TORONTO — Janet Macbeth says “to be trans is to wait.”The 40-year-old waited until her wife was pregnant with their second child in 2017 to come out as transgender. Then she waited for her relatives, friends and professional colleagues at Walpole Island First Nation’s Heritage Centre to adjust to her gender identity.After starting hormone therapy at a trans-health centre in London, about a two-hour drive from her home in Wallaceburg, Ont., Macbeth waited the requisite one year to be approved for gender-affirming surgery under the Ontario Health Insurance Plan (OHIP) in spring 2018. She waited several months to book a date for the procedure, which was several more months away.But on Monday, Macbeth’s wait was finally over as she became one of the first patients to undergo vaginoplasty at a Canadian public hospital, according to medical officials.“For trans people, not everyone gets surgery … but for those who decide to get the surgery, it’s a life-saving treatment and medically necessary,” said Dr. Yonah Krakowsky, a urologist and medical lead of the Transition-Related Surgery Program at Women’s College Hospital in Toronto.“Their ability to live true lives really depends on our ability to do our work.”Krakowsky said Monday marks the first time vaginoplasty, a surgery that constructs a vagina for trans patients, has been performed in Ontario in more than two decades.Previously, he said, the only options for Canadians seeking trans-related surgical care were a private clinic in Montreal or to look abroad.While OHIP compensates out-of-province providers for some procedures, patients must cover their own travel costs, said Krakowsky, which often means they have to recover without the support of their loved ones. The distance also makes it harder for patients to receive follow-up care, which is associated with better health outcomes, he said.In 2016, the Ontario government changed its policies to make it easier for people to qualify for gender-affirming surgery, creating a backlog of patients waiting for care, Krakowsky said.He said Women’s College Hospital launched the Transition-Related Surgery Program in 2018 to help fill that gap, offering services including mastectomies, chest contouring and breast augmentation; the surgical removal of ovaries and testicles; plastic surgery of the scrotum and penile and testicular implants.But it took more than a year of training involving doctors from several departments, nurses and social workers for the program to prepare for its first three vaginoplasty surgeries this week, said Krakowsky.This effort speaks to the specialized knowledge required to perform vaginoplasty, which is considered “the jewel” of gender-affirming surgeries, said Dr. Marci Bowers, a world-renowned American gynecologist and surgeon who helped train the team at Women’s College Hospital.“It’s a surgery that I’ve often said takes as much art as it does science,” Bowers said while in Toronto to assist with this week’s surgeries. “You have to be comfortable crossing disciplines, and you obviously have to have a very thorough knowledge of pelvic anatomy.”Bowers said the surgeries at Women’s College Hospital will use a modified penile inversion, in which the surgeon creates a vaginal cavity between the rectum and urethra, which is then lined with skin from the shaft of the penis or scrotum.The procedure involves elements of urology, gynecology, general surgery and plastic surgery, said Bowers, as well as a dash of “artistry” to construct the clitoris, labia and pubic mound from existing tissues.While the program is still in its early days, Krakowsky hopes the teaching hospital’s multidisciplinary approach will help establish a model that can be adopted by medical institutions across the country.“I think the long-term goal is for this to be available in every province,” he said. “There’s a clear need. There are patients waiting for medically necessary surgery that’s not available.”While she could have had her surgery at a private clinic months ago, Macbeth said she was willing to wait a little longer to be part of a program with so much potential to better the health of Canada’s trans community.“This is just the beginning,” Macbeth said in an interview last week. “Canada now has two (trans-related surgical centres), so we probably need to work on the third one, the fourth one. There’s more trans people out there than people realize.”All trans women are women, she emphasized, regardless of whether they decide to pursue gender-affirming treatment. While no medical procedure could change her identity as a mother, a worker or a woman, Macbeth said her surgery will help her feel more at home in her body.“This is something that’s necessary for me,” Macbeth said. “It reduces the dysphoria I have, this conflict between myself and my body.“It will help align myself with who I am, and in general terms, make me a lot healthier.”Adina Bresge, The Canadian Press
For NHL fans of a certain age,1Full disclosure: I am of this demographic, albeit one of the younger members. the definitive Los Angeles Kings team is Wayne Gretzky’s Los Angeles Kings team. The franchise existed for 21 seasons before Gretzky arrived in Los Angeles in 1988, but the banality that he single-handedly made hockey relevant in LA is largely true. Kings attendance soared with No. 99 in the fold,2Increasing 27 percent in Gretzky’s first season with LA and another 11 percent in his second, per Rodney Fort’s data. the team’s value increased sharply during his tenure there,3The Kings ranked as the NHL’s third-most valuable team in 1994, according to contemporary estimates by Financial World magazine. In 1995, the team sold for a price ($113 million) nearly three times its value in 1988, when Bruce McNall bought 51 percent of the team for $20 million. and Gretzky instantly transformed the on-ice product into a legitimate contender by powering one of the best offenses in the game. Behind a 40-point postseason by Gretzky, the Kings reached their apex in 1993 — losing in five games but earning what was, at the time, the franchise’s lone Stanley Cup Final berth. For years, the Gretzky era easily represented the high-water mark of hockey’s four-decade experiment in Southern California.Not anymore. The Kings now are back in the finals for the second time in three years, and are looking for another Stanley Cup victory to follow the one they won in 2012. But this team isn’t Gretzky’s. It’s constructed differently and it plays a different game. And it might be better for it.If you’re looking for an NHL “Moneyball,” the modern Kings may be as close as any team to embodying the ethos of hockey’s sabermetric revolution. As FiveThirtyEight contributor Eric Tulsky has noted before, the current Kings pursue a strategy of constant control of the puck. With a host of possession superstars, the Kings have led the NHL in close-score4To filter out the influence of score effects. Fenwick percentage — a proxy for time of possession that measures a team’s share of all unblocked shots directed at either net during its games — for two years running, and the year before that they dominated the metric down the stretch after swapping defenseman Jack Johnson5A particularly poor Fenwick player, it should be noted. for center Jeff Carter at the trade deadline.No opposing team can score (or even shoot) when it doesn’t have the puck. During the regular season, LA allowed the league’s third-lowest rate of unblocked shots per minute of 5-on-5 play, and its second-lowest rate of total shots allowed per game. Along with decent goaltending from Jonathan Quick, that’s how the Kings helped clinch the William Jennings Trophy, given to the goaltenders on the team that allows the fewest goals all season. Maximizing possession is a hockey hack that helps at both ends of the rink.But all that possession hasn’t guaranteed the modern-day Kings a bushel of goals. The Kings spent most of the 2013-14 regular season struggling to light the lamp, despite firing the league’s second-highest rate of unblocked shots at the opposing net.6Per 60 minutes of 5-on-5 play. Their 5-on-5 shooting percentage with the score close, which had been average in 2012-13, slumped to third worst in the NHL this season. Still, LA kept emphasizing possession and putting the puck on net, seeming to trust that shooting percentages tend to regress heavily to the mean.And the Kings rediscovered their scoring touch at just the right time. During the playoffs, they’ve scored on a substantially higher proportion of shots than they did during the regular season. It doesn’t hurt that they also acquired right wing Marian Gaborik — whose career shooting percentage ranks among the best of any active player’s — at the trade deadline. But the biggest reason for the Kings’ offensive resurgence is that they rode out their poor shooting luck and continued to focus on dominating the puck, the way statheads have been calling for teams to do for years.The Kings squad that Gretzky tearfully joined on Aug. 9, 1988, played a very different kind of hockey.We don’t know for sure because play-by-play records from that era are not available, but it’s unlikely that Gretzky’s Kings dominated possession of the puck. According to estimates of close-score Fenwick percentage for older seasons, Los Angeles ranked among the top half of teams in possession rate just once (1990-91) in the eight seasons the Great One wore silver and black. Most of the time, they were actually somewhat bad at keeping control of the puck, ranking 18th out of 26 teams in estimated close-score Fenwick percentage during Gretzky’s tenure.Instead, they lived off a suspiciously high shooting percentage that modern analysts might decry as luck. During Gretzky’s first three seasons as a King, LA finished no worse than second in goals per shot. But Gretzky’s playmaking wizardry was probably a very real effect. Over that span, he paced the league in assists by a wide margin,7He notched 107 more helpers than No. 2 Adam Oates. You could have finished 70th in assists over the same period with the leftovers Gretzky didn’t need to pass Oates. and his teammates shot 9.1 percent better in those seasons than they would over the rest of their careers.The defense couldn’t measure up to the offense, though. Those Kings allowed the league’s second-highest number of shots8Only the miserable San Jose Sharks, in their second year of existence, played softer D. and its fourth-highest number of goals.Gretzky’s squad didn’t have a deep roster, either. According to Tom Awad’s catch-all summary stat Goals Versus Threshold (like Value Over Replacement Player for hockey), the 1992-93 Kings were a notably top-heavy team. They were led by stars such as Luc Robitaille and Jari Kurri. (Not to mention Gretzky, who recovered from an injury in time to post 65 points in 45 games.) But they also lost 17.8 goals because sub-replacement-level talent was on the ice, one of the largest totals in recent memory by a team that won more than half its games.The current iteration of the Kings has superior depth, and nary a Gretzky type to be found. Since LA’s top scorer Anže Kopitar debuted with the club in 2006-07, his best offensive season was 86 adjusted points. Gretzky’s worst full-season mark as a King by far was 83 adjusted points9Adjusted points are, well, adjusted — meaning they remove the influence of scoring environment — so Gretzky doesn’t get an unfair advantage for playing in a more high-flying era. in 1994-95 — and he cracked the century mark in five of his six full seasons in Los Angeles. Today’s Kings rely less on a single superstar to carry the bulk of the offensive workload.Superior depth and puck possession don’t automatically equal a better hockey team, though they often do. The proof is in the results for the current Kings, who over the last three seasons are already twice as close to a quantifiable dynasty as the franchise was during Gretzky’s entire stay in Southern California.10200.0 dynasty points compared to 97.6. If advancing deep into the postseason is the standard for success, today’s Kings beat No. 99’s in a landslide.Gretzky himself has said that the present-day Kings are impressive. Of the Cup-winning 2012 team, the Great One said, “They’re a much better team than we were in ’93.”He’s right. Gretzky’s team was an exciting offensive squad, and one of the last successful relics of the high-octane playing style that had ruled the game in the 1980s. But today’s Los Angeles Kings are exemplars of the modern game. They know that if you always have the puck on your stick, you can’t lose.
Facebook Twitter Google+LinkedInPinterestWhatsApp Related Items:forgive, lime, pnp, washington misick TCI Country Leaders condemn vicious memes Recommended for you Facebook Twitter Google+LinkedInPinterestWhatsAppProvidenciales, 14 Nov 2015 – The PNP Administration is certain that a motion passed in the House of Assembly today not only saved consumers money but saved telecommunications industry jobs; LIME was forgiven some $12 million in debt when the Government’s motion passed 10 in favor and nine against at Parliament. The Government side calls it a hearty debate which ended with LIME benefitting from “a measure of good gesture, to the longest standing corporate citizen of these islands…”The Office of the Premier explains the move to erase the late fee penalties which were accrued over four years after an audit of the telecommunications company picked up on the expensive error came after negotiations.It was revealed that from June 2010 to May 2014, LIME had not levied taxes on its clients for a wide range of taxable services which amounted to some $3.5 million dollars. But it is the so called, overarching accrual of the penalty charges which brought LIME’s bill to $13 million. LIME paid off the $3.5 million in taxes, and agreed to $1 million dollars of the penalties but asked the government to waive the balance on those penal fees. Finance Minister Washington Misick brought the motion, and shared: “…Governments must be prepared to make tough decisions for the preservation of corporate partners and the business community and for the protection of jobs and citizens who could otherwise be negatively impacted in such situations.” The Opposition side wholly rejected the motion; asking for more information on the situation. Olive branch extended by Opposition Leader, says it is time for Turks and Caicos leaders to unite Opposition Leader responds to Throne Speech 11 days later; says PDM Govt plan puts TCI in ‘deep doo doo’