Photos from Washington, DC #Charlottesville

2017.08.13 Charlottesville Candlelight Vigil, Washington, DC USA 8056
2017.08.13 Charlottesville Candlelight Vigil, Washington, DC USA 8056 (View on

Just another day in the capital of a world learning to ❤️ better.

All photos @CreativeCommons licensed. Feel free to use.

Adventures at Low Carb San Diego

It's really getting low carb in here. And no afternoon snack because everyone is intermittent fasting, of course. #LowCarbSanDiego #AffordableCME #LCHF #ketogenicdiet #ketogenic
It’s really getting low carb in here. And no afternoon snack because everyone is intermittent fasting, of course. #LowCarbSanDiego #AffordableCME #LCHF #ketogenicdiet #ketogenic (View on

“But morning is where you earn your carbs” – said the flight attendant when I declined the processed shortbread. At least the knowledge that a high-carbohydrate diet is not-so-great is changing…

I started this blog post before I attended Low Carb San Diego (@LowCarbUSA), and I’m finishing it as I’m leaving.

First, some facts about myself that are relevant

  1. The obligatory flashback. I now remember my first exposure to diabetes. It was when I was in 6th grade, and I was told that my teacher was not allowed to eat candy. I asked why and was told, “He’s diabetic, he can’t have sugar.”
    • And then, through my professional journey, all of this got convoluted and people with diabetes were being told to eat sugar, in the form of high carbohydrate diets. It never really made sense.
  2. I know what it’s like to live as a fat person. It’s a unique experience. As a result, the medicalization of obesity, as a disesase of willpower, that happened in the early 2000’s always concerned me. Now that we have data that the #1 explicit (openly expressed) bias that medical students possess is directed against obese people (greater than that expressed, also openly, against LGBTQ people) my concern level is justified.
  3. The conversation about medical students learning nutrition (and by nutrition I mean, “what to eat,” – there’s plenty on nutritional biochemistry) is not new. It was happening when I applied to medical school, I was aware that we wouldn’t get much teaching in this area, and much of the nutrition science I learned in college. Regardless, I did not go to the gym during the lectures we did have on nutrition 🙂 .

    • By the way, I semi-don’t knock medical school for not teaching me about what to eat – there is so much to learn about human physiology and pathology that you can’t learn anywhere else. More importantly, the skill of critically reading the literature is something that transcends medical schools and helps physicians learn throughout life.
  4. Despite the lack of formal teaching on diet, there were clues in medical school that the evidence base being promoted wasn’t itself based in evidence. I still remember those clues to this day – they were in our medical textbooks, even.
  5. Post-medical school, in several cycles of board certification (for the awesome specialty of family medicine), nutrition is barely addressed, so it’s still pretty DIY, and that means path of least resistance.

  6. However/and I am not a least resistance person. I live in the future, where innovation happens in the out of the way places. I am usually ahead of my time, sometimes joyfully, often painfully, ultimately happily, glass 3/4 fully. I like change, and I like innovation and I like interacting with people who are also ahead of their time.
Explicit attitudes among medical students 54441
Explicit attitudes among medical students 54441 (View on

Which brings me to the present time and Low Carb San Diego

I came here, to this fully accredited continuing medical education course (thank you @JeffreyGerberMD) because after all that we’ve been taught/told, I keep finding out that

The challenge is made worse by the fact that many advocates of the low-fat diet are also expert in evidence-based approaches, but interpret the data differently. I’ve commented on this previously, that I can’t know what a study means unless I also read the comments, the twitter feeds, the financial interest statements.

Very fortunately, a lot of the people analyzing the evidence live in social media, unlike so many other health movements (cough environmental stewardship cough), so it’s easy to connect and learn more. So here I came for direct learning, reading can only get a person so far.

Interestingly, people who know me know I am not a fan of sitting in a dark room watching powerpoint presentations, however, I was on the thirsty side when it came to getting information, so this was not a problem for me. A few wall sits and isometric lunges keeps the BDNF flowing.

I am awaiting the presentations and videos, which I actually want to review again, because the breadth of topics and experts was pretty excellent.

Some key points of learning for me

  • diabetes and diet
  • diabetes and cardiovascular disease (and their inextricable linkage + maybe it’s the other way around)
  • diabetes and every other disease including Alzheimer’s (Diabetes Type III)
  • Non-Alcoholic Fatty Liver Disease (crazy high prevalence & correlation with glucose intolerance)
  • The human and global environment including sustainability (this image is terrifying)
  • the power of the medical profession to alternately create change or slow change, sometimes with great results, sometimes with devastating ones

In the history or Medicine compared to science, there have tended to be worship of ideas based on the people promoting them, with devastating results. Because my generation of physicians trained during the most profound ethical crisis in our profession's
In the history or Medicine compared to science, there have tended to be worship of ideas based on the people promoting them, with devastating results. Because my generation of physicians trained during the most profound ethical crisis in our profession’s (View on

I’ll continue posting as I learn more of course.

A Note About the Medical Profession

As I type this I am sitting next to someone who is obviously a physician, dictating a patient chart note in a public place (hmmm HIPAA…), and it reminds me to remind others to avoid placing blame on the profession or the people in it. I cringe a little when I hear proclamations about what physicians need to do when they have at their base mal-intent on the part of physicians. As the implicit bias literature shows, physicians have the same amount of biases that their community colleagues do, no more, no less. I believe physicians want to perform well for their patients, when it is known what performing well is. This is a community-created issue and is owned by everyone.

Speaking of adventures, I also took a little sojourn into the realm of #TransVisibility at the Port of San Diego next door – again, challenging the norms that society imposes on humans that don’t have a basis in science. It’s all related…

As it says in the photo above, my generation of physicians trained during the most profound ethical crisis in our profession’s history, and when we witnessed what we did, we promised to change everything, in the interest of the people we serve. A part of that work is to know what change is needed. Embrace curiosity/if someone is doing something better than I am, I want to know about it.

Photos from the days 1, 2, 3, 4 below. Enjoy.

The Greatest Generation Walk and #TransVisibility, San Diego, CA USA

2017.08.03 #LowCarbSanDiego San Diego CA USA 7891
2017.08.03 #LowCarbSanDiego San Diego CA USA 7891 (View on

While here for a continuing medical education course (more on that later), I happened upon this community honorarium / art installation at the Port of San Diego (@portofsandiego). When I learned that my community colleague Connie Rice has served on the USS Midway, I realized that the people depicted in the sculptures exist across the spectrum of gender identity and sexual orientation, by definition. They are all human. So to my eyes, these works of art are really statements of visibility, including transgender person visibility.

Everywhere I walk I learn something new 🙂 .

Thank you for your service. Enjoy the rest of the photos below.

The Greatest Generation Collection, as well as the other military memorials in the park, honor and celebrate the people, events and military heritage spanning the time from World War II to today. Located in the shadow of the decommissioned aircraft carrier USS Midway, the artworks and provide a magnificent setting in which to learn, remember and become inspired.Greatest Generation

Photos: Protest Trans Military Ban, Washington, DC USA

2017.07.26 Protest Trans Military Ban, White House, Washington DC USA 7660
2017.07.26 Protest Trans Military Ban, White House, Washington DC USA 7660 (View on

As I have posted here previously, the combined nursing and medical professions have decidedly spoken against the denial of care or public accommodation to people who are transgender.

My generation of physicians came to health care during one of the most (if not the most) significant ethical crisis in our profession’s history. It’s why we pledged to change everything. And make sure that love always wins (it usually does anyway).

Rest of the photographs are below. All are creative commons (@CreativeCommons) licensed.

Transgender Pride Flag Emoji Submission for inclusion in the Unicode Standard for 2018


Update 4: August 8, 2017

Not approved at this time, appears to be grouped in with other flag proposals for consideration in October.

Recommendations as of August 8, 2017 (via @Unicode)

Primer on ZWJ sequences (for the curious)

Update 3: August 6, 2017

@PinkNews is reporting that the proposal has not been accepted by @Unicode. However, we have not received any communication from the Unicode consortium about this. See the dialogue about this on twitter.

Update 2: July 7, 2017

Thank you again for your proposal. This is just a status-update. The emoji subcommittee needs a larger discussion about how to handle different types of flags. Your proposal is being held with some others pending outcome of that discussion.

Update 1: June 30, 2017

Thank you for your submission. This is to let you know it has been safely received, and will be reviewed by the emoji subcommittee.

Transgender Pride Flag Emoji Submission


Emoji Proposal – Transgender Pride Flag – Download (pdf)

As the title of the post says, this is the official submission to Unicode for the Transgender Pride Flag Emoji.

Monica Helms, the creator of the Transgender Pride Flag, is a signatory on the submission 🙂 .

The transgender pride flag signifies visibility in a world that’s learning to love better. A sticker may seem like a small innovation but it means a lot to a community that’s been marginalized.

This year at Capital Trans Pride, we lamented that the only emojis we could send to each other are the rainbow pride flag.

“My reason for wanting a trans flag emoji is so that a trans individual can feel a sense of belonging and visibility when using technology to communicate.”
Bianca Rey (@BiancaRey), Co-Chair, Capital Trans Pride, Washington, DC (Trans Pride Sticker Set Site)

If you don’t like the news, go make your own. Hopefully the news will be good. Feel free to review the submission and provide us with your comments.

More people with health care = more humans living authentically and able to help the world learn to ❤️ better. Isn't this century great? equalitymarch2017 #EqualityEqualsHealth #dc #WeareDC trans.equalityy
More people with health care = more humans living authentically and able to help the world learn to ❤️ better. Isn’t this century great? @equalitymarch2017 #EqualityEqualsHealth #dc #WeareDC @trans.equalityy (View on

Finding LGBTQ Material at the @NMAAHC – a helpful twitter dialogue


One of the many reasons I love social media. The National Museum of African American History and Culture (@NMAAHC) responded to my blog post (Being #TransVisible at the National Museum of African American History and Culture) via Twitter and provided helpful information for my next visit. And there will be one (when I am able to get in 🙂 ).

More learning per square inch in Washington, DC than any other place I have ever been. The dialogue is below, feel free to reference it on your trip.

Being #TransVisible at the National Museum of African American History and Culture

I ❤️when we support things. #BeKP kpthrive nmaahc #lovealwayswins #EqualityEqualsHealth #TransVisibility #KPpride #activetransportation
I ❤️when we support things. #BeKP @kpthrive @nmaahc #lovealwayswins #EqualityEqualsHealth #TransVisibility #KPpride #activetransportation (View on

The information desk could not direct us to any displays featuring transgender people. The bathrooms are gendered. When I asked a staff person where the LGBT section was, she said “What does LGBT stand for?”

I know that’s not the intent of the National Museum of African American History and Culture (@NMAAHC) based on the work they’ve done (see the Twitter moment at the bottom of this post), so these things are not a big deal in the overall experience that the NMAAHC is.

I could only be there for a brief time (when you see a chance you take it) and I experienced multiple incredible micro-interactions that I can’t even express here, not just with the imagery, with the staff, the other visitors, that were meaningful and remind me why there’s more learning-per-minute in Washington, DC than any other place I’ve been.

Not to mention that it’s the most inclusive city in the world…

The best moment of the day was the selfie that myself and colleague Bianca Rey (@BiancaRey) took in front of the sweet home cafe, which is generously supported by Kaiser Permanente.

After I snapped the photo I asked what hashtags to use and she said, “include #TransVisbility. I’m including that on every photo now.” Of course I did.

30% of Americans know someone who is Transgender. 37% of the youngest Americans (age 18-29) do (see: Many Americans know someone who is gay, fewer know someone who is transgender | Pew Research Center)

Science clearly demonstrates that bias is reduced by contact of a specific nature:

optimal intergroup contact would be of equal status, involve cooperation to achieve common goals, and should be supported by important societal institutions.Just Read: Methods for reducing unconscious bias, implications for transgender person health and medical care

That’s us. Equal status (both people who power Kaiser Permanente, I actually report to Bianca as a Produer on Capital TransPride, she is Co-chair of our Multicultural Business Group), involving cooperating to achieving common goals (Helping our health system learn to love better), supported by important societal institutions (Kaiser Permanente is the highest performing health system in the United States).

One more photo. This is of Bianca at the first ever transgender youth ball in Washington, DC last month, produced by the also-amazing Ruby Corado (@CasaRubyDC). She’s welcoming the attendees and affirming them as valuable members of the Washington, DC community, along with Ruby.

2017.05.19 Capital TransPride Weekend Washington, DC USA 5087
2017.05.19 Capital TransPride Weekend Washington, DC USA 5087 (View on

Let a few more Americans discover what it’s like to know someone who makes the world a better place for them. My generation of physicians came to health care to make sure that happens, and we will 🙂 .

Rest of my NMAAHC photos below. Thank you for a great experience.

How an iMessage App helped make history at the first transgender pride crosswalk in the United States

2017.06.10 Painting of #DCRainbowCrosswalks Washington, DC USA 6410
2017.06.10 Painting of #DCRainbowCrosswalks Washington, DC USA 6410 (View on

Washington, DC did it first (again). The first transgender pride crosswalk in the United States, the second in North America. (see: Photo Friday: Where crosswalks are inclusive, too. Washington, DC USA for more information about this work)

The history on top of the history is that the crosswalk’s creation included the creator of the transgender pride flag, Monica Helms (@MF_Helms).

Monica learned about the crosswalk because of this blog post:

Special Pride Project Complete: Transgender Pride Flag iMessage App

Which was shared on Facebook, which she responded to, and connected this work to her work. It turned out that Monica and her partner Darlene happened to be in Washington, DC (they are from Atlanta area) on the day we painted, and so, we painted.

A Crisscross of History – Monica and Ted

The first transgender pride flag was unveiled in the LGBTQ Pride Celebrations in Phoenix, Arizona in the year 2000. I was born and raised in Phoenix, Arizona, and it turns out I was born and raised less than a mile from where Monica grew up. My father completed his residency training at a new hospital in the newish community that Monica’s family settled in at the time.

I’d like to be able to say that many who leave Arizona go on to do great things, or great things for the LGBTQ community specifically (Cleve Jones @CleveJones1 is also an Arizona native)….maybe it is that the places that are at times the least tolerant create the greatest innovation.

A 5 Star Experience

2017.06.10 Painting of #DCRainbowCrosswalks Washington, DC USA 6336
2017.06.10 Painting of #DCRainbowCrosswalks Washington, DC USA 6336 (View on

As Oprah herself defines 5 star experiences, this was one of those. Maybe a 6 star. My favorite images in the collection below are of my fellow citizens, humans, leaders, marking their identity on the streets of our nation’s capital. Fully sanctioned, fully supported, following in the footsteps of the Mayor herself who painted the previous day, protected by a Metropolitan Police Sergeant who also happens to be transgender herself.

The power of a flag to indicate that a person exists, that they matter, is undeniable to someone who is LGBTQ. Others may never understand it, but they can work to understand it 🙂 .

When I said goodbye to Monica my voice cracked a little when I said “thanks for changing the world.” A person doesn’t get to say that to a lot of people in their lifetimes. Although, in Washington, DC, I seem to say that to a lot more people than any other place I’ve been.

2017.06.10 Painting of #DCRainbowCrosswalks Washington, DC USA 6415
2017.06.10 Painting of #DCRainbowCrosswalks Washington, DC USA 6415 (View on

Isn’t this century the best? (It is)

Photos below. As Washington DC goes, so goes the nation.

I am what I am
And what I am needs no excuses
I deal my own deck
Sometimes the aces sometimes the deuces
It’s one life and there’s no return and no deposit
One life so it’s time to open up your closet
Life’s not worth a damn till you can shout out
I am what I amGloria Gaynor

Beyond walking in parades with us, things I’d like you to do to produce health for LGBTQ humans

2016.06.13 From DC to Orlando Vigils 06073
2016.06.13 From DC to Orlando Vigils 06073 (View on
I was unable to attend the 1 year vigil for the murder of 49 humans in Orlando on June 12, 2016 in Washington, DC. The photograph above, taken on June 13, 2016 in Washington, DC, captures some of the emotion that’s felt when remembering what happened.

2016.06.13 From DC to Orlando Vigils 06103
2016.06.13 From DC to Orlando Vigils 06103 (View on

I am about to post photos of this past weekend’s Capital Pride (@CapitalPrideDC) events in Washington, DC.

Before I do that, I wanted to write about some things I’ve been experiencing personally and professionally in the last year that I suggest people work to address.

It’s great that we’re joined in parades and celebrations, however, we need to reconcile that activity with activities that are needed year round. A few suggestions are below, based on actual situations. If you don’t understand what’s being asked or know what the right answer is to these questions, post in the comments or contact me, I’m happy to educate.

  • If you are a publication, are you using accurate and compassionate language in your writing, instead of inaccurate and triggering language? Are you a @DailyDot (an exemplar) or are you a @USAToday or @NPR (both need work) See this post: Thanks for publishing my photo AND listening, DailyDot, in “What Does Transgender Mean, and How Do People Transition?”
  • Do you manage comments on articles, as several publications do successfully, or do you allow unhealthy or anti-LGBTQ sentiment to be posted without any recourse?
  • If you are a company or organization that employs people, are you creating an open environment or are you directly or indirectly requiring people to “fit in”?
    • When LGBTQ employees report issues with others’ behavior, are they the ones tasked with resolving them?
    • In organizational communications, are anti-LGBTQ sentiment or statements tolerated?
    • On discussion boards
    • On company intranets
    • In events or meetings
    • Do you respond to people’s requests to listen with “I’m trying to help you.” or do you start with “Tell me more?”
    • Are employees’ names correctly reflected in all aspects of their work experience? This includes computer logins, payroll and benefits systems, email, etc.

If there is one bisexual man in your unit his fitting in depends on how open to diversity your unit is. It is NOT based on how hard he tries to fit in.UK Army LGBT Forum

  • If you’re in health care, do you speak of LGBTQ health care, or more specifically transgender person care, as something that’s “difficult” “complicated” “expensive” or name-your-pejorative?
  • If you’re not sure about whether you or the organization you’re affiliated with are doing any of the above, do you know who to ask, or do you assume it’s not happening?
  • When you encounter an organization or company that’s behaving in a discriminatory way, do you let them know via social media or other means? Maybe you shouldn’t. Instead, work to help the world love better. Read this piece by a young transgender man humiliated by an eating establishment for some advice: Thanks for publishing my photo and #WhatAParentLooksLike: Trans Discrimination: From Lunch Counters to Refused Hot Wings
  • Have you considered a mentor relationship with someone who is LGBTQ that you don’t supervise or otherwise have control over, on an ongoing basis, to review behaviors and attitudes with a lens toward improvement?
  • Do you call yourself “an Ally” or do you work to be an Ally in the eyes of those who it matters to? See this post: WAIT = Why am I Talking? Learning how to be a better Ally

All of these activities (or lack thereof) have a significant impact on the health and wellness of LGBTQ people, their families, and the communities around them.


What we do here matters. Remember 😢 #Orlando #CTP2017 #transpride #UnapologeticallyProud ✌️️‍🌈🌎 capitaltranspride
What we do here matters. Remember 😢 #Orlando #CTP2017 #transpride #UnapologeticallyProud ✌️️‍🌈🌎 @capitaltranspride (View on

It’s not what you do, it’s what you tolerate.

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