“Sanotize was never a Covid-specific company,” Miller said. While, during the pandemic, the company accelerated its application of enovid for viral contagions, the original research was to treat sinusitis, warts, nail fungus and diabetic foot ulcers. “We are already pivoting back,” Miller said.

SaNOtize has an organizational model that’s the opposite of most Israeli startups: R&D is in Canada while manufacturing is in Israel. Why the flip? I asked Miller. “Israel was simply faster. It would have taken us 18 months to ramp up production in North America.”

You’re probably wondering at this point what were the results of my SaNOtize clinical trial? While I don’t know if I got the real spray or the sham, I also didn’t catch Covid or the flu. 

Was that just good luck or does enovid really work? The science is promising; ask me again in ten years if, like Miller, I remain flu and Covid-free.

In the meantime, with an overseas trip scheduled in just a week’s time, I bought a bottle of enovid at my local SuperPharm “just in case” and plan to prophylactically do the recommended three to four sprays a day (twice in each nostril) while on the road. 

“It’s another tool in our pandemic preparedness toolbox,” Regev told me.

In that respect, I hope that enovid can live up to its catchy tag line: “Hand sanitizer but for the nose.”

I first wrote about my experience using enovid for The Jerusalem Post.

Covid is finally over. How do I know? I took my mask off. 

Not everywhere, but in more places than I have before – at a hotel, while dining indoors, during a packed lecture, picking up The Jerusalem Post from my local Steimatzky bookstore.

Of course, I know that Covid is not really over. People are still getting sick every day. The U.S. is on track to see 150,000 Covid deaths this year. (If current numbers hold, Israel will have just over 1,000 Covid deaths in the coming 12 months.) 

But at a certain point, despite the documented dangers, we have to make the switch to “live with Covid.” Not just in words but in deeds, too.

For many people, that moment came when indoor mask mandates were relaxed. My wife, Jody, and I held on for longer. Our turning point was the fifth vaccine, the Omicron booster, which we got a few weeks ago.

The feeling on that day was: We’ve done all we can do. This booster probably won’t prevent us from getting Covid again (Covid is likely to continue to infect 50% of us every year, according to Trevor Bedford, a virologist at the Fred Hutchinson Cancer Center), but the cumulative effect is to make the disease less severe. 

Besides which, I had a pretty positive experience when I caught Covid in March and a dose of Paxlovid knocked out my mostly mild symptoms in under a week. So, my thinking went, I may be immunocompromised, but I survived it once, I will survive it again.

We’re still masking up on public transportation, on planes, in crowded locations. Which leads to an awkward place.

“Mask-wearing has been relegated to a sharply shrinking sector of society,” writes Katherine Wu in The Atlantic.“It has become, once again, a peculiar thing to do.”

How could it not when influential figures like U.S. President Joe Biden declare, as he did on TV’s 60 Minutes, that “the pandemic is over…if you notice, no one’s wearing masks.”

But wishful thinking is not epidemiological accuracy. Donald Trump was not some Greek Oracle when he proclaimed in 2020, “One day – it’s like a miracle – it will disappear.” No, you can’t will Covid out of existence; that’s not how viruses work. 

And long Covid remains a huge problem. 

An alarming study from Maccabi Healthcare Services, one of Israel’s largest HMOs, found that 34.6% of participants reported not returning to their baseline health condition some five months since recovery from Covid.

Nevertheless, masking – in America at least – is down to 29% of the population, compared with 50% to 80% in the first two years of the pandemic. 

“It feels like something that now needs an explanation,” a friend told Wu. “It’s like showing up in a weird hat and you have to explain why you’re wearing it.”

“It’s OK, you can take your mask off here,” has become an increasingly common refrain, even when it’s clearly not OK. 

I first encountered it during the height of the pandemic when I flew to Florida for my vitreoloysis treatment, an experimental laser procedure for eye floaters. The doctor, with whom I was in close physical contact, said just that while not wearing a mask himself (this despite the sign at the front door clearly stating masks must be donned). 

I wore my mask during the procedure and didn’t get Covid. Yet I felt a strong urge to conform. He was a doctor, after all. 

“You can feel when you’re the only one doing something,” immunocompromised physician Meghan McCoy told Wu for her Atlantic article. “It’s noticeable.”

McCoy noted that, typically, “there’s no big sign on our foreheads that says, ‘This person doesn’t have a functioning immune system.’” 

Masks now have kind of become exactly that kind of sign.

In our new post-Covid reality, masks draw attention, like a wheelchair, prosthetic device or service dog. They “invite compassion but also skepticism, condescension and invasive questions,” Wu writes. 

To go mask-free, by contrast, is like “reverting to a past that was safer, more peaceful,” Wu notes. “Discarding masks may feel like jettisoning a bad memory, whereas clinging to them reminds people of an experience they desperately want to leave behind.”

Don’t we all want that?

Well, yes…and no. 

I’d be lying if I didn’t admit it was exhilarating to eat in a restaurant again, to walk around a museum unencumbered by a tightly-tied Sonovia cloth. 

And yet, this “new normal” is also an admission that we’ve failed. 

— Failed to stop a virus that will now circulate among human beings forever. There are, after all, still DNA remnants of the 1918 flu pandemic in today’s annual flu outbreaks. 

— Failed to depoliticize science such that mask-wearing, along with vaccines, became not a matter of public safety but one of red vs. blue, right vs. left.

— Failed to embrace good governance over populism, vilification and victimization.

The other night, Jody and I went to the Yes Planet in Jerusalem to see Cinema Sabaya, Israel’s top Ophir award-winning film this year. We didn’t wear our masks – until we heard the man behind us coughing. We donned our cloths in the dark and felt somewhat more secure.

We’ll also wear our masks more consistently prior to a big event or vacation, so that we don’t get sick and miss out.

I wish Covid never came into our lives. Moreover, I wish masking could be a personal choice, free of stigma. 

Wu asked her mother, who lives in Taiwan, “How is masking going in Taipei?” 

It is still quite common in public spaces, even where it wasn’t mandated, her mother explained. 

When Wu asked why, her mother’s response was telling. 

“Why not?”

I first wondered if Covid was over at The Jerusalem Post.

Photo by Isaac Quesada on Unsplash.

Bullies love to tell lies.

“You’ll never amount to anything.”

“You can be easily replaced at work.”

“That pain in your stomach will never go away. You’re going to die. Probably soon.”

“Bibi’s coming back. Trump too. Get ready for the end of civilization as we know it.”

The bullies I just mentioned are not real-life ones. Rather, they’re the bullying voice in our brains, always present and ready to spring into action whenever they sense weakness.

When I’m feeling out of sorts, anxious or depressed, my brain bully detects an opportunity to beat up on me. My bully especially likes it if I’m in any kind of physical or emotional pain or if I haven’t slept well – then it really goes to town on me.

My bully knows me really well. After all, I experienced enough real-life bullying when I was a teenager to generate significant trauma.

There were the bullies who knocked the books out of my hands if I got too close to my high school’s “senior rail.” And how could I forget the brute who once kicked me so hard in my neck I could barely move for days.

Real-world bullies grow up. They become vile politicians, crazy drivers, rude customer service personnel. What they have in common: They all lie.

“Of course, you can cancel any time you want.”

“I wasn’t tailgating. You were driving too slowly.”

“I declassified those documents before I sequestered them in my bedroom.”

Self-bullying, though, is the worst. While its origins make sense – it was an evolutionary adaptation that served us well when predators could be lurking behind every rock – bullying continues to live on in our fight-or-flight-focused lizard brains, which is why it’s so hard to banish the bullying cry.

Bullying is not the same as teasing. Teasing is mostly benign; you can laugh at the situation. Bullying makes you feel ashamed.

Bullying oneself goes hand in hand with catastrophizing. It eliminates your ability to see other possibilities other than the worst-case scenario.

Standing up to the disempowering voice in your head means understanding that the words a bully uses are not necessarily true.

It’s a message I internalized when I started meditating. Your thoughts are not you. Indeed, when you sit quietly, it can be overwhelming how many ideas and feelings flit into the mind unbidden.

Did I will that thought into existence? No. Then why give it agency?

My worst case of bully brain came when our family contracted Covid earlier this year. My daughter, Merav, and then two-month-old grandson, Ilai, already had symptoms. I knew it was only a matter of hours before I’d most likely get sick too. In order to get some sleep, I upped my usual dose of medical cannabis that night.

Then the phone rang.

Ilai had been rushed by ambulance to the hospital with a 104-degree fever. This was serious, to be sure, but my response was out of control. I would never see Ilai again. He wouldn’t survive the night. I became catatonic, literally losing the ability to speak. (Spoiler alert: We’re all fine now.)

What can one do to quiet an overactive bully in the brain? Here are several techniques to consider.

1. Shut down perfectionism. If you base your self-worth on your performance or success, it can set unrealistically high standards. The result is demoralizion, failure, underachievement and procrastination. Exactly what a brain bully desires. Can “good enough” be good enough?

2. Don’t over-personalize. If you instantly believe that a friend’s worried look means you have done something to upset that person (rather than it being something entirely unrelated to you), you’ve given your bully ample room to take up residence. Remind yourself: It’s not all about you.

3. Talk back to your bully. You don’t have to simply accept what the bully dictates. Get in dialogue with it. Argue. “Yes, it is expensive, but I can afford it. What you’re saying is a lie.”

4. Take a CBT reality check. Cognitive behavioral therapy can help you challenge bully-fueled distorted thinking with charts. I adapted one CBT document to work specifically against self-bullying. In the first column, I write the bullying thought down. “My tumor is going to grow, and I’ll need to start cancer treatment again soon.” Then I compose a reality check. “Yes, there was some growth, but it wasn’t significant. My doctor isn’t worried.” And finally, I log a line of gratitude. “My cancer remains stable; I’m so grateful not to need more chemo for now.” Therapy may not cast out a bully entirely, but it provides tools to slow it down, to experience what it feels like when the bully backs down.

5. Avoid self-blame. Blame promises seemingly simple solutions to complex problems. “It was you, not me!” Self-blame ups the ante. It can make you feel as if you have the power to change things, since the fault must lie within your own control. That, too, is a lie that bullies tell.

6. Don’t let the bully make you forget the good. When anxiety comes calling, it can be difficult to remember the positive qualities you possess. Don’t let a bully overshadow all the wonderful things in your life.

7. Don’t compare, inspire. What you envy in others also exists in you. Rather than serve as a source of stress, first, acknowledge what it is you admire in someone else. Then reach out and tell that person they inspire you. Your bully surely wasn’t expecting that!

For more on bullying – and CBT in particular – especially if you’re a parent, Dawn Huebner’s book “What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety” is a particularly good guide.

I first wrote about brain bullies for The Jerusalem Post.

Picture from Dee @ Copper and Wild on Unsplash

As I lay on the operating room table, I began to shake uncontrollably. I don’t know whether it was because the room was cold, my hospital gown was thin, or I was just terrified. Probably some combination of all three.

After two years of suffering with floaters, and a failed attempt at treating them with laser vitreolysis (“Playing Space Invaders with my Eyes,” February 11, 2022), I was finally biting the bullet and having them surgically removed.

A quick recap: Floaters are microscopic fibers within the jellylike vitreous humor of the eye that can clump together, casting shadows on the retina as they bob about. They can be incredibly bothersome: large grey blobs and clouds of thousands of dots and squiggles that bounce around anytime you change your gaze. 

It’s not surprising that I was shaking: The surgery I was about to undergo – a vitrectomy – involves drilling three small holes into your eyeballs – one to drain the vitreous fluid, along with any floaters; the second to replace it with a saline solution; and the third for a small light to illuminate the area.

Retinal surgeons are generally very reticent to perform FOVs (“floater only vitrectomies”). There’s nothing actually “wrong” with your eyes, they will argue. The floaters are annoying, yes. Dangerous, not so much. Eye surgery, on the other hand, comes with a whole host of possible complications including retinal tears and infections. You could even go blind.

Moreover, most everyone who has a vitrectomy will also develop cataracts. That wasn’t a concern for me: It was the cataract surgery I had nearly three years ago that unleashed the floaters in the first place. I also had a posterior vitreous detachment (PVD) in at least one eye, meaning the vitreous gel was no longer connected to my retina, making a tear less likely.

Vitrectomies are among the most common operations retinal surgeons do – just not for floaters. If you need a biopsy to check for eye cancer or there’s a macular hole in the retina that needs repair, the ophthalmologist will readily remove the vitreous. 

The nurse covered me in a blanket to help with my shivering. An IV was inserted into my arm – “just in case, although we almost never use it.” 

During the procedure, I heard machines whirring and imagined I saw the floaters sucked away. The most uncomfortable part was the needle to anesthetize the eye. After that, I didn’t feel a thing.

45 minutes later, I was done. A patch was affixed, and I was sent home with a backpack full of eye drops.

When my surgeon removed the patch the next day, it was nothing short of a miracle: My vitreous was clear. No floaters at all. There had been no complications, and my vision was 20/20. 

I scheduled an appointment to do the other eye.

Even though I knew what to expect, I was shaking all over again for my second surgery. Something could still go wrong. 

This surgery, too, went well with no complications. But when the patch came off, I spied what appeared to be new floaters! 

“How can this be?” I asked my doctor, trying to play it cool. 

“It’s probably some debris from the surgery,” the doctor replied. “A bit of blood can get in and look like floaters. It will likely resolve in the next few weeks.”

Except that it didn’t. 

A month later, the floaters/debris were still careening around. Two months, three months in, no change. I felt deflated. 

Then I noticed something unusual. These new floaters were different. Rather than hovering right in the core of the eye, obscuring my vision, they were mostly off to the side.

Could applying a metaphor comparing the core vs. the edge help me deal with my situation?

After all, the main part of my vision was still clear. Would it be possible for me to ignore that pesky edge?

This is something I struggle with in many areas, not just my eyes. 

Professionally, if I get something wrong with an article I’m writing, it drags me down, even though 90% of the piece – the core – was just fine.

If I have a fight with my wife, I can spiral into depression, even though the spat is just an edge case and the core relationship remains strong.

On vacation, a missed opportunity will gnaw at me even if the majority of the trip was wonderful. 

Even my cancer has a core vs. edge element to it. Yes, I have tumors from my relapsed lymphoma, but they are growing slowly. My overall health remains pretty good.

Sometimes, though, it becomes impossible to dismiss the edge in favor of the core. 

One morning, a few months following the vitrectomy that led to that edge debris, I awoke to a burst of new floaters, worse than anything I’d experienced previously. Apparently, my right eye, unlike the left, hadn’t actually developed a PVD yet and some transparent vitreous had remained, hidden from my doctor. The emergence of a PVD now – brought on it seems by a very bumpy dune bashing “safari” during our vacation in Dubai – negated all the progress I had made. 

Now I had no choice.

I underwent a second vitrectomy on the same eye two weeks ago. My surgeon had to put in stitches which are very uncomfortable, but there was good news when the patch came off this time: He got all the floaters and all the vitreous. 

I was ecstatic. But even more important: I had learned a valuable lesson along the way about appreciating what I have in the core. 

The benefits – for my eyes and for my mental health – are crystal clear.

I first wrote about my vitrectomies for The Jerusalem Post.

In the summer of 2012, exactly ten years ago, my wife, Jody, and I bought a Renault Fluence Z.E., the 100% battery-powered car sold in Israel by high-flying battery swap startup Better Place. We were, at the time, staunch electric car champions. 

A decade later, though, my electric enthusiasm has started to lose its charge.

We were sold on Better Place because we believed electric vehicles (EVs) represented a small but significant step towards reducing the ravages of climate change. EVs would help wean the world off fossil fuels, reduce pollution-related illness and death, while providing a smoother, faster and more sophisticated ride.

None of that has changed, per se, but EVs, it turns out, aren’t as carbon neutral as I’d once hoped.

The problem isn’t while cruising around town, where the emissions from EVs (there are none) are far superior to their gas-guzzling counterparts. Rather it’s what happens before the car is even assembled – and what happens when it’s time to put that EV out to pasture.

Steve Greenfield, founder and CEO of Automotive Ventures, a venture capital fund focused on investments in the mobility space and author of the forthcoming book The Future of Automotive Retail, shared with me some sobering facts.

One of the key elements making up the modern electric car battery is lithium. Mining it is far from climate friendly, requiring some 70,000 liters of water to make a single ton of lithium. 

More than half of global lithium resources is located in the so-called “lithium triangle” between Argentina, Bolivia and Chile. The lithium must then be sent – on decidedly carbon unfriendly ships – to China, where 80% of the world’s lithium-ion batteries are made.

EV batteries also require cobalt, where the waste generated from mining this metal pollutes both air and soil, leading to decreased crop yields, contaminated food and water, and respiratory and reproductive health issues. As for the atmosphere, mining cobalt releases both CO2 and nitrogen dioxide. 

There’s also the human cost. 

More than 70% of the world’s cobalt comes from the Democratic Republic of the Congo, where an estimated 200,000 miners – including 25,000 children – can be found digging underground in small-scale “artisanal mines” with little oversight and even fewer safety measures.

“Cobalt is an essential mineral for the green transition,” says Anneke Van Woudenberg who directs the corporate watchdog Raid, “but we must not turn away from the abusive labor conditions that taint the lithium-ion batteries needed for millions of electric vehicles.” 

At the other end of an EV’s life, another environmental calamity awaits: Electric cars have nowhere to go to die. 

Traditional internal combustion engine vehicles, after they’ve reached a certain age, are either stripped down for parts or, if they’re still roadworthy, sent to emerging economies where they embark on a second life. 

In the first case, when an internal combustion engine (ICE) vehicle passes its prime, a network of global “dismantlers” stands at the ready to take it apart and sell off any raw materials. Dismantlers have serious concerns regarding EVs, however, Steve told me: Electric car batteries have been known to explode and the chemicals in them can be toxic if not handled carefully. 

As for giving EVs a second life, there’s little appetite for them at the present moment in much of Africa, India or Asia, where electric charge spots are nearly non-existent – although, as Yosef Abramowitz, CEO of Gigawatt Global, told me, “Distributed solar charge spots could be a good solution” in places where the power grid is spotty and reliable delivery of fuel is tenuous. 

Despite all these very real problems, nearly every automotive manufacturer has plans to electrify its offerings in the coming years. General Motors CEO Mary Barra says her company will stop making gasoline-powered cars entirely by 2035. And the success of Tesla is undeniable: In February of this year, the company’s valuation was roughly six times the market value of GM and Ford combined.

It’s understandable why battery-powered electric vehicles have become the next big thing. Batteries are a well-understood technology that can be tweaked to provide better range and energy density, as opposed to something entirely new that still requires years of R&D.

And yet, I sometimes feel that electric car enthusiasts and manufacturers have a blind spot when it comes to the EV’s overall benefit in ameliorating climate change.

I don’t mean to be a curmudgeon by throwing shade on the electric battery juggernaut that has enraptured so many. The problems with lithium-ion battery disposal and recycling will eventually be solved. New battery technologies are coming that will reduce our reliance on cobalt. 

Other fuel types – hydrogen in particular – hold promise, too, if not for cars (that train has long since left the station) then for transportation that entails longer distances than a rack of limited-range batteries can handle (think air travel, where being forced to land a dozen times en route in order to recharge is a non-starter). 

Plus, the only emissions from a hydrogen-powered vehicle are water vapor, although producing hydrogen remains problematic. (Reconfiguring the grid to generate electricity from renewables such as solar, wind and hydro will be key here – for charging EVs, too.)

I loved our Better Place Fluence Z.E. Despite getting burned when the company declared bankruptcy in 2013, we will probably buy another EV when the time comes. 

But let’s be prudent and remove our ideological blinders. EVs are not a magic panacea. They may be the most immediate and functional approach to addressing climate change on an individual level, but there is still much work to be done. 

The future of transportation technology will ultimately be more nuanced than today’s evangelical all-or-nothing EV approach.

I first waxed pessimistic about EVs and climate change at The Jerusalem Post.