Category: current events

Extending Telehealth for Medicare Recipients

Posted on by Grayson

The following is an email from the US Pain Foundation dated yesterday, March 21:

Since access and coverage of telehealth has been a wonderful and safe convenience for people with chronic pain during the pandemic, we have been closely following government policy around telehealth coverage and want to update you on recent developments.

Last week, President Biden signed into law HR 2471, the Consolidated Appropriations Act of 2022 which finalized the fiscal year 2022 federal budget and included a number of provisions to extend Medicare telehealth coverage implemented as part of the government’s response to COVID-19. The COVID-19 Public Health Emergency (PHE) has not yet officially ended but is expected to end sometime in the next few months. HR 2471 will extend Medicare telehealth coverage for 151 days or approximately five months after the PHE ends. These extensions include the following:

  • Patients’ Location – Medicare beneficiaries can continue to receive coverage for telehealth services from wherever they are located within the U.S., including their homes. Before the PHE, telehealth coverage was restricted to beneficiaries being located in hospitals and certain provider locations in order to receive coverage for telehealth.
  • Eligible Practitioners – Medicare beneficiaries can continue to receive coverage for telehealth services from physical therapists and occupational therapists.
  • Mental Health Coverage – Medicare beneficiaries can continue to receive coverage for telehealth services from mental health providers without the requirement of an in-person visit within six months of the first telehealth service with that provider nor the requirement of an in-person visit every 12 months.
  • Audio-only Telehealth – Medicare beneficiaries can continue to receive coverage for telehealth services using audio-only technology.

This is great news for Medicare beneficiaries! However, although Medicare coverage policies tend to be a bellwether for changes in private payer and Medicaid coverage, please keep in mind that private payer and Medicaid coverage for telehealth services varies by state.

Forty-three states and the District of Columbia (DC) have laws that govern private payer reimbursement of telehealth but what specific services and providers are covered varies greatly. And, while all 50 states and DC now reimburse for some types of telehealth services in Medicaid, many of the reimbursement policies have restrictions and limitations. It is important to check with your state Medicaid program or private insurer to find out what telehealth services are covered.

You can learn more about the efforts that the US Pain Foundation takes around advocacy – including ways to get involved – here.

New Kawasaki Disease Guideline Released by American College of Rheumatology and Vasculitis Foundation

Posted on by Grayson

The following is a press release dated March 8:

The American College of Rheumatology (ACR), in partnership with the Vasculitis Foundation (VF), released a new guideline for the management of Kawasaki disease that addresses diagnostic issues relating to Kawasaki disease, the treatment of high-risk patients, and the management of convalescent patients.

Kawasaki disease is a vasculitis that is most common in children under 5 years old. It makes blood vessels in the body (particularly those that supply blood to the heart) become inflamed. This guideline is the final companion to three other ACR/VF vasculitis guidelines released in July 2021.

“Kawasaki disease continues to be an area of evolving understanding in clinical treatment,” said Mark Gorelik, MD, an Assistant Professor at Columbia University Vagelos College of Physicians and Surgeons in New York, and the lead investigator of the guideline. “There are various degrees of severity in this disease and a set of complications and therapies that rheumatologists should be aware of. These guidelines will help clinicians better treat patients by augmenting existing guidelines from the American Heart Association, especially for complex patients seen by rheumatologists.”

The guideline provides eleven treatment recommendations, a good practice statement that all Kawasaki disease patients should be initially treated with intravenous immunoglobulin (IVIG), and an ungraded position statement on the use of either non-glucocorticoid immunosuppressive therapy or glucocorticoids for patients with acute Kawasaki Disease and persistent fevers after repeated treatment with IVIG. The strong recommendations include prompt treatment of incomplete Kawasaki disease, aspirin therapy, and obtaining an echocardiogram in the setting of shock. The conditional recommendations include use of IVIG with other adjuvant agents for patients with high-risk features for IVIG resistance and/or coronary artery aneurysms.

“IVIG is the central therapy for patients with Kawasaki disease and should be administered as soon as the diagnosis of Kawasaki disease is made. IVIG significantly reduces the rate of coronary artery aneurysms,” said Dr. Gorelik.

Two recommendations in the new guideline differ from current standards. Currently, all patients with Kawasaki disease are treated essentially identically. The guideline recommends higher risk patients be treated with short courses of corticosteroids at time of first diagnosis. The guidelines also recommend that physicians can choose to use either low or high dose aspirin for therapy, since there is no evidence that either higher or lower doses are more effective for preventing vascular complications.

“Kawasaki disease is the leading cause of acquired heart disease in children,” said Joyce Kullman, Executive Director of the Vasculitis Foundation. “This guideline will hopefully take the guesswork out of determining which treatments might work best for newly diagnosed patients, or patients who have been under treatment for a while without success.”

While the guideline was being developed, the COVID-19 pandemic began. A novel multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 emerged with some features suggestive of Kawasaki disease. The ACR has published a separate clinical guidance on MIS-C, but further study is needed to understand the relationship between MIS-C and Kawasaki disease.

“Based on clinical experience with many MIS-C patients, recognition and differentiation of MIS-C from classic Kawasaki disease is important. Patients who meet criteria for Kawasaki disease should be treated using the therapies discussed in this guideline. Additional study is needed to determine optimal treatment for MIS-C with and without Kawasaki disease features,” said Dr. Gorelik.

Like many other ACR guidelines, the guideline for Kawasaki disease was developed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, which creates rigorous standards for judging the quality of the literature available and assigns strengths to the recommendations. The papers containing the full list of recommendations and supporting evidence is available on the ACR website.

COVID-19 Infection in a Toddler

Posted on by Grayson

Content note: death and autopsy of a toddler

covid-19 infection in a toddler

I recently found a journal article about COVID-19 infection that everyone needs to read. Published in August, it should have been on everyone’s minds as people decided the fate of children returning to school.

Ismael Gomes, Karina Karmirian, Júlia T. Oliveira, Carolina da S.G. Pedrosa, Mayara Abud Mendes, Fernando Colonna Rosman, Leila Chimelli, Stevens Rehen. SARS-CoV-2 infection of the central nervous system in a 14-month-old child: A case report of a complete autopsy. The Lancet Regional Health – Americas, Volume 2, 2021, 100046, ISSN 2667-193X, https://doi.org/10.1016/j.lana.2021.100046.

A 14-month old Black baby girl died due to COVID-19. Four months before her death, she fell ill. Doctors assumed she had viral meningitis. She was hospitalized multiple times between then and her death. By the time they suspected pneumonia, she was just on the cusp of becoming unstable. The child died within days.

 

Findings

For those of us who need the findings in plain language:

  • Microthrombosis – Thrombosis is when a blood clot forms in a blood vessel. Microthrombosis simply means that these blood clots are incredibly small. These were found in the child’s left ventricle (heart), thyroid, and kidneys.
  • Pulmonary Congestion – Excess fluid in the lungs, which often leads to a lack of oxygen in the blood.
  • Interstitial Oedema – Swelling within the lungs in the areas surrounding the air sacs in the lungs.
  • Lymphocytic Infiltrates – A non-cancerous or benign build-up of white blood cells. These were found in the child’s right ventricle (heart), the mucous bits within the throat, tongue, stomach, intestines, liver, and more.
  • Bronchiolar Injury – A complication connected to blunt trauma and injuries during intubation. Without proper treatment, this can lead to pneumonia and other life-threatening conditions.
  • Collapsed Aalveolar Spaces – A complete or partial collapsed lung. Some of these spaces were filled with collections of protein and inflammatory cells.
  • Cortical Atrophy – The loss of brain cells called neurons. Other conditions that can lead to this include stroke, dementia, seizures, a traumatic brain injury, Huntington’s disease, AIDS. “The brain weight (635 grams) was about 33% less than normal for age.”
  • Severe Neuronal Loss – The death of brain cells. This often occurs in those with conditions that are linked to brain and cardiovascular health.
  • Hemorrhagic Foci – A type of bleeding within the brain.
  • Spongiosis – Parts of the brain turn into sponge-like tissues. Her brain became sponge-like.
  • Gliosis – A process where your body creates new or very large glial cells (which support nerve cells). These cells can cause scars and lesions on the brain.
  • Macrophages – We know that one, right?
  • Diffuse white matter edema – Swelling in the white matter.
  • Neuronal Mineralization – Tissue within the brain turns into minerals.
  • Encephalopathy – Brain swelling.
  • Overproduction of cytokines, leading to systemic inflammation.
  • Other Issues Found
    • Laryngitis.
    • Infection in the salivary glands.
    • Fewer lymph-related cells in the tonsils, thymus, appendix, and lymph nodes.
    • Swelling and blood clots within the esophagus.
    • Stomach congestion, blood in the mucous, gastritis.
    • Steatosis, or fatty liver disease.
    • Necrosis or dying tissue in and around the pancreas.
    • Blood clots within the pelvic region.
    • The taste and smell center of the brain was not around due to softening.
    • A breakdown in the blood-Cerebral Spinal Fluid barrier.

I want to highlight that MIS-C – or Multisystem Inflammatory Syndrome in Children – is similar to both Kawasaki Syndrome and Macrophage Activation Syndrome. Many of these are symptoms that those of us familiar with those conditions are very aware of. And, again, this child’s brain began to turn into a literal sponge.

 

Please continue to wear your mask, especially if you’re at higher risk.

2021 Care Rationing Survey

Posted on by Grayson

2021 Care Rationing Survey - #NoBodyIsDispoable Fat Legal Advocacy, Rights, & Education Project - Have you struggled with or delayed getting medical care during the pandemic? Are you a provider concerned about care rationing at your organization? Please take this survey.

The #NoBodyIsDisposable Coalition and the Fat Legal Advocacy, Rights, & Education Project have created a short survey to hear from people who are being denied medical care because of limited medical resources. Responses will be used to help advocate for fair medical treatment.

This survey was created to help gather the stories of folks who are having trouble getting medical care during COVID. Stories will be shared to create awareness and support advocacy. (Respondents can choose whether or not to share anonymously.)

Who should take the survey?

Please take the survey if you or someone you know had a hard time getting medical treatment during COVID due to limited medical personnel and supplies/equipment shortages and you suspect part or all of the reason you did not receive necessary care was based on discrimination including but not limited to your weight, disability, race, age, or other factors.

Take the survey if you have been delaying necessary medical care because you worry if you do get COVID that you will be deprioritized for life-saving medical treatment based on your weight, disability, race, age, or other factors.

Take the survey if you work at a health care organization and have concerns about the care rationing policy, or how it is implemented.

Link to the Survey

The survey is available in English and Spanish.

Please help spread the word. They will be reviewing answers on an ongoing basis.

Rheumatology Patients on Immunosuppressive Medications Qualify for Third COVID-19 Vaccine Dose

Posted on by Grayson

The following is a press release from the ACR released within half an hour of this post:

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices today recommended that rheumatology patients being actively treated with high-dose corticosteroids, alkylating agents, antimetabolites, tumor-necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory receive a third dose of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines.

The approval came one day after the FDA announced it would be revising the current emergency use authorizations (EUA) for the two mRNA vaccines to permit a third dosage in certain immunocompromised patients. The recommendation applies for ages 12 and older for individuals receiving the Pfizer-BioNTech vaccine and18 and older for patients receiving the Moderna vaccine. The new EUA is specifically for the two mRNA vaccines and does not extend to recipients of the Johnson & Johnson vaccine currently.

“This will be enormously important for our immunocompromised patients, and we are thankful to the FDA and CDC for hearing our concerns, recognizing the needs of this population and moving forward,” stated ACR President Dr. David Karp. “We look forward to working with the agencies as they communicate this new recommendation.”

The additional dose of mRNA COVID-19 vaccine should be administered at least 28 days after completion of the primary vaccine series, and patients and providers should stick to the same brand for the third dose, if possible. No determination was made on the safety of receiving one of the mRNA vaccines if a patient initially received the Johnson & Johnson shot.

All immunocompromised patients, including those who receive an additional mRNA dose should continue to follow prevention measures, including:

  • Wearing a mask
  • Staying 6 feet apart from those they don’t live with
  • Avoiding crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider
  • Close contacts of immunocompromised people should be strongly encouraged to be vaccinated against COVID-19.

These preventative measures remain critical due to real-world data that shows immunocompromised individuals are more likely to have a lower response to the initial vaccine dosage and are more likely to experience breakthrough infections. According to the CDC, 40-44 percent of hospitalized breakthrough cases are immunocompromised patients.

In a recent randomized trial of a third dose of Moderna vaccine in transplant recipients, 33 – 50 percent of those who had no detectable antibody response to an initial mRNA vaccine series developed one with a third dose, and the proportion of the group who are seropositive increased to 68 percent with the third dose. No serious adverse events were reported, and the symptoms reported were consistent with previous doses, with mostly mild or moderate symptoms reported.

The CDC noted that the effectiveness and accuracy of antibody testing are still being evaluated. Patients who are moderately to severely immunocompromised should discuss a third dose with their providers.

“Not all medications that our patients take have been shown to have significant effects on responses to vaccination. Patients should ask their provider if they are likely to see a beneficial effect from additional vaccination,” Dr. Karp said. “Luckily, we have not seen any safety signals in patients with autoimmune and rheumatic diseases from the COVID-19 vaccines, so there should be no concern for the third dose.”

The ACR’s COVID-19 Vaccine Clinical Guidance Task force is meeting Monday, Aug. 16 to discuss potential changes to the ACR’s clinical guidance and expect to share recommendations shortly after.

For more on this, you can also check out the recent town hall webinar from ACR now uploaded to YouTube.

Cognitive Load & The Pandemic

Posted on by Grayson

There’s an article that’s been going around about Surge Capacity. It’s worth reading, but it also brought up another term for me: cognitive load.

Cognitive load is the thing where it gets really hard to make decisions when you have too many options, like trying to pick from the menu at The Cheesecake Factory. You might make a decision only to lose it while looking at the menu, or you might just struggle to pick the decision that brings the most joy. If you’re like me, you’ll make a panicked decision and get something you likely didn’t want.

Cognitive load is usually used to talk about information absorption. In one common example, our memory is like an iceberg. The top part, visible to all, is our short-term memory. It can take in a fair amount, but can’t really absorb everything we expect it to throughout the day. The bottom part of the berg is our long term memory. For the most part, things that make it there are easy to remember.

When there isn’t enough room in our short-term memory, not only are we overwhelmed but we lose ideas and information. They slide off that tiny tip of the iceberg, freezing in the sea like Jack when Rose wouldn’t share her damn door.

We can prevent this, though, through receiving information in manageable chunks.

Apply that to our world right now… We have SO MUCH information coming our way, from pop culture to politics to social injustice to the absurdity of navigating video meetings that should’ve been emails…

It’s especially easy to get overwhelmed.

Thankfully, there are ways to address cognitive load. We can make life easier for ourselves that also don’t require opting out of important things like staying abreast of current events or being involved in activism.

1) Recognize and acknowledge that we’re not just working or learning or doing other things from home, but doing so during a time of great unrest. Not only does that mean extra stress from the world’s ick, but that we’re also bringing work or school into our comfy spaces. That’s a lot less space for us to be at rest, from a cognitive standpoint.

2) Try to create a space that’s only (as much as possible) for joy. Maybe only watch entertaining things like Great British Bake-Off on the TV in your bedroom versus watching the news, for example. Even if it’s a corner full of fun spooky season decor, find a way to cultivate joy specifically in your living space.

3) Listen to your brain and your body. If you’re doing school or work from home, you have deadlines and I get it. As much as you can, though, try to listen to what your body and mind are telling you. For example, I take breaks to look at social media or move around every 20-60 minutes. Sometimes I need more breaks, sometimes I need fewer.

4) For the people you live with, provide options when asking questions like “What do you want to do/eat/drink?” It’s a lot easier to pick between two concrete options when you’re frozen from cognitive load than to try to pick one thing out of several possibilities. Ask for the same when you need it.

5) If you’re in a position to give them, provide clear instructions to the people around you whether they’re kids or coworkers or partners. If you get instructions, ask for as much clarity as possible.

6) Break up bigger tasks into smaller ones. Have you ever used an organization tool like Asana? You can add a ton of smaller tasks onto a bigger one. Think like that about all the tasks in your day, from showering to cooking to work. If you haven’t used Asana or something similar, let’s talk showering. It’s not just getting into the shower, right? It’s grabbing a towel, going into the bathroom, starting the shower (and fan), taking your clothes off, maybe picking music to listen to – and that’s just before!

7) Think about the best ways you consume or take in information. Is it via audio, visual, text, or by doing? Or another way? Make sure the people around you know your learning style and try to set up the things you take in to match. If visual is best for you, maybe IG or TikTok would be fun break time things. If audio is more your thing, perhaps listening to a podcast or music would be helpful.

8) Be patient! This is a wild time in the world, and it’s not something that’s easy. Give yourself space and grace – space to grow and feel and be human, and grace when you have a rough day or make a mistake.

We’re human and it happens, especially with so much on our plates.

We are dealing with profound grief & loss, on a level that is unquestionably upsetting. What we’ve all lost during the pandemic alone is hard, but throw in it being an election year, all of Cheeto Voldemort’s BS, and bigots galore… It’s understandable to feel some type of way.

We often feel at odds, too, when we find joy during a tumultuous time. One thing a lot of us struggle with is the plurality of our existence, that we can be both excited for the next episode of the show we love and angry at politicians for not addressing racism. Look, it’s okay for that to be difficult to rationalize! Our brains like black & white, not the rainbow of colors and the nuances that happen in life.

We have to remember humans are complicated and our brains are, too

I know that, sometimes, we need to hear these things from someone other than ourselves, so buckle up…

You have permission to exist as a human right now, to feel all of the complicated and possibly upsetting things this time in history is bringing up.

As a feelings nerd, I encourage you to lean into the feelings. Investigate them down to their roots. Is it ‘just’ stuff right now giving you existential dread, or is this bringing up something from your past, too?

We have to fight the effects of chronic stress in our lives because it can literally be deadly. Chronic stress can add to our risk factors for emergency situations, including heart attacks and strokes – and it can bring on chronic pain.

Find your joy!

Eat all the pumpkin spice things and flip off anyone who gives you grief about it. Learn the WAP dance (but watch yourself on that split because I DID NOT). Take time to create videos on Tiktok (or just watch my guinea pig ones). Binge a show you’ve wanted to watch.

I really enjoy my job! There are definitely issues with public health, but my coworkers are really great

And I’m moving! Ian & I move to a 2br this weekend meaning we have a legit office room

Racism is a Public Health Crisis

Posted on by Grayson

More white people are waking up to how insidious racism is. It’s both great and upsetting at the same time. It should not have taken this long for people to see the issue and want to address it.

In public health, we often talk about the notion of racism and discrimination being a part of society’s culture. Some types of discrimination are especially clear in different types of settings. For example, ageism plays a huge role in pain management. Young people aren’t believed about pain. Older folks are presumed to have little quality of life, and are either over or undertreated.

While racism is not just an issue that affects only Black folx, I am focusing this piece mostly on Black pain due to racism.

When we say ‘racism is a public health crisis,’ what does that mean?

The following is from a Rolling Stone article entitled ‘Racism Kills: Why Many Are Declaring It a Public Health Crisis‘ –

When it comes to discussing racism and public health, words matter. Specifically, [Mary] Gregory says that it’s important to refer to racism as a public health “crisis” instead of an “issue.” Not only is it more accurate, she says that racism also meets the four criteria the CDC requires in order for something to be considered a public health problem. That means that (1) it places a large burden on society that continues to increase, and (2) impacts certain parts of the population more than others. In addition to that, (3) there’s evidence that preventative strategies could help, but (4) this hasn’t happened yet. And while we’re on the subject of words, Gregory wants to remind us that when we talk about “race,” we’re really talking about skin color. “There is one race on this planet — homo sapiens — and to use the word ‘race’ in talking about skin color is our first mistake,” she explains.

I highly suggest reading that article. It’s a fantastic picture of racism as a crisis.

Here in Wisconsin, it might be even worse than in some states. Still, despite Milwaukee being one of the most segregated cities in the US, Wisconsin was the first state to declare racism a public health issue.

Let’s examine just some of the ways that racism can impact someone’s life.

 

Environmental Racism

The Flint water crisis is still happening. They still do not have clean water, and it’s been SIX YEARS. The government continues to fail to address this issue in a way they wouldn’t be able to if Flint was full of white middle-class people. The only way they’re getting away with this is because the population is primarily BIPOC (Black, Indigenous, & People of Color) folx living in poverty.

 

Medical Racism

Black folx are around four times more likely to die of pregnancy complications than white folx.

Black people, on average, have a lower life expectancy than whites. In addition to outright physical violence, part of why this occurs is the chronic stress of being Black. As we well know, stress can cause and worsen chronic conditions. Combine this with a lack of access to medical care – or not trusting the medical system because it routinely engages in racism – and it’s a recipe for disaster.

Currently? We know that BIPOC are one of the groups dealing with the most impact from Covid.

 

Police

I recently covered the 2015 murder-by-cop of Madison-local Tony Robinson for my podcasts. You can listen here.

Police continue to murder Black folx at higher rates. The police ‘issue’ isn’t something we ignore, either, as half of all people murdered by cops are disabled.

A lot of people think that means the policing system needs reform. In reality, white people created policing exactly this way. The notion of police in America came out of that of the slave catchers. That’s right – the police developed from a system literally only designed to protect the property, livelihood, and well-being of white people. It likely goes without saying that, as time went on, this also meant the police attacked and oppressed anyone they saw as a threat to that – disabled, trans, queer, BIPOC, etc.

 

Institutional Racism

Each of these types of racism is a part of institutional racism. It’s much worse than most white folx realize.

Moving into the Civil Rights era, white people took special care to ramp up attacks on Black folx. Lawmakers drafted and passed laws around public housing, financial assistance, and many other areas. They did this to specifically target Black communities. These included laws against those convicted of felonies and drug charges living in public housing or lowering their job prospects. This combined with police increasing patrols and arrests in Black communities began to lead to the higher incarceration rates for Black folx – particularly Black men. That later transferred to affect all genders while simultaneously forcing those who are transgender or gender non-conforming into incorrectly gendered facilities where they face additional harm from guards and fellow inmates.

Combine all of that with the increase in social workers stealing children to put them in foster care under false pretenses, the school-to-prison pipeline, and rapid underfunding of any organization that might actually be able to help? It’s a recipe for disaster.

Black people are then gaslit and told that these systemic forms of oppression are their fault. While nothing could be further from the truth, the impact of those lies cannot be understated.

 

Epigenetics

Now, imagine this going on for any of our families for half a millennium. Consider what it would mean if we couldn’t even trace our ancestry back that far because no one had cared to collect our family stories. There’s a lot of trauma that can affect people in many ways.

Epigenetics is the study of how our DNA changes how it expresses itself in response to things like diet, exercise, and stress. Toxic stress can cause long-term problems including post-traumatic stress, changes in brain physiology, and more. These changes pass down through generations. The stress of going through abuse can be passed down to the abused person’s children, etc. This applies to historical trauma, such as slavery, too.

Epigenetics is such a new field of study that we have no knowledge yet around how to help heal those wounds. There is a specific type of post-traumatic stress called Post-Traumatic Slave Syndrome. Things like therapy can be helpful for our own experiences, but can they touch on historic pain? Not really.

 

What do we do now?

If you’re white – and, from my readership stats, I know you probably are – it’s time to start learning. Here are a few resources:

We Live on Stolen Land

Posted on by Grayson
If you are not indigenous, you live on stolen land.

 

“Okay, but why are you talking about it?”
I’m white. I also get that this site isn’t necessarily one that you’d all expect me to talk about this on. That doesn’t mean it’s not important or that those of us who want to end injustice should stay silent on. That combined with my new job in public health and us talking more in general about injustices and, well, here we are.

 

“So, what’s going on?”
The US government stole and conquered this nation, pushing indigenous folx to smaller and smaller spaces, violating treaties over and over again while openly engaging in genocide and causing irreparable harm to folx.
We then tried to steal indigenous culture by using social workers and others to steal their children and raise them in ‘boarding schools‘ [pronounced institutions] meant to make them more like white Christians. We stripped them of their native languages as well as family and tribal connections.

 

The harm continues.
Things like healthcare that our government stated they’d provide are woefully inadequate. Tribal services are often not culturally competent and there aren’t enough providers – or resources given to them – to actually provide care. Many indigenous folx have been pushed to reservations where water is scarce, they have little to no access to the internet and power or other services, and food doesn’t grow in addition to being miles away from grocery stores.
To top it off, we white folx have carved monuments to our whiteness into their holy areas like Mount Rushmore. When indigenous folx try to speak up about things like this or proposed pipelines like Standing Rock, they’re met with violence of the worst kind. The police have become increasingly militarized against the people we stole this land from. If you’re reading this the weekend of July 4, 2020, this is literally happening as you read.
That doesn’t even get into the inability of indigenous folx to arrest white folx committing crimes on their lands and against them. Law enforcement in the white world doesn’t give a shit and rarely does anything when there’s a ton of evidence, let alone if they have to actually investigate. This lends itself to the problem related to Missing and Murdered Indigenous Women. There are so many resources on MMIW that I can’t include them all, but please make sure to read more below:

There are also very real issues with policing harming indigenous folx, both directly and indirectly. For more, read:

So, today I urge y’all to learn about whose land you occupy by visiting https://native-land.ca/ I live on stolen land of the Kiikaapoi, Peoria, Ho-Chunk, Miami, Očeti Šakówin, and Sauk and Meskwaki tribes. What about you?

On The Passing of John McCain

Posted on by Grayson

black background with yellow textbox and black text: On The Passing of John McCain Not Standing Still's Disease

Senator and former POW John McCain died yesterday.

Scroling through social media, I’m dismayed. I keep seeing statements from people who have forgotten McCain was not a man of the people. And, me being me, I’m upset by that. McCain was not a good person, at least politically, and we need to remember that. He did a lot of harm to communities – that’s his legacy.

I don’t have to be sad that a person who spent his life harming communities I’m a part of or I support died. This man is not some amazing person to put up on a high pedestal… unless you want to praise the systematic oppression of anyone who isn’t white, cishet, rich, conservative, American-born, and the right kind of Christian.

It’s okay to speak that truth. In fact, I would say we have a duty to do so because the GOP sure as hell isn’t going to take a break from attacking marginalized communities. They’re still scheming while tweeting out their sympathies.

McCain was horribly racist. He used racial slurs and continued doing so, though less publicly. He played a major part in selling sacred indigenous land to mining companies and golf courses. He also voted against MLK day, later saying he wished he hadn’t. Of course, McCain also elevated Sarah Palin which essentially co-founded the birther and tea party movements. That led to the administration we see today, especially with prominent birther Trump in charge.

Don’t forget that this man thought the ACA repeal effort – the one disabled people put lives on the line to stop last year – didn’t go far enough. He fought like hell to stop the ACA from being put in place. Instead of working to fix it, he campaigned on repealing it after it became law. It floors me that someone who helped with the ADA and tried to pass a patient bill of rights could also be so cruel.

On a more personal note, I didn’t have insurance coverage as a child because my mother sucks. Because SJIA is a pre-existing condition, I couldn’t get insurance on my own covering my SJIA until the ACA passed. It took a few years for me to get a job with an insurance option. I can’t imagine having had to wait until then to get care.

I could have easily died if McCain got his way, either by defeating the ACA initially or repealing it. MANY people would have. I don’t have to applaud him for making it through unspeakable things when he would’ve forced many of us into not dissimilar situations.

He could have saved disabled people. We could have stayed on home instead of being arrested. We could’ve taken care of ourselves instead of spending energy on basic human rights. All he had to do was say he would vote against it. Instead he wanted to pull a publicity stunt at the last second, telling reporters to ‘wait for the show.’

While I cried in bed, wondering what the fuck me and my disabled siblings were going to do without the ACA, McCain sat grinning on the inside like a son of a bitch. He did not care that his cavalier attitude was harming people. We were confronted with losing lifelines and he treated it like a game.

I stopped seeking diagnoses for things going on. I was afraid that whatever is going on neurologically or with my heart would get diagnosed. Without protections from the ACA, I could easily lose the ability to get any current diagnoses treated. McCain literally played a part in my poor health last year.

I won’t do about McCain’s legacy. I also won’t pretend that being a POW means he was a good person. What he chose to do when he got home and involved in politics is important. He chose to harm. He was a good republican.

I won’t speak well of someone who took pride in being a selfish asshole. If you choose to do that, you should re-examine why whitewashing history is a hobby of yours.