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September 10, 2009

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Homeless veterans: a sad commentary on our national priorities and values

In October 2005, the City of Philadelphia set out to become the first city in the nation to end homelessness.

As of Sept. 9, nearly three years into the city’s 10-year plan to provide affordable housing for every resident in need, there were 550 homeless people on the streets and 2,603 in shelters.

Clearly, we have a long way to go if we’re serious about ending homelessness, and 2015 no longer seems to be a feasible end date. But in the midst of a recession, at a time when social-service budgets are tightening at every level of government and winter is closing in, it’s critical for us to reinvigorate the conversation about poverty.

Too often the homeless are treated like indolent leeches, as if they deserved to live in misery because they didn’t work hard enough to realize the American Dream.

Poverty, however, is a complex social problem with a variety of causes, and the debate over its causation has long been mired in ideology.

While I think it’s appalling that any human being has to struggle to satisfy basic needs in a country as wealthy as ours, I believe that any respectable American should agree that it’s unacceptable for veterans of our military to be hungry or homeless.

According to the Department of Veterans Affairs, nearly one-third of homeless adults have served in the military.

“Current population estimates suggest that about 131,000 veterans (male and female) are homeless on any given night and perhaps twice as many experience homelessness at some point during the course of a year,” according to the VA’s Web site. “Many other veterans are considered near homeless or at risk because of their poverty, lack of support from family and friends, and dismal living conditions in cheap hotels or in overcrowded or substandard housing.”

Forty-five percent of homeless veterans suffer from mental illness and 70 percent struggle with alcohol or drug abuse. Ninety-seven percent of them are men and 56 percent are Latino or African-American.

Many of them have difficulty coping with the post-traumatic stress that comes with witnessing the grisly death of friends and enemies. Many of them have trouble readjusting to normal life after living by military rules of engagement.

But what’s most striking about the homeless is how easily they blend into the background. I learned this firsthand when I volunteered a few years ago at Operation Stand Down, an outreach-event for homeless veterans.

Lighthouse Field in North Philly was transformed into a huge tent city over Labor Day weekend, and homeless veterans were invited in to eat, sleep and shower – to seek medical treatment, government benefits and the comfort of friendship. Most of the homeless veterans I met looked no different than the vast majority of people I’ve seen on the streets of Center City.

No matter what we may think about war, these veterans deserve to be treated with dignity and respect.

That’s what Stand Down is all about, and that’s why the event is held in 15 or more American cities each year.

The next Philly Stand Down will be held Sept. 12-13 outside the Philadelphia VA Medical Center, 3900 Woodland Ave. More than 400 homeless veterans are expected to attend.

The event will be staffed largely by VA employees volunteering their time, but members of the public are also encouraged to help out. If interested, you can show up on Saturday morning and jump in.

If you can’t make it but still want to help, you can make a tax-deductible donation to Stand Down, a 501(c)3 nonprofit organization. Checks should be sent to Stand Down, 520 Quincy Ave., Penndel, PA 19047.

For more information, contact Stand Down committee member Jerry Corrento at 215-743-6179.

Joel Hoffmann

 

Commentary: Complications fewer for gynocological surgeries

Women who need surgery for gynecological problems do not want to be out of commission for weeks. Many of them already have small children and lead busy, active lives. They don’t want to hear that they have to stay in bed or can’t lift their child for six or more weeks.

When I began my medical practice more than 22 years ago, long, slow recuperation times were common. Today’s minimally invasive surgery not only shortens recovery, but also means safer, more effective and precise procedures with the potential of fewer complications. This translates to minimal impact on the patient’s life with maximum quality of care.

At Chestnut Hill Hospital, for example, where I recently became chairman of the Department of Gynecology, we treat various conditions with robotic surgery and most patients can go home the same day. Some common procedures include uterine fibroid removal (myomectomy), reattachment of fallopian tubes that had been tied, and removal of cysts or scar tissue that interfere with fertility or pregnancy.

With any condition, my number one rule is avoid surgery if you can. But if you can’t, make it as minimally invasive as possible. That is why the da Vinci robotic surgical system, recently installed at Chestnut Hill Hospital, is so effective. It allows surgeons to operate with small incisions, a much higher level of precision, and more control of instruments than ever before.

For many years, these procedures were preformed by traditional “open” surgery or with a laparascope (a lighted scope or camera) that gives a two-dimensional view.

The “robot” facilitates laparoscopy taking it a step further because surgeons can control the robotic instruments in exactly the same way that they move their hands and wrists — in three dimension — and with far more control. At the same time, they use pedals and a handpiece to move the camera and surgical instruments.

The amplified view is truly stereoscopic so the surgeon’s vision is far better than with a two-dimensional laparoscope. This is particularly important when making very fine sutures (stitches) that are small enough to thread a hair.

For example, when a fibroid is removed, the uterus may be reconstructed with a three-layer closure that could involve 30 sutures. The robot gives the surgeon a high-definition, highly magnified view and the ability to make these sutures with great precision.

Minimally invasive surgery with the da Vinci robot also means less bleeding. If bleeding does occur, the surgeon can control it better. And minimally invasive surgery has less risk of infections.

The robotic procedure involves four or five small incisions in the belly. Two are dime-size incisions, each for instruments operated by the surgeon’s right and left hands. The other, slightly larger incisions are portals for a camera scope and other instruments used to cut or suture the area. The robot actually gives the surgeon a third “hand” to hold tissue or the fibroid, for example, while the other two hands perform different surgical moves.

The da Vinci robotic surgical system can be used for many procedures. At Chestnut Hill Hospital, it is used to treat cancer of the prostate, repair pelvic floor disorders, remove cysts on abdominal organs and perform other procedures. Most of the time, women don’t need surgery for fertility problems, but when they do, it is available at Chestnut Hill Hospital.

Ben Gocial, M.D., is chairman of the Department of Gynecology at Chestnut Hill Hospital and associate of RMA of Philadelphia specializing in reproductive endocrinology, gynocologic surgery, fertility and menopausal problems.

 

In praise of walking

I was catching up on several weeks of Chestnut Hill Local reading after returning from vacation and found myself musing about the backlash from area residents over the Good Food Market.  The recent hyperbole of choking children and heart attack victims aside, what really made me gasp was a resident who thought that most Hillers wouldn’t walk five blocks for a coffee or walk in the winter.  Eeekgad!

If that is true, we have bigger troubles than a market trying to serve us coffee and gelato.  Walking does more than just get us from point A to point B in a stop-and-smell-the-roses kind of way.  As Nietzsche said, “All truly great thoughts are conceived by walking.”  So as you’re walking for your morning espresso, your morning meditation is being taken care of by your feet. But the benefits certainly do not stop there.

According to walkinginfo.org, “walking reduces risk of coronary heart disease, stroke, diabetes, and other chronic diseases, lowers health care costs and improves quality of life for people of all ages.  Older adults benefit from a stronger heart, more positive mental outlook and an increased chance of remaining indefinitely independent, increasingly more important as the bulk of our population ages in the coming years.” 

Walking also keeps the weight off.  Walking for 30-60 minutes at a moderate pace burns stored fat and can build muscle to speed up your metabolism. A Washington State study, on walkscore.org,  found that residents of pedestrian friendly towns were 7 pounds lighter than their countrymen in the burbs. 

The Amish have one of the lowest rates of overweight and obesity of any community in North America.  A pedometer study of 96 Amish revealed that they log over 18,000 steps per day.  This can be very challenging for most of us.  I borrowed a friend’s pedometer to find that on most days I was walking around 6000 steps during my daily routine — which included walking the dog!  If you can manage 10,000 steps per day, as is the RDA, you’re doing pretty well.  By my pedometer’s reading, it takes about 150 steps to walk one block.  I have the feeling it’s a little off, since I counted 180 steps, so maybe I’ve been ripped off all this time.  But the idea is that if you can kill two birds — exercise and errands — with one stone, walking, you are way ahead of the game.  A five-block cup of coffee will net you at least 1,500 steps.

Because my husband and I share a car, I spend much more time walking about town than driving.  We use to have a second car, a much-loved Vanagon, which has taken on a new life as a wood storage shed for my father in northern PA.  The added yearly expense of our Vanagon was probably less than the $7,834 (from AAA) most people spend on their vehicle ownership, but we decided that living in a walkable town made this extra car an extravagance that we could live without.  With the exception of school trips — this year my son rides the bus! — I rarely have to drive.  It’s been challenging since many stores have closed along the avenue this past year, Caruso’s being the most sorely missed.  I have walked many blocks in search of half and half at 8 a.m. in the morning, but I still try to find what I need here before venturing out in the car.

When I walk, I see and talk to many of my neighbors. For years I didn’t know many of them  because I only went from my house to the car and back again.  This “social capital” is what happens every time there is face-to-face interaction.  Walking info.org states that, “Studies have shown that for every 10 minutes a person spends in a daily car commute, time spent in community activities falls by 10 percent.”  Social interaction is a major factor in improving the quality of life in a town. 

In order to keep people walking and talking, it helps to have destinations that promote walking and amenities that make us feel comfortable once we get there. This is what gives us our sense of identity and place. 

It’s no surprise then that home values would be tied to the walkability of a town.

A new CEO’s for Cities publication called Walking the Walk, claims that “houses with an above average level of walkability will command a premium of about $4,000 to $34,000 over houses with just average levels of walkability in the typical metropolitan areas studied.”  This paper studies the relationship of walking scores based on how many amenities are located within a walkable distance about a half mile and real estate values.

 According to newurbanism.org, “Pedestrian friendly places are the highest quality environment possible for living.  It includes a full range of services within a 5-10 minute walk of every residence. At minimum, this would include grocery stores, deli’s, bakeries, newsstands, coffeehouses, vegetable stands, open-air markets, personal services, parks, and green spaces. A full range of entertainment and cultural activities are also desirable, all in an attractive, friendly atmosphere.”  New Urbanism is an urban design movement that began in the early ’80s and promotes a healthy diversity of residences and job types, that also takes into account the needs of people over cars.

There are many aspects of our current culture that have made us unhealthy, but car culture tops the list.  As Wired Magazine puts it, “Consider the unmitigated ecological disaster that is the automobile. Every time you turn on the ignition, you’re enmeshed in a system whose known outcomes include a polluted atmosphere, oil-slicked seas, and desert wars.” Perhaps we can retrain ourselves by promoting walkable places and encouraging foot traffic.

Do you want to know the walking score for your home?  Go to www.walkscore.com  which rates the top 40 walkable cities (Philadelphia ranks 5th) and will also give you a score of your own home once you type in your address.  Chestnut Hill’s score is 73 out of 100, meaning very walkable.  Some of the top scorers in the country are around 90.  Only 29 percent of other Philadelphia residents have a higher score, and they are in Center City.

 




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