#and not about... the healthcare

[colorisbyshe]

I do think it's interesting (yet extremely predictable) that the meme-ification of and conspiratorial thinking around Luigi has 100% smothered the embers of intentional movement. If you spend all of your time talking about how he didn't do it, someone else did, he's totally been framed you end up spending no time on actually talking about... what to do next?

A movement where no one actually did anything and nothing actually happens will always be a movement where no one does anything and nothing actually happens.

But it was always obvious it was going to go this way and it's gonna keep going this way because people are more interested in seeming smart and seeing the truth and jokes where no one else sees them than they are in like... figuring out what to do next

And I'm not above that, I don't know what to do next besides things so abstract they're meaningless but like... if there was a communal interest in doing this, it'd be much easier to figure this shit out together instead of just all of us, separately, spewing things so abstract they're meaningless

But tbh this post is a week late, everyone has moved on because no one has the attention span for a movement anyways

[gingersnapwolves]

So today I want to talk about puberty blockers for transgender kids, because despite being cisgender, this is a subject I’m actually well-versed in. Specifically, I want to talk about how far backwards things have gone.

This story starts almost 20 years ago, and it’s kind of long, but I think it’s important to give you the full history. At the time, I was working as an administrative assistant for a pediatric endocrinologist in a red state. Not a deep deep red state like Alabama, we had a little bit of a purple trend, but still very much red. (I don’t want to say the state at the risk of doxxing myself.) And I took a phone call from a woman who said, “My son is transgender. Does your doctor do hormone therapy?”

I said, “Good question! Let me find out.”

I went into the back and found the doctor playing Solitaire on his computer and said, “Do you do hormone therapy for transgender kids?” It had literally never come up before. He had opened his practice there in the early 2000s. This was roughly 2006, and the first time someone asked. Without looking up from his game of Solitaire, the doctor said, “I’ve never done it before, but I know how it works, so sure.”

I got back on the phone and told the mom, who was overjoyed, and scheduled an appointment for her son. He was the first transgender child we treated with puberty blockers. But not, by far, the first child we treated with puberty blockers, period. Because puberty blockers are used very commonly for children with precocious puberty (early-onset puberty). I would say about twenty percent of the kids our doctor treated were for precocious puberty and were on puberty blockers. They have been well studied and are widely used, safe, and effective.

Well. It turned out, the doctor I worked for was the only doctor in the state who was willing to do this. And word spread pretty fast in the tight-knit community of ‘parents of transgender children in a red state’. We started seeing more kids. A better drug came out. We saw some kids who were at the age where they were past puberty, and prescribed them estrogen or testosterone. Our doctor became, I’m fairly sure, a small folk hero to this community. 

Insurance coverage was a struggle. I remember copying articles and pages out of the Endocrine Society Manual to submit with prior authorization requests for the medications. Insurance coverage was a struggle for a lot of what we did, though. Growth hormone for kids with severe idiopathic short stature. Insulin pumps, which weren’t as common at the time, and then continuous glucose monitoring, when that came out. Insurance struggles were just part and parcel of the job.

I remember vividly when CVS Caremark, a pharmaceutical management company, changed their criteria and included gender dysphoria as a covered diagnosis for puberty blockers. I thought they had put the option on the questionnaire to trigger an automatic denial. But no - it triggered an approval. Medicaid started to cover it. I got so good at getting approvals with my by then tidy packet of articles and documentation that I actually had people in other states calling me to see what I was submitting (the pharmaceutical rep gave them my number because they wanted more people on their drug, which, shady, but sure. He did ask me if it was okay first).

And here’s the key point of this story:

At no point, during any of this, did it ever even occur to any of us that we might have to worry about whether or not what we were doing was legal.

It just never even came up. It was the medically recommended treatment so we did it. And seeing what’s happening in the UK and certain states in America is both terrifying and genuinely shocking to me, as someone who did this for almost fifteen years, without ever even wondering about the legality of it.

The doctor retired some years ago, at which point there were two other doctors in the state who were willing to prescribe the medications for transgender kids. I truly think that he would still be working if nobody else had been willing to take those kids on as patients. He was, by the way, a white cisgender heterosexual Boomer. I remember when he was introduced to the concept of ‘genderfluid’ because one of our patients on HRT wanted to go off. He said ‘that’s so interesting!’ and immediately went to Google to learn more about it. 

I watched these kids transform. I saw them come into the office the first time, sometimes anxious and uncertain, sometimes sullen and angry. I saw them come in the subsequent times, once they were on hormone therapy, how they gradually became happy and confident in themselves. I saw the smiles on their faces when I gave them a gender marker letter for the DMV. I heard them cheer when I called to tell them I’d gotten HRT approved by insurance and we were calling in a prescription. It was honestly amazing and I will always consider the work I did in that red state with those kids to be something I am incredibly proud of. I was honored to be a part of it.

When I see all this transgender backlash, it’s horrifying, because it was well on the way to become standard and accepted treatment. Insurances started to cover it. Other doctors were learning to prescribe it. And now … it’s fucking illegal? Like what the actual fuck. We have gone so far backwards that it makes me want to cry. I don’t know how to stop this slide. But I wrote this so people would understand exactly how steep the slide is.

[bluesky-out-of-context]

[artyphex]

Also while I’m on my “please have more neutral education around pregnancy and birth” kick something I think NEEDS to be normalized is pregnancy reduction

If you don’t know what that is, it’s a procedure that reduces the number of fetuses in a pregnancy. For example, triplets down to twins, twins down to a singleton, etc.

It’s presented as a tragic last resort only valid in the most painful medical circumstances, but I FULLY believe it should be destigmatized and presented as a normal option during pregnancy. The reality is, not everyone wants twins! Some people only want one child and find out they’re having twins when they are not mentally, or financially, ready to parent more than one child and they should know they can reduce their pregnancy. Many doctors won’t even offer it without “medical need” with multiples being treated as a “oh surprise!” Thing and not something that can genuinely be very hard

I’ve decided I never want to carry more than two fetuses at a time, and honestly, two is pushing it. It’s a huge strain on the body. It could damage my health, and the health of the fetuses. If I found out I was expecting triplets (god forbid) I would get the pregnancy reduced, and I’ve been judged for saying that. To me, that’s ridiculous. It needs to be an option, and it needs to be presented in a neutral way in ALL circumstances that it may apply, not only when a provider decides it’s “medically acceptable”

[theabigailthorn]

"trans people deserve love respect and dignity" - sweet nothing, pablum, easy to co-opt into nonperformative statements, it's giving Labour Party

"Public Official X's specific decision to Y is completely unevidenced and is harming trans people. Public Official X should resign or face consequences." - unco-optable, focused on justice, deliciously angry

[stemiwithme]

samira mohan the best patient advocate in that emergency department hands down. the way she takes care of joyce st. clair never ever fails to give me goosebumps. when she steps back and screams at everybody to stop and the whole department stands still and then she immediately gets down to business, confirming that joyce has sickle cell and ordering the appropriate treatment. and when whitaker seems doubtful of the validity of joyce’s condition samira educates him concisely and directly without being unkind, but still with the full intensity and seriousness that that conversation deserves. and while still being respectful towards addicts!!! and then there’s the case with the influencer suffering from mercury poisoning that samira refuses to ship off to psych because her patient is telling her something is off and she trusts her patient. and the fact that she’s actively researching racial disparity in the ER by painstakingly reviewing patient charts from the last 5 years!!!!! THAT’S dedication and passion!!!! people call her slow-mo and she’s made her peace with that bc she knows it’s for the right reasons, bc she refuses to cut corners or overlook things or ignore her gut. bc she cares deeply for every single one of her patients, no matter how they treat her (see: the morphine addicted dad visiting from new york for his daughter’s wedding). like she really is that girl!!!!! she really is!!!! samira mohan i LOVE YOU and you’re the BEST RESIDENT DOCTOR EVER and i would TRUST YOU with MY LIFE

[reasonsforhope]

A new treatment combining ReCET and semaglutide could eliminate the need for insulin in type 2 diabetes, with 86% of participants in a study no longer requiring insulin therapy. The treatment was safe and well-tolerated, and further trials are planned to confirm these results.

Groundbreaking research presented at UEG Week 2024 introduces a promising new treatment approach for type 2 diabetes (T2D) that has the potential to greatly reduce or even eliminate the need for insulin therapy.

This innovative approach, which combines a novel procedure known as ReCET (Re-Cellularization via Electroporation Therapy) with semaglutide, resulted in the elimination of insulin therapy for 86% of patients.

Globally, T2D affects 422 million people... While insulin therapy is commonly used to manage blood sugar levels in T2D patients, it can result in side effects... and further complicate diabetes management. [Note: Also very importantly it's fucking bankrupting people who need it!!] A need therefore exists for alternative treatment strategies.

Study Design and Outcomes

The first-in-human study included 14 participants aged 28 to 75 years, with body mass indices ranging from 24 to 40 kg/m². Each participant underwent the ReCET procedure under deep sedation, a treatment intended to improve the body’s sensitivity to its own insulin. Following the procedure, participants adhered to a two-week isocaloric liquid diet, after which semaglutide was gradually titrated up to 1mg/week.

Remarkably, at the 6- and 12-month follow-up, 86% of participants (12 out of 14) no longer required insulin therapy, and this success continued through the 24-month follow-up. In these cases, all patients maintained glycaemic control, with HbA1c levels remaining below 7.5%.

Tolerability and Safety

The maximum dose of semaglutide was well-tolerated by 93% of participants, one individual could not increase to the maximum dose due to nausea. All patients successfully completed the ReCET procedure, and no serious adverse effects were reported.

Dr Celine Busch, lead author of the study, commented, “These findings are very encouraging, suggesting that ReCET is a safe and feasible procedure that, when combined with semaglutide, can effectively eliminate the need for insulin therapy.”

“Unlike drug therapy, which requires daily medication adherence, ReCET is compliance-free [meaning: you don't have to take it every day], addressing the critical issue of ongoing patient adherence in the management of T2D. In addition, the treatment is disease-modifying: it improves the patient’s sensitivity to their own (endogenous) insulin, tackling the root cause of the disease, as opposed to currently available drug therapies, that are at best disease-controlling.”

Looking ahead, the researchers plan to conduct larger randomized controlled trials to further validate these findings. Dr. Busch added, “We are currently conducting the EMINENT-2 trial with the same inclusion and exclusion criteria and administration of semaglutide, but with either a sham procedure or ReCET. This study will also include mechanistic assessments to evaluate the underlying mechanism of ReCET.”

-via SciTechDaily, October 17, 2024

--

Note: If it works even half as well as suggested, this could free so many people from the burden of the ongoing ridiculous cost of insulin. Pharma companies that make insulin can go choke (hopefully).

[sunlight-shunlight]

anyway dai solas you will always be famous to me. nothing but respect for my boy who wandered off mid-cutscene in the hinterlands to go help out refugees, is extremely good at Lies Of Omission™️, has a whole spy/agent/informant network of elves who followed him, fervently argues that it's unethical to be happy about killing bandits bc they had lives and loved ones, describes his own temple(?) prison(?) as having "indecipherable" elven writing, has ferocious debates with dorian and iron bull about slavery, set himself on fire once by mistake, and within about a year of his 10000 year lifespan, went from seeing all the world as disposable emotionless husks, to developing actual friendships and even falling in love.

and then! still thought it was necessary to destroy and reset the world! but he would treasure the chance to be wrong again!!

[charl0ttan]

whats really really scary that i think abt a lot is how many people lived their entire lives not knowing it could be better and what are the odds that i was born into a life that breaks that cycle. what am i missing out on

[sergeant-angels-trashcan]

idk i just. i gotta say there is something so powerful about having two alpha male coded characters discussing their emotions on a rooftop while grappling with overt suicidality and having the most alpha of the two not only providing emotional support and words of affirmation but actively endorsing therapy. admitting that he goes and it helps. do you understand how insane that is. they really wrote jack abbot to be in the middle of a venn diagram of suicidal demographics and said we're not going to leave him there, we're going to make him be the one who is advocating for the mental health care of healthcare workers. Do you get this. he's a white male veteran between like 18-50 who undoubtedly has access to a firearm. he's disabled, he works in emergency medicine as an attending and we have no idea what kind of support system he has outside of work. like. that is a man i would be actively worried about in my workplace. that is a man who knows how to kill himself and make it stick. and he's talking about his therapist out in the open. the amount of stigma and internalized masculine ideals and military masculinity he has worked through. do you. do you understand. do you understand what an incredible character jack abbot is. i'm tearing up. robby is terrified someone will find out he has ptsd and panic attacks and jack is telling him it's okay. implying he has them too. it's okay because you came out and went right back in it. you were who we needed you to be, and it wasn't fair and it's okay to not be okay. it's okay to need help. jack. jack abbot said those things.

jack abbot you have my entire heart

[gmaybe666]

free luigi the new italian american folk hero

[gingersnapwolves]

You know what since I’ve got a ton of new followers because my post on puberty blockers took off and people apparently want to see me rant, I’m gonna get up on my soapbox for a PSA for tumblr’s aging userbase.

Do not! Get! A Medicare Advantage plan!

Tell your parents not to get one. Tell your aunts and uncles not to get one. Tell your friends not to get one.

Why is that, you might say? Kouri, what is a Medicare Advantage plan, you might say?

tl;dr Medicare is the government healthcare plan for Americans of a certain age or with certain disabilities. It is owned, administered, and operated by the government. You are entitled, if you wish, to outsource your Medicare and have your policy run by a commercial group, such as United HealthCare, Cigna, Aetna, et cetera.

Here’s how it works: For everyone who signs up for, say, a plan that rhymes with Figna Medicare Advantage, Medicare gives Figna a certain amount of money and says ‘use this to take care of this patient’.

You can see where this is going, right? Figna says ‘sure boss! *wink nudge*’ and then shoves as much of that money into their own pockets as possible, and they do that by finding excuses to NOT pay for your medical care.

Medicare Advantage plans are pushed and marketed heavily. They’ll call you. They’ll set up stands in your PCP office to try to encourage you to buy in. They will say things like ‘with Medicare, you have to pay a 20% coinsurance, but with us you only have a 10% coinsurance’ and completely neglect to tell you that having a smaller coinsurance only matters if they approve the fucking care that you need, which often they won’t (while Medicare would have) and if your doctors are willing to accept it, which often they don’t (while they do accept Medicare).

Is Medicare perfect? Absolutely not! I've got my share of bones to pick with them. But simply put:

Medicare is government administered. It is a service. It costs the government money, which is why the GOP is always trying to cut funding to it. Medicare Advantage is corporately administered. It is supposed to make money. Which gives them incentives to deny your care and fuck you over that Medicare simply does not have.

Do not. Get. A Medicare Advantage Plan.

[wilwheaton]

[arch-aeology]

Merry Christmas! Here’s a Jayvik au where they’re college students in 80s New York

[irlcupcake]

10 of my favorite easy glow up tips! 𐙚 ‧₊˚ ⋅

get a gua sha!! not expensive at all and made such a difference in my face shape and carving out my cheek bones and jawline. there’s lots of good tutorials on tiktok or youtube!

tea in the morning/night! there’s so many teas to help with different things but my favorite’s are spearmint tea for clearing skin and green tea for reducing bloating.

ice your face! helps SO much with de-puffing and closing up your pores! dipping your face in a bowl with ice water can reduce inflammation, help with acne and reduce oily skin!

make sure to get enough sleep! It’s so easy to stay up scrolling on tumblr until the sun comes up but getting enough sleep is so important mentally and physically!

find a skincare routine that works for you and remember too much skincare can be bad for your skin! my skin was breaking out the worst when i was using a bunch of skincare and It’s cleared so much since i simplified my routine.

use a lash/brow serum! my favorite brand is grande lash and it’s a little pricey but using castor oil works as well and it’s super affordable.

going on walks! I’ve never been a fan of intense exercises and I’m a chronic bed rotter but putting on my favorite hot girl playlist and strutting on the treadmill/sidewalk is genuinely so fun!

rosemary oil for hair growth! my holy grail of hair growth products along with a scalp massager. my whole life my hair grew so slow and since using rosemary oil i have to trim my bangs twice a month sometimes!

i cannot stress this one enough..wear what YOU want! don’t let new trends or judgment from others stop you from embracing your true style. we look our best when we feel most confident!

most importantly ~ take care of yourself! make sure you’re eating enough, drinking water, listening to your body and being gentle with yourself always. improving ourselves can be so fun but make sure it’s not at the expense of your mental health <3

[biracy]

Thinking abt when people kept posting about Breaking Bad being about "the failures of the American healthcare system" or w/e even tho that's blatantly untrue and isn't a theme carried by the show past like, episode three. I genuinely think "American healthcare bad" is just far easier for people to parrot than to realize that their favorite critically acclaimed prestige television show is primarily about gender and masculinity and fatherhood (and the failings of those things)