Israel Medical Association Journal

Endometriosis is a chronic disease characterized by ectopic deposits of endometrial glands and stroma located outside the uterus. Women with symptomatic endometriosis may experience premenstrual bleeding or staining, pain and other physical sensations, as well as other symptoms dependent upon the stage and location of the endometrial implants. We discuss the particular implications of these symptoms for women who observe the part of Jewish law known as hilkhot niddah. The laws of niddah, also known as taharat hamishpahah (family purity), dictate the timing of the physical relationship between a married couple. These laws proscribe any physical contact between the couple during the time that the wife has the status of niddah. This status is obtained by any uterine bleeding that is not caused by injury. Menstruation is the most common cause of the niddah status, but niddah and menstruation are not synonymous. Since, to the best of our knowledge, there is no written discussion of the specific implications of endometriosis for this population, we discuss the relevant halakhic and medical literature and hope that such analysis will facilitate efforts to assist the observant couple in gaining regular niddah-free segments of time.

Background: Congestive heart failure is extremely common in octogenarians and is associated with severe fatigue, shortness of breath, recurrent hospitalizations, and death. These patients, many of whom are anemic, are often resistant to standard CHF[1] therapy including angiotensin-converting enzyme inhibitors, beta-blockers and diuretics.

Objectives: To examine whether correction of the anemia (hemoglobin <12 g/dl) in CHF patients lowers their resistance to therapy.

Methods: Forty octogenarians with anemia and severe resistant CHF were administered a combination of subcutaneous erythropoietin and intravenous iron sucrose.

Results: This combination therapy led to a marked improvement in cardiac function, shortness of breath and fatigue, a marked reduction in the rate of hospitalization and a stabilizing of renal function.

Conclusion: Anemia appears to be an important but ignored contributor to the progression of CHF, and its correction may improve cardiac and renal status as well as the quality of life in elderly patients.