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NMP (“Not My Problem”) Medicine and The World that’s Learning to ❤️ better

2018.03.04 Low Carb Breckenridge, Breckenridge, CO USA 3750
With Georgia Ede, MD (@GeorgiaEdeMD) 2018.03.04 Low Carb Breckenridge, Breckenridge, CO USA 3750 (View on Flickr.com)

This is a companion to my just posted Now update (June 2018, What Am I Doing Now?), which is always a fine time to reflect (which I’m allowed to do, it’s my feed 🙂 ).

It’s almost two years since the death of 29 year old Jess Jacobs, where I described “NMP”, which stands for “Not My Problem” in health care (see: Remembering Jess Jacobs). Which is a problem. For a lot of people, and touched on in this tweet by our sage colleague Gregg Masters (@2HealthGuru).

I am incurably 🥛 3/4 full & we need to be accountable to the Jess’ of the world, who don’t get to be here to do what’s needed.

I’m also still here and I’d like to mention places where the world is learning to ❤️ better, to honor her contribution to our understanding of what’s needed.

The LGBTQ, and specifically, the Transgender human revolution

This is arguably the most successful civil rights movement in our generation. We won. And we were right.

Jess was there when I started on this journey, by the way, and I still remember to this day how accepting and open she was, in a world that was closed. She completely “got” that love always wins. This is her at a table with Ruby Corado (@CasaRubyDC), who is now an internationally recognized humanist, activist, leader.

Capital Pride and Kaiser Permanente Present Build Your Best Life Total Health Festival 42506
Capital Pride and Kaiser Permanente Present Build Your Best Life Total Health Festival 42506 (View on Flickr.com)

To put a finer point on this, when Jess knew we were working on this, virtually no human in the United States was afforded access or even compassion from our health care system. Now, as I can attest, transgender and gender nonconforming person centered care is very much our problem, and we wouldn’t have it any other way.

Things I never thought I would see in a medical office. More signs that the future has arrived and it is beautiful. Multspecialty Transitions Clinic @kpthrive, Oakland, CA USA #TransVisibility #EqualityEqualsHealth #KPpride 👍❤️🏳️‍🌈

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The Metabolic Health Revolution

This is the social movement waiting in the wings, and it will impact all humans. If there’s going to be a flag bearer of “this is our problem” medicine, it’s going to be Dr. Tim Noakes (@ProfTimNoakes), who was (this month) exonerated of all charges of attempting to subvert nutritional dogma in South Africa.

Watch this interview of Tim and his wife, Marilyn Noakes, by Nina Teicholz (@bigfatsurprise).

Pay attention to what Marilyn says, about the physicians she encountered, who were persecuting her husband. She spoke about doctors that she couldn’t imagine taking care of patients, in the way they behaved. I always hesitate to say that anyone lost on here (I focus on winning), however, those doctors lost, this doctor won.

After that, we’ll embark on a new era of diabetes reversal, unfathomable previously in our lifetimes, and yet, it’s here.

Dietary fat and cardiometabolic health-466
Dietary fat and cardiometabolic health-466 (View on Flickr.com) See this blog post: Just Read: Dietary and nutritional approaches for prevention and management of type 2 diabetes, via #Food4Thought18

And this is no longer as scary as we once thought, because I’m meeting physicians all over the country who are bouncing into their medical offices with the confidence and joy that they are doing something real for their patients. Believe me, the future is their problem.

2018.03.02 Low Carb Breckenridge, Breckenridge, CO USA 3671
2018.03.02 Low Carb Breckenridge, Breckenridge, CO USA 3671 (View on Flickr.com)

Did I mention – the patients and the citizen scientists, too (now, one and the same)

The General ‘this century is the best century’ Revolution

Society is changing, and the people in health care are changing too. In some places in society, there is an active movement to change not the people in health, the things they learn and do in health.

We’re All Still Here, and Problems Still Exist

I have had some conversations with people recently about what the people we serve expect from us. Some of the people we serve are no longer here with us. I imagine they expect us to be future focused, steady, deliberate in helping the 🌎 learn to ❤️ better, because they don’t have time or the ability to worry about our problems. And why should they.

Yes, Healthcare Is HILARIOUS! June 7 2018 edition – TED EYTAN! | Mighty Casey on Patreon as @MightyCasey says. At the same time, as I page through my Instagram feed since Jess’ death, I am really overwhelmed with positivity. I know, selection bias. It’s what we came to medicine for, though – to change everything.

Hope this reflection is useful. As I state in all of my Now updates, feel free to evaluate what I’m doing and suggest additional activities.

The only thing we need now is a transgender pride emoji symbol and we’ll be set. If you can help us with that…. (June 2018 update: Why isn’t there a Transgender Pride Flag Emoji?)

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June 2018, What Am I Doing Now?

2018.06.10 Capital Pride Behind the Scenes and Closing with Sony A7III, Washington, DC USA03319
2018.06.10 Capital Pride Behind the Scenes and Closing with Sony A7III, Washington, DC USA03319 (View on Flickr.com)

This is my June Now Update based on a movement created by Derek Sivers

(previous updates are here)

Greetings from Washington, DC (of course) and welcome to my eleventh now update.

My Now (@NowNowNow) Profile is visible at Link: Ted Eytan, MD Profile on NowNowNow.com

Let’s see, a lot happened between April and now 🙂

Capital TransPride – my 6th

Why I attended (and helped produce) Capital Transpride 2018

Invisibility is so 20th Century.

6 year #friendaversary – the future is as awesome as I predicted 😀✌️🌎🏳️‍🌈 @capitalpridedc #ElementsOfUs @capitaltranspride #TransVisibility #KPPride18 #DC #InstaDC & Proudly @kpthrive & @permanentedocs in Washington, DC USA

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Capital Pride 2018 – My umpteenth

As a member of the media team for the first time (for real) in my life, I walked with wonderment as I saw history made in front of my eyes.

2018.06.09 Capital Pride Parade, Washington, DC USA 03108
2018.06.09 Capital Pride Parade, Washington, DC USA 03108 (View on Flickr.com)

The music was great, too.

& thanks @Billboard and @BillboardPride for publishing my photos this year

Thanks for Publishing my Photos, Billboard and Billboard Pride

My my my 💜 | Photo: @tedeytan

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2018.06.10 Capital Pride Behind the Scenes and Closing with Sony A7III, Washington, DC USA8312
2018.06.10 Capital Pride Behind the Scenes and Closing with Sony A7III, Washington, DC USA8312 (View on Flickr.com)

A reminder to remember

2018.06.12 A Candlelight Vigil to Remember Pulse, Washington, DC USA 03768
2018.06.12 A Candlelight Vigil to Remember Pulse, Washington, DC USA 03768 (View on Flickr.com)

Now

Still captivated by #DiabetesReversal and #MetabolicHealth

..can’t help it

2018.05 Low Carb and Low Carbon Presentation Slides 412
2018.05 Low Carb and Low Carbon Presentation Slides 412 (View on Flickr.com)

* Watching the diet-heart hypothesis fall and joining the medical profession in mourning the death of the low-fat diet
* I am now getting (more) ready for @Ketofest 2018, aka what happens when an entire town is converted to a #DiabtesReversal #MetabolicHealth lifestyle. Plus I need to increase my library of #LCHF dishes
* Still reading Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars

Here’s a good quote describing the ongoing dissonance and tension between the last century and this one:

It is interesting that the ADA recommends eating starches and sugars and then the simultaneous use of acarbose to prevent their digestion.

Bernstein, Richard K.. Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars (pp. 260-261). Little, Brown and Company. Kindle Edition.

Speaking of the future, if you don’t like it, just create a new one

The 🌎 doesn’t change itself. Thank you @WeWork @permanentedocs @kpthrive for helping ours learn to ❤️ better. #Pride2018 #ThriveWithPride #EqualityEqualsHealth #VisibilityEqualsLife #AllGender #LGBTQ #TransVisibility Washington, DC USA @capitalpridedc @capitaltranspride 🏳️‍🌈

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It’s what we do in Washington, DC, which is where the future is created every day.

Until next month-ish.

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Thanks for Publishing my Photos, Billboard and Billboard Pride

2018.06.10 Troye Sivan at Capital Pride w Sony A7III, Washington, DC USA 03467
2018.06.10 Troye Sivan at Capital Pride w Sony A7III, Washington, DC USA 03467 (View on Flickr.com)

Thanks for publishing my photos of @TroyeSivan, @Billboard and @BillboardPride at this year’s Capital Pride Concert (@CapitalPrideDC), in Washington, DC USA (of course).

My my my 💜 | Photo: @tedeytan

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2018.06.10 Troye Sivan at Capital Pride w Sony A7III, Washington, DC USA 03477
2018.06.10 Troye Sivan at Capital Pride w Sony A7III, Washington, DC USA 03477 (View on Flickr.com)

#tfw you’re full of #pride | 📸: @tedeytan

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Besides the fantastic performance, what I remember is Sivan’s recounting of his own personal experience coming out to his family, which is recounted here:

Sivan’s parents — Jewish South Africans who moved to Perth, Australia, when he was 2 in order to avoid rising crime in Johannesburg — sent him to a Modern Orthodox day school, and he often sang in synagogue. (Sivan, Troye’s middle name, is the Hebrew word for the third month of the Jewish year.) When he came out to them at 15, “They leapt immediately into, ‘Are you OK? How can we equip you to deal with this?’” He soon worked up the courage to say he wanted to attend his first Pride parade.

“They were like, ‘Oh, we’re 100 percent coming,’” recalls Sivan, smiling at the memory. “Even though it was mildly embarrassing — I walked in the parade with my parents and my [two] brothers and my sister — it was cool because I realized that they weren’t just tolerant of their gay son, they were stoked and proud.” They still are — it’s obvious in the way they dote on him and call his boyfriend, Jacob, by his Hebrew name, “Yakov.”Troye Sivan On Coming Out, His Daring New Music & Why He’s ‘Not Holding Back’ | Billboard

Our city is happy that people like Sivan exist, and remind us how wonderful this Century has become.

The rest of the photos of Troye are in this blog post, and they are photos from the future.

More Photos from the Future: Troye Sivan at Capital Pride, Washington, DC USA

It was an honor to be part of the media team for Capital Pride. Of course I’d do it again in a heartbeat, since it’s not about the photos, it’s about the human spirit ✌️

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Thanks for Publishing my Photo, in DC votes for change in tipping, no change in elected officials – Greater Greater Washington

2018.05.12 DC Funk Parade, Washington, DC USA 02211
2018.05.12 DC Funk Parade, Washington, DC USA 02211 (View on Flickr.com)
Thanks for publishing my photograph, @ggwash.

It’s of Washington, DC Mayor Muriel Bowser (@MayorBowser), at this year’s U Street Funk Parade (@FunkParade). Funk, and the future, doesn’t create itself.

More photos from the parade:

Photos: 2018 Funk Parade, Washington, DC USA

DC voters are pretty happy with their incumbents, based on results of Tuesday’s primary, re-nominating Mayor Bowser, Delgate Norton, and all DC Council incumbents. Meanwhile, voters approved a change to the tipped minimum wage, 55-45%. 

Source: DC votes for change in tipping, no change in elected officials – Greater Greater Washington

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Thanks for Using my Photo, in How to support your LGBTQ friends and family – CBC Kids

2017.06.11 Equality March 2017, Washington, DC USA 6576
2017.06.11 Equality March 2017, Washington, DC USA 6576 (View on Flickr.com)

Have I ever mentioned how much I love this century?

Thanks for using my photograph, @CBCKids. It was taken during last year’s historic Equality March, in Washington, DC USA.

Remember that love is love, and when two grown-ups love each other, it’s never a bad thing.

I’m happy to support the work that 🇨🇦 is doing to help the 🌎 learn to ❤️ better

Thank you for supporting (our) Capital Pride (@capitalpridedc) in 2018:

2018.06.10 Capital Pride Festival and Concert, Washington, DC USA 03534
2018.06.10 Capital Pride Festival and Concert, Washington, DC USA 03534 – As the flag of our ally Canada flies from the Canadian Embassy, Washington, DC – Capital Pride 2018 Concert (View on Flickr.com)

Stand up to those who make homophobic jokes, and other important ways you can be an LGBTQ ally.

Source: How to support your LGBTQ friends and family | Explore | Awesome Activities & Fun Facts | CBC Kids

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Just Read: Dietary and nutritional approaches for prevention and management of type 2 diabetes, via #Food4Thought18

Dietary and nutritional approaches for prevention and management of type 2 diabetes-467
Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ [Internet]. 2018 Jun 13;k2234. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.k2234 (View on Flickr.com)

(The problem from the above comes when people take guidelines intended for well people and apply them to people with chronic illness, and vice versa. This unfortunately happens a lot in medicine.)

This paper is a good overview of how to think about nutrition for various populations, via the #Food4Thought18 series.

Unlike the previous paper in the series that I just read (Just Read: Dietary fat and cardiometabolic health evidence, controversies, and consensus for guidance (written by the team of non-usual collaborators…)), I don’t know how often this group of authors collaborates.

I know and visited Will Yancy, MD, (@DrWillYancy) recently at the Duke Diet and Fitness Center (@DukeDFC), and was really impressed with what I saw (Just Read and Just Visited: Duke Diet and Fitness Center and Management of Type Diabetes With a Very Low–Carbohydrate Diet – More reasons I love this century)

The Most Important Question, The One That’s Not Being Asked in Medicine (yet)

What is the best dietary approach? Is it possible to achieve remission of type 2 diabetes with lifestyle behaviour changes or is it inevitably a condition causing progressive health decline?Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ [Internet]. 2018 Jun 13;k2234. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.k2234

Physicians, mostly trained in the 20th Century (that’s changing…) were typically not that diabetes is progressive, or “manageable” at best, but not reversible.

This narrative from my conversation with an author about this phenomenon says it all – we are simply not programmed to think any other way than glass half-empty. Glass half-full-ers (or 3/4 full-ers) rejoice :).

A Different Take- My Conversation With the Author: Diabetes Remission Data from Kaiser Permanente Shows that Patients are Right to Have Hope

The Reality that Diabetes is Reversible

Again, an important statement for this century

Secondly, it is now recognised that dietary advice for both the prevention and management of type 2 diabetes should converge, and they should not be treated as different entities (fig 1). However, in those with type 2 diabetes, the degree of glycaemic control and type and dose of diabetes medication should be coordinated with dietary intake.Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ [Internet]. 2018 Jun 13;k2234. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.k2234

There’s now a diagnosis code in the UK for Diabetes in Remission

This is the biggest news for me in this paper.

..a “diabetes in remission” code (C10P) is now available in the UK.Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ [Internet]. 2018 Jun 13;k2234. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.k2234

Therapeutic Nutrition and Approaches to Reversing Diabetes

There’s a lot here, and I can tell the influence of the scholarly work of the authors, which is extensive. The things that caught my eye:

  • Exoneration (more or less, in couched physician terms) of unprocessed red meat (“evidence of possible harm because of the development of type 2 diabetes is less consistent and of a smaller magnitude”)
  • A more charitable view of the flexibility of the ADA Guidelines than I perceive from my read of the 2018 Guidelines. From my read, the 2018 guidelines are not that flexible, when the entire section is read. I’ll post on the later; my opinion is that it still has inherent biases toward a one-size-fits-all view based in 20th Century thinking. Feel free to check my assessment by reading this section yourself, starting page 47 or so.
  • A fairly rigorous/vigorous discussion of low fat and low carbohydrate dietary approaches.

Depending on one’s bias the discussion of these issues could be perceived as winning or losing.

Glass 3/4-ers only speak of things winning, so my assessment is “the future is winning/won.”

I say that because this is what has happened in the past and it’s the wrong direction.

2018.05.29 Low Carbohydrate Meetup, Washington, DC USA 452
2018.05.29 Low Carbohydrate Meetup, Washington, DC USA 452 (View on Flickr.com)

Reminder of my disclosures, potential conflicts

In the spirit of the discussion at #Food4Thought18, my disclosures are below. Panelists were asked to state what they eat as well. I eat low-carbohydrate, real food, and was formerly on a low-fat, calorie restricted diet, as a formerly fat and currently normoglycemic LGBTQ human.

2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation 453
2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation 453 (View on Flickr.com)

Citation

Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ [Internet]. 2018 Jun 13;k2234. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.k2234

As always, feel free to check my work in the comments or via social media or the contact form. More information is better.

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June 2018 update: Why isn’t there a Transgender Pride Flag Emoji?

These tweets still cross the wire.

The answer to the question in the post is – “I don’t know”

Not much has changed since I last spoke about this aspect of the unicode standard (My Thoughts on Emoji Recently Added, v11.0, without #Transvisibility, without full #LGBTQ inclusion). The short version of that post is “They were able to add luggage, but not a transgender pride flag.”

Well, a few things have changed –

Apple’s own Emoji Proposal – it’s gorgeous

https://www.unicode.org/L2/L2018/18080-accessibility-emoji.pdf

Wow. Really impressive what a company with the resources of Apple can do to follow a process that it is engaged indirectly in creating. The proposal is as beautiful and complete as a new mobile device produced by the company.

Unfortunately, the average citizen probably can’t produce something as gorgeous. We did our best (see: Transgender Pride Flag Emoji Submission for inclusion in the Unicode Standard for 2019 (Update 11: Submitted, March, 2018)).

I think it’s pretty good, and it has global representation of authors. We’ve been reached out to from time to time to see if any assistance can be provided. My response has been “help me understand the process.”

Pride 2018 in the United States – A bigger turnout for transgender pride flags than ever

The proposal for a new emoji character has several requirements, meant to ensure that a new character is distinct, recognized, and non-duplicative.

Here are photos from Washington, DC’s 2018 Capital Pride parade (@CapitalPrideDC). There has never been, in our city’s history, this visibility for this symbol. And note that it’s shown with/next to, not instead of, the rainbow pride flag.

2018.06.09 Capital Pride Parade, Washington, DC USA 03168
2018.06.09 Capital Pride Parade, Washington, DC USA 03168 (View on Flickr.com)
2018.06.09 Capital Pride Parade, Washington, DC USA 03108
2018.06.09 Capital Pride Parade, Washington, DC USA 03108 (View on Flickr.com)
2018.06.09 Capital Pride Parade, Washington, DC USA 03118
2018.06.09 Capital Pride Parade, Washington, DC USA 03118 (View on Flickr.com)
2018.06.09 Capital Pride Parade, Washington, DC USA 03304
2018.06.09 Capital Pride Parade, Washington, DC USA 03304 (View on Flickr.com)

Comparing our proposal to the one created for the Rainbow Flag

Adding RAINBOW FLAG to Unicode

This was produced in 2015, essentially via email, and approved.

The transgender pride flag emoji, following the comprehensive process, has not been approved.

That’s what I know.

Comments welcome. You can review all the posts on this blog about the proposal here.

There are many more photos of the future in this post, feel free to review:

Photos from the Future: Capital Pride, Washington, DC USA

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Thanks for Publishing my Photos, in D.C.’s startup scene – D.C. Policy Center

2018.04.18 TransVisibility and LCHF, Washington, DC USA 01329
2018.04.18 TransVisibility and LCHF, Washington, DC USA 01329 (View on Flickr.com)

Thanks again, @DCPolicyCenter, for using my photographs to adorn this informative analysis on our startup scence.

Noting:

In 2016, District startups within the Accommodation & Food Services sector created on average over 25 percent of all new job within the sector each quarter. Typically, firms within the Accommodation and Food Services sector provide customers with lodging and/or meals, snacks, and beverages for immediate consumption. They include hotels and recreational facilities, as well as full-service restaurants, food trucks, bars, catering companies and other food service providers.Source: D.C.’s startup scene – D.C. Policy Center

The photograph above is of the new restaurant, Sababa, that specializes in Israeli cuisine.

Compass Coffee, Washington DC 49480
Compass Coffee, Washington DC 49480 (View on Flickr.com)

Enjoy the analysis.

On the surface, the District’s startup scene appears to be more lively than ever before. But the jump in startup activity has been driven by only handful of industries.

Source: D.C.’s startup scene – D.C. Policy Center

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Thanks for Publishing my Photo, in Thousands Plan To Protest Trump’s Child Separation Policy Outside White House: DCist

2017.08.13 Charlottesville Candlelight Vigil, Washington, DC USA 8050
2017.08.13 Charlottesville Candlelight Vigil, Washington, DC USA 8050 (View on Flickr.com)

Thanks for publishing my photograph, @DCist.

It appears there will be more photos to be taken, details below.

The rally will take place on Saturday, June 30, at Lafayette Square.

Source: Thousands Plan To Protest Trump’s Child Separation Policy Outside White House: DCist