Annie D

Kaleidoscope

POV: This is what an #emptynester #nightshiftnurse #californiagirl does when she gets called off due to low census after unsuccessfully trying to sleep all day.

Rolled straight out of bed into my controversial string bikini, drank a protein drink, ate some burnt roasted Brussels sprouts and half of my bean burrito from Los Inmortales that I didn’t finish last night at work. Then I took some selfies by the pool to show you my scars and my results as they are today, bed head, no make up and all. Then I swam for a bit, to burn off the crazy, and then got in the hot tub with my Schmoopy. (And they don’t call it a hot tub for nothin’, just sayin’)

I am almost 7 weeks post-op for my bilateral dog ear removal under my arms left over from my breast reduction and a small amount of liposuction on the sides (R>L) to correct some asymmetry left over from my extended tummy tuck. My incisions are closed, and I only have a few minor spitting stitches on my left side, not causing wounds. I put Biocorneum, a silicone gel, on my fresh scars to help them stay moist and heal and encourage them to lay flat and fade nicely. I don’t put the scar gel on my tummy tuck incision or on my older breast reduction scars anymore. That shit is expensive. I already got whatever benefit from the scar gel that I’m going to get in those areas, now they just need time to blend in. Like me. Time to adjust and to accept and to fade.

I gave you a few poses so you can see the results of my plus size tummy tuck with a 40 lb weight loss after surgery. I am by no means “snatched” and I know just how imperfect I remain, stretch marks and all. But, together we have decided that we are all perfectly imperfect and it’s high time we stop judging each other and stop comparing ourselves to one another. We are all on our own journeys, and the best parts of you may not be the best parts of me.

I paid a man to cut off the parts of me that I hated.

And I know that in some ways that is a weakness.

But,

There is so much strength in that decision, too. I took back my life, stole it right out from under that hanging belly. Stole it out from under the burdens of a lifetime.

I am stronger than ever, inside and out. I am evolved into this fledgling super hero, the savior of my own damn life.

When I made a video in this same bikini and told everyone not to judge me unless they were willing to put themselves on the internet at age 49/50 in a string bikini, I got so much hate for it. That video has close to a million views, with comments both in support of me and in condemnation. Outright insults. I have accepted that it goes with the territory and it’s part of the side gig.
And some people are just assholes.
But if I count them all out, the majority of the people that are watching me live out loud have picked me up and carried me on their shoulders when I couldn’t even get out of bed on my own. When I fought my way out of years of pandemic depression without a lens to see myself in light.

I picked up a few new lenses. Maybe a whole damn kaleidoscope.

So let’s fuckkng go.

These words may all be cheesy, or as Cass would say, cringy, to you. I also know you may be getting tired of hearing my story, but it’s gotta come out. It’s gotta breathe and be spoken, and it’s got to be heard and understood. It’s got a heartbeat of it’s own as if it is separate from me. Like a whole different life. And like I have said before, you are either along for the ride or you’re not.

I even spelled “you’re” right for the wordsmiths.

So, here I am.

Right in the middle of this messy, beautiful, fucked up, perfect life.

Go ahead and check out my scars. They were always visible anyway, even before my surgeries.

🖤💪🏼

Gray hair, don’t care, bed head, no make-up, no filter, age 50. We are here.

Just me, sitting down in a bikini without my belly covering my lap. Oh, and my new belly button.

I still have swelling here on my right side where Dr. Yamahata did lipo to correct the asymmetry. It will be several more months before my lymphatic system repairs itself and the skin remodels and we see the final results. He removed 17 lbs of skin from my belly and flanks and 2200mLs of fat via lipo during my tummy tuck. It was a huge surgery and quite common to need a minor revision after a surgery like that. You cannot always predict how the body will heal, considering there is quite a bit of swelling that occurs during a six-hour procedure. You can see my scar peeking out above my bikini bottoms and if you look closely, you can see the fresh, healing incision under my arm, extending to my back.

Left side, less lipo, less swelling, less healing, shorter incision.

One of the best decisions I have made was to put this pool and hot tub in, a handful of years ago. It’s the best empty nest a girl could ask for. Oh, and he’s still cute. And he’s funny as hell. Love him long time. 💛

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Fly Girl

I’m all in my feels today. Let me count the ways:

1. I went back to work and I worked three in a row with some of my closest friends. They made it easy on me cuz they are all the strongest of nurses. It’s easy to be in charge when you are surrounded by experienced RNs. We get it done and we laugh while we do it cuz if we ain’t laughin’ we cryin’.

And we aren’t afraid when we are together.

I have now worked on the same unit for the same hospital for 11 years. Some of us take turns being in charge and we train the newer nurses. You can be strong and new, don’t get it twisted. And let’s face it, some people are the ones that run into the fire and some people are the ones that are more cautious. It’s good to be a little of both when you are an RN, to be real. Even when you are new. So although they all worked harder than me, overall it was a good weekend. People were still smiling at the end and once again my tattoos broke the ice in a difficult situation and I like that. They give me street cred and something to talk about with someone I might have very little in common with- aside from our tattoos.

Being a nurse fills my cup when we do it right.

2. This morning I weighed 185 lbs. with a BMI of 31.8. By definition, anything above 30 is Obese. I’m still obese and I hate that fucking word. I have been obese almost my entire adult life. When I lose 11 more pounds I will no longer be the O word. And that, my friends, gets me all emotional.

Those of us that are heavier people but have also been relatively healthy know that BMI alone is a poor gauge of health. It’s bullshit, really. But every time you go to the doctor, they calculate it. Hell, they don’t even have to calculate it, the computer does it for them as soon as they enter your weight. They use this measurement against you, to decide if you are worthy of praise or if you need counseling. Some MDs feel the need to discuss healthy lifestyle choices at every appointment, even if you are there for a sinus infection. I literally had a dermatologist tell me “you are a beautiful woman, you just need to lose weight.” This was said to me after I stood in front of the old white man naked, for him to inspect my skin for signs of skin cancer- at a time when I couldn’t even look at myself naked in the mirror. Vulnerable. Ashamed. Disgusted. Embarrassed. Judged. And then shamed by him. Insulted. Demeaned. Sexualized. Violated. By an old white man who was supposed to keep me safe. I should have reported him. Asshole.

So, as much as I would like to tell the inventor of the BMI to fuck right off, it’s stigma has some meaning to me. 11 more pounds will bring my BMI below 30, and although that’s still considered “overweight,” it’s not “obese.” When being obese has just been part of who you are, it seems unattainable to blast through that definition and no longer associate it with your own descriptors. To take it out of your own vocabulary, the one that tells your story.

So, I am 11 pounds away from what has seemed an unattainable goal for all these years. And the idea that with the help of my doctor and science and plastic surgery and my own effort I may actually get to that elusive place seems big. It seems monumental to me. It still seems unreal, though.

I’m scared.

I’m afraid that none of this weight loss will stick. I’m afraid that at the end of June when my Eli Lilly coupon for Mounjaro expires, that I won’t be able to get my insurance to cover the only tolerable medication that has ever been able to really help me. I’m afraid that I gave in to my own resolution to never starve myself again and to accept my plus size body the way it was after plastic surgery and to stop beating myself up about a fucking number that has defined me even though I should be strong enough to not give a fuck. Even though I should love this body no matter it’s size or shape.

I am afraid of gaining it all back and feeling like shit again. Like I have every other time I have lost any significant amount of weight.

This time it’s supposed to be different because the science has proven that obesity is a chronic disease that should be treated as such. Even the American Medical Association classified obesity as a chronic disease back in 2013, and yet a majority of doctors and insurance plans still don’t recognize it as such. They still don’t recognize that for some people it takes more than diet and exercise to win the battle. To maintain the loss over time. To fix a broken brain. To give someone like me the power to control my cravings and quiet the “food noise” and ignore the psychological drive for filling my body with too many calories in a fucked up attempt at filling the emptiness of that little girl lost.

Run, little girl, run.

I’m afraid that even though I am more consistently active than I have been since I was in my 20’s, and I know how to feed my body and have portion control and make good choices, that those things alone will not be enough to maintain this loss. Because it was never enough before Mounjaro. Not for me, anyway. Will power can fuck right off.

So, I have to put my trust into Dr. Spielvogel and hope he writes the best gotdamn request for prior authorization he has ever written and that the right person evaluates it at my insurance company. And if they deny it this time, as they did the first time, I have to trust that Dr. Spielvogel will write an even better request for prior auth on appeal and a more educated and empathetic person approves it because I have jumped through all the hoops. I have paid all the dues. And I have done all the work.

My list is long. Back in 2010 Dr. Ramos diagnosed me with PCOS and pre-diabetes, with labs that showed my hyperinsulinemia and insulin resistance. He put me on Metformin, and I took it for two months in an attempt to get past the debilitating gastrointestinal side effects. I had abdominal cramping and gas, nausea and vomiting. I had to stop taking it, with no back up plan. Over the years I have taken so many drugs for weight loss, and they were either intolerable or not safe to take long term. I have taken Phen-Fen, phentermine alone, Meridia, Topamax, Qsymia, Contrave, metformin, Wellbutrin. I have done Weight Watchers, over and over again, never reaching my “goal weight.” I have done every diet under the sun: Atkins, Beach Diet, HCG, Jenny Craig, Dr. Hernreid’s protein shake aka starvation diet. And let’s not forget that elevated a1C that for years has been in the pre-diabetic range. I have several family members with diabetes. I do not want diabetes, nobody does. Mounjaro has helped to lower my a1C, showing that my glucose levels over a three month period are lowered by taking it. I am no longer pre-diabetic, on Mounjaro. My risk factors for so many other chronic diseases have been significantly lowered by this weight loss. If one medication and it’s effects can decrease the risk of heart disease, hypertension, diabetes, joint injuries, and more importantly, detrimental self hatred aka self inflicted psychological abuse, why wouldn’t our insurance companies see the huge fiscal impact one medication can make? Why are they continuing to ignore the science in justification for denial of coverage? It just doesn’t make sense anymore.

Have we come a long way, baby?

Or have we not?

I really like this new feeling of lightness I carry with me wherever I go. I finally feel normal, or at least what I always thought “normal”would feel like. But that feeling is contingent and fleeting, and I’m just trying to hold on for dear life.

So let’s hope my health insurance gets with the program. It’s literally called “health insurance” so why doesn’t it ensure my health by covering this particular medication?

3. As I sit in my hot tub, all alone, in my beautiful backyard that I paid for with my little ol’ Associate Degree job, I am grateful. Grateful to live in California where nurses are valued and paid well. Grateful that I can choose to be surrounded by friends that are like family or be completely alone and content. Grateful for social media as a means to express myself and fill my empty nester time instead of wallowing in the misery of my children’s absence. Even though their absence is the hallmark of their growth and my accomplishments as a good mom, sadness could prevail if I let it. I miss them and yet, I was a steadfast and present mother, and it’s my fault they left. I was a foundation builder and they jumped off into the sort-of-unknown, but with a great big safety net.

So go ahead and jump off. We meant to do that. I am just going to keep myself busy by living out loud without the shame of a lifetime. I’m going to be who I always was but lacked the confidence to be.

Fake it til you make it and then be as you are.

And I am grateful for this blog as a replacement for talk therapy and as a means to let go of the shame I have been burdened with, whether I write about my traumatic GenX childhood or of my plastic surgery or weight loss or my own personal growth. If I write it and post it I don’t have to keep telling the same story over and over again, to a therapist that can’t fix it no matter how many times I tell it. If I write it and post it and you read it, my truth is validated and I am set free.

And I fly.

#oldladygang MERCH

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Strong Like Mulan: Round 3

Today is post-op day 5 for my revision, dog ear removal and liposuction to correct some asymmetry. Today was a big day for me. It didn’t feel like it was a big deal while it was going on, it felt good. But now, as I lay in my bed, I am tired. Exhausted. Swollen. I don’t feel good.

My friend Kristi picked me up to take me to to see Dr. Yamahata cuz I can’t drive yet and the hubby needed to work and Kristi is a lovergirlsisterfriend with a rad work schedule who always says yes. We call him YamaTATA. He did Kristi’s boobs, too. Yet another thing we have in common. 🖤

So I had my first post-op follow-up appointment with Dr. Yamahata today. His assistant, Nin, helped take my dressings off. “Can I look,” I asked. They have a full length mirror in their exam rooms. It felt so good to take that binder off! The bruising is already mostly fading, you know the shade, when the purple has gone from black to plum to blue to greenish yellowish. The incisions are much longer than I expected. They start under each breast in the middle, and go all the way to my back. I need to take it easy for a bit longer, at least until it scabs over. I really hope I don’t have spitting stitches again. That sucked.

The left side lays mostly flat and the breast looks perfectly rounded. The right side, where he did more lipo, is very swollen and no where near flat.

Trust the process they say.

Trust the process, I will continue to do.

Nin gave me a silky robe to wear, as if it doesn’t come off as soon as the doctor is in the room. “Everything looks good,” he said. He wants me to wear compression 23/7 and shower and walk everyday. Same as before. Follow up in a week.

Dr. Yamahata’s nurse gave me a Stage 1 faja on the day of surgery in a size XL. I think I was in a 3XL after my tummy tuck. Can you believe that? Including surgery and weight loss while taking Mounjaro, I have lost 59 lbs. From plus size to midsize. And today they gave me a surgical bra and two ace bandages to go with the faja. Shower first, faja second.

After the appointment, Kristi and I went to Sephora, mostly for her teenage daughter’s Easter basket stuff. Like mother like daughter. Kristi is my beauty product guru. I got some liquidy eye shadow from Glossier, Lidstar in the color Branch. And a white eye pencil, for my waterline. It was only $6 and I want to try it. It’s supposed to brighten up your eyes. We will see.

After that we went and had some Greek food. I ate less than half of my falafel sandwich, but it was delicious. Then we went to Dick’s Sporting Goods so I could pick up my second pair of Nike Waffle Debut sneakers. I love the retro yet modern look and fit so much that I got a blue pair for work and a white pair for home. They were on sale for like $56.

Nike Waffle Debut, Click photo for link to Amazon

Then we went to Walmart to finish up the Easter baskets for Kristi’s kids. I was feeling good. I didn’t even take any pain medicine today…yet. When the swelling peaks, then I will take it.

It felt good to be out and about while I was out and about. Good to spend time with my friend and get out of the house for the first time in 5 days. But as soon as I got home, I got into bed and took a nap. Exhausted. And I still needed to shower.

The first shower feels so good. It feels good to take the binder off. My skin was so itchy!! Dr. Yamahata suggests using Dial antibacterial bar soap before surgery, and after. As an RN that takes care of surgical patients, I know to start from clean to dirty, do not rub the incisions, use gentle clean hands and warm, soapy water and let it run over the incisions and rinse well. Don’t have the water too hot because sometimes it can make you get dizzy or light headed. If you ever feel that way, get back to bed and drink more water and eat/drink more protein. After the shower, blot to dry with a clean towel from clean to dirty again. Allow it all to air dry, then get into compression.

So here we are again. Back in the faja, with lipo foams and two ace bandages wrapped tightly around my chest with clean hair and a clean vajay. Bruisex cream all over. Just FYI, this part sucks. I know from experience things will get exponentially better over the next two weeks, and by comparison this is so much easier than my other surgeries…

I just have to remember that although it is easier than an Extended Abdominoplasty with repair of the Diastasis Recti with Liposuction to the Flanks followed by a Breast Reduction and lipo to the bra line 10 weeks after the first surgery, that it was still a significant revision. I’m no plastic surgeon, but I think this was more than the average dog ear removal. No wonder I needed IV sedation and two hours in the OR and not just local anesthesia in the office. Dr. Yamahata hooked me up. He said he did more lipo than I expected to fix the asymmetry as well. Now that I have seen the incisions, how long they are, I need to dial it back a notch and take it easy. Today was great, but I need these incisions heal properly. I need to move on with my life.

Dear Goddess, Please let my incisions heal nice and flat and please can I not have the spitting stitches this time and please can it look amazing and symmetrical and please help me to keep fucking going every day and love myself no matter what it all looks like in the end. A few months makes a huge difference, I know. My lymphatic system has to repair itself again…I won’t see all of the results for a year. I knew this. I know this.

And I know everything is gonna be alright.

Cuz I am strong like Mulan and can handle anything that comes my way.

I keep telling myself that anyway.

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GRWM: Plastic Surgery Revision Edition

Today is my only day to get this nest ready for me to be back in surgical recovery mode. Lots to do cuz I don’t live my life in the house is always clean zone. I choose that, I know. Did the shopping yesterday, I’m stocked with: jello, apple sauce, Gatorade, protein shakes, saltines, chicken noodle soup, pineapple juice, protein water, collagen powder, prunes (yeah, I’m that old!) My Amazon order arrives today: Bruizex, telfa pads, arnica. I picked up all the meds: colace, amoxicillin, Percocet. Already had: Tylenol, Motrin, milk of mag (thx, Kristi!), chux (for the first day lipo ooze), multivitamins. Got my wedge pillow and neck pillow re’to’go.

Can you tell I have done this before?

So today it’s the nesting. Laundry, clean sheets, clean bathrooms, locate all remotes, do all the shaving and chlorhexidine showering, take an ambien and set the alarm for the butt-crack-of-dawn to arrive at Dr. Wayne Yamahata’s surgery center for my 2-hour procedure: removal of bilateral “dogears” under my arms left over from the breast reduction and some minor liposuction to my right side to correct some asymmetry left from my tummy tuck. This is considered a minor revision in the plastics world, and quite common. Dr. Yamahata has been a wonderful doctor and skilled surgeon throughout this journey. I am incredibly grateful for his impact on my life. You must understand that not all plastic surgeons take on cases like mine. Most plastic surgeons are still stuck on the BMI as their main criterion in taking a case to the OR. Most do not look at the big picture and consider the latest data in determining if a patient is a safe candidate for plastic surgery. If the benefits outweigh the risks. Dr. Yamahata, with >35 years experience, may be “old school” in many ways and closer to retirement than I am, but he is also on the cutting edge amongst his peers.

On the day of my first surgery, an Extended Tummy Tuck with Repair of the Diastasis Recti and Liposuction to the flanks, I weighed 245 lbs. My BMI was 41. He safely removed 17 lbs of skin and subcutaneous fat, and 2200 mLs of fat via liposuction that day. That’s a lot for one surgery. When he did my breast reduction, he took off 1L of tissue from each breast and like 250mLs of fat via lipo to the bra line, on each side. Which is also a lot for that area. He told me repeatedly, “we took quite a bit off the sides.” One thing is for certain, you can’t take less skin after the fact, but you can always take more at a later date. The body is dynamic and ever changing, you have to get through the healing process to see how it all plays out. Your surgeon has to play a guessing game, predicting how each individual’s skin will heal and respond to the nips and tucks, to the sutures. How it will lay on the frame that is yours forever. The surgeon cannot alter the bones and can only make artistic decisions in the moment. Dogears are when the skin doesn’t lay flat at the end of an incision, usually because more skin needs to be removed. With swelling and all the fluids used and lost during surgery, the surgeon has to leave enough skin to close you safely and allow for the breasts to take their shape after the “drop and fluff.” Sometimes, after the swelling goes down and the lymphatic system repairs itself (which can take a year or more) the dogears become obvious and can no longer be chalked up to “let’s see how your body heals.” Most plastic surgeons can remove dogears under local anesthesia in their office. With the combination of me losing 40 lbs after my surgery (today the scale says 185!) I probably have a little more skin to remove than I would have, so he needs to extend my incisions more than what he would usually do, because I asked him to get it all. I’m done with it. My huge boobs used to hide the side boob/underarm action from my view in the mirror. I couldn’t really see what was going on over there. Now that my boobs are normal sized and sit where they are supposed to, I can see it and I want it gone. I don’t want to have to tuck it into my bra anymore. And although I could live with the asymmetry of my right side, near my rib cage, and still know that my body is hugely improved after my tummy tuck, and no body is 100% symmetrical, I never had that when I was younger, before and/or after I was fat. It also wasn’t immediately evident at the time of my surgery. My body had to heal and the swelling had to go down to see it. That can be fixed and camouflaged and sculpted with a little bit of lipo, and Dr. Yamahata wants me to love my results. He’s doing me a favor. And he stands by his work and he respects his patients. He made the conversations easy and he’s taking me back to the OR at no further cost to me. Again, I am so very thankful I chose him.

He forever altered the shape of my body and forever changed my self image, self esteem, and my quality of life has skyrocketed! My only regret is that I didn’t do it sooner. My physical form is new and improved and my mental state along with it. You can’t do 50 as fabulously as I am today, as I was prior to surgery. Not only was my body going downhill fast, my head was, too. He, like so many of the people I surround myself with these days, saved my life in a hundred ways. I am so grateful for Dr. Yamahata’s vision and his skill and willingness to see the big picture. To see that although I was morbidly obese, that was my only risk factor. By cutting all of that off, he launched me into a journey of consistent exercise and smaller portions. Today my BMI is 31.8! I may possibly get it under 30 and then I will no longer be considered obese! It wasn’t technically weight loss surgery, but it has proven to be more effective and lasting than any gastric surgery would have been, for someone like me.

So let’s fucking go!

I’m going to be bruised and in pain for awhile. I’m going to be swollen and likely lopsided for awhile. My lymphatic system will take another hit and I won’t see the complete result for another year. But in 6-8 weeks I will be back in a bikini and ready for HOT MOM/OLD LADY SUMMER by the pool, sipping Limoncello Spritzers with my dog and my homegirls cuz that’s how I do 50.

Now I got to get off my blogger ass cuz I got some shit to do! 🤗😘🖤💪🏼

This is me modeling a swim suit that was gifted to me by an Amazon seller in exchange for making a promo video and photos for them. You can kinda see the dogears poking out on the sides, if you look closely. And I have learned to pose to try and camouflage the asymmetry, by popping my left hip out and slightly leaning to the right.

The suit and sunglasses are linked in my Amazon Closet if you like them!

Mommy Makeover Must Haves

Annie’s Amazon Closet

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It’s About Damn Time: Treating Obesity as a Chronic Disease

During one of my TikTok scrolling sessions, I came across a video made by Nurse Practitioner Maria Lena Walls reading a letter one of her patients wrote to the CEO of her employer in regards to adding anti-obesity medications to their employer provided health insurance formulary. I was moved by the words she spoke and reached out to Maria to request that she put me in contact with the writer. HIPPA is tricky, but she was able to give my contact info to @lauralai_7 who eventually reached out to me and gave me permission to post her letter here. Please take the time to read it, it is so important to so many of us, one in three people in the USA, to be exact. Also, I will attach a link to a fill-in-the-blank version of this letter for you to forward to your own employer’s CEO in hopes that a small wave will turn into a tsunami and make a difference in the lives of all people affected by obesity. People like her. And people like me.

1 in 3 Americans are affected by the chronic disease of Obesity.

15 September, 2022

Dear [CEO],

With Diversity Week 2022 approaching, I felt inspired to write a letter regarding a topic that is near (and not dear) to me, but not often discussed because of the social stigma. When I think about diversity and inclusion, one of the first questions that comes to mind is, “Can I be my true and authentic self at work?” The answer I must give is, “No, not all the time.”

The American Medical Association (AMA) classified obesity as a disease in 2013. Almost ten years later, many healthcare organizations, insurance companies, and even physicians, do not treat obesity as a disease, but consider it a moral issue, a personal failing, a problem with willpower and laziness, and not a result of genetics, epigenetics, societal factors, medication side-effects, environment, and/or underlying diseases.

There is implicit and explicit bias of obese individuals that is often ignored and at times even encouraged. If [our] employee and non-employee population is a cross-section of the rest of the population of adults in the United States, then approximately one in three of our caregivers is personally affected by obesity per the AMA.

When I worked [on site], my chair would frequently sink down, and eventually broke, because of my weight. A lot of task chairs have a weight restriction. The Americans with Disabilities Act doesn’t consider obesity as a disability, so filing an ADA request for a reasonable accommodation of a larger chair would have likely been denied immediately upon filing. “Will that chair hold me?” “How many people are already on the elevator?” “Can I fit at this crowded conference room table in this small room?” “Should I sit in a chair in the back so other people aren’t uncomfortable?” “What will the temperature of the room be?” Those are some of the questions that frequently crossed my mind.

I once asked during an HR town hall why [our medical plan] doesn’t cover medications that are FDA-approved treatments for obesity but does cover the exact same medication for other diseases like type 2 diabetes. The answer I was given by one of the benefits leaders at the time was that [our organization] is on par with what other organizations don’t cover, plus we have discounts to Weight Watchers. As someone who has battled obesity for most of her life, and attended Weight Watchers in the past, it was another in a long list of brush-offs I’ve received from healthcare.

My first thought was, “So? Who cares if it’s what everyone else is doing? Why can’t we be the groundbreakers?”

Many insurance plans, including [our medical plan], consider medications like Wegovy (the semaglutide brand marketed to treat obesity) to be “vanity drugs” and not treatment for a disease. Yet, [our medical plan] does include Ozempic on its formulary, the same semaglutide medication as Wegovy, but branded to treat type 2 diabetes.

Considering the many medications in clinical trials that will eventually be FDA-approved to treat both diabetes and obesity (tirzepatide, mazdutide, retatrutide), we will see more and more in the coming years. Mounjaro (tirzepatide) is a new medication that hit the market a few months ago as a treatment for type 2 diabetes, but it has been so overwhelmingly successful in the SURMOUNT-1 clinical trial for weight loss in non-diabetic overweight and obese patients that tirzepatide will be approved by the FDA as a treatment for obesity likely within the next year.

These medications have been described as game changers for the treatment of obesity, on par with what can be lost via weight loss surgeries and will be a welcome and safe tool for so many who have struggled for years battling this disease, even after going to Weight Watchers.

We, as an organization, can make the decision to cover medications like Wegovy and other FDA-approved medications for obesity in our formulary. Instead of being leaders of change, we, like so many others, kick the can down the road. We cover treatments and medication for the high blood pressure, the cardiovascular disease, the joint replacements, the cancer, the infertility, the diabetes, the strokes, the mental health issues, the organ failures, and many more secondary diseases that are linked to obesity. These can ultimately cost just as much or more than the cost of medication that could help someone not suffer from secondary disease in the first place.

[Our medical plan] does cover certain weight loss surgeries if eligible after being on a physician-supervised plan (like Weight Watchers) for six months, but I hypothetically ask, should asking someone to remove 80-90% of their stomach in a risky and costly last-resort surgery be the preferred treatment to a medication approved by the FDA and prescribed by a physician?

It is time to end weight bias and stigma, and treat obesity like the disease that it is proven to be. If one in three adults is affected by obesity, then more internal medicine physicians need to be certified by the American Board of Obesity Medicine (ABOM). If I wanted to find a new primary care physician with an ABOM certification for all my general health needs, not just for weight management, then I would have to look outside of [our system]. I could only find one ABOM-certified internist with [our system], and she’s not accepting new patients. Hiring more internal medicine physicians who are ABOM-certified and encouraging our current physicians in [our organization] to become ABOM-certified, would go far in improving the health of the communities we serve.

I appreciate your time in reading this letter.

Sincerely,

@lauralai_7

Click here for a Fill-in-the-blank version of @lauralai_7’s letter for you to send to your CEO!

Click here to see
Nurse Practitioner Maria Lena Walls’ TikTok Video that started this wave!

Click here to see Annie D.’s
Mounjaro Weightloss Update, currently at >850K views!

*Updated to add this from @lauralai_7:

“The CEO did write me back, and said he appreciated my vulnerability and that he would share my request for anti-obesity medications with our benefits team. I also escalated to my boss’s boss, who is a director of Human Resources, so that she could escalate to her colleagues in benefits. I found out a few weeks ago that it’s officially on the agenda for the benefits team to review for 2024. I’m assuming they will review it this spring, as most plans and formularies are decided on for the following plan year in June or July of the previous year. Fingers crossed we get good news, but I’m using every opportunity that I have to be vocal! My organization has over 30,000 employees, and I know it would make a difference to not just me, but to them, as well as other organizations as they follow suit to remain competitive.“

SO SEND THAT LETTER ASAP!!

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50th Birthday Tattoo Tour

I have been staring at an empty spot on my wrist, trying to decide what to put in that small space, for like two years. It’s surrounded by the leaves of one of my peonies, a Delft Blue tempest in a teacup for my mama, and my Covid syringe. I knew I would be staring at it everyday, and so would my patients and pretty much everyone. And the wrist hurts like a bitch. I think the pain is nature’s way of telling you not to kill yourself cuz it hurts too much. It’s a significant spot, but not much room for detail or extravagance. But, I crave significance in all of my tattoos, so this decision could not be made lightly and it couldn’t just be a filler. They all have meaning to me. And I am a lucky girl. I am lucky AF.

So, I decided on a four leaf clover.

Hand drawn to fit the space by Bri, aka @foxeyrose at Honeymoon Tattoo in Fair Oaks, CA

The heart shaped leaves represent the four of us, in my little family. I’m so lucky to have this life. To have them. To be loved by them and although the leaves stretch out towards the sun as they grow, all four are connected at the center. Four leaf clovers are rare, hard to find. I’m lucky. Green represents new growth. I want to carry this luck with me everywhere I go. I want to be reminded, even on the darkest days, I am lucky. Fortunate. Blessed.

The Celts believed that four leaf clovers carry magical powers of protection and they ward off evil. I need protection. And haters back off. Evil can pass right over me. They also claim that the bearer of the magical clover can see fairies. I want to see fairies. Maybe I’m a little Fae myself. I live near Fairytale Town and Tanglewood Forest, so, it’s possible. But the Celtic fairies are mischievous and potentially dangerous, like steal your children dangerous, and carrying this clover with me will allow me to see them and evade them, if needed.

I am magic.

I also wanted a little spot on the opposite side of my wrist, a spot I can’t see easily, to be filled. I thought I would just get a tiny black heart there. I wear my heart on my sleeve, get it? And sometimes it’s a cold, shut-down, dark, brooding, depressed black heart. But hearts, no matter their color, are full of love. Deep love. So deep, put your butt to sleep. (that’s an inside joke, lol, if you know, you know.)

To love me, you have to get around my darkness to see that deep love. To feel it. I do, too.

You all turn my cold black heart luke warm gray. 🖤

I have been eyeballing one of my tattoo artist’s flash tattoos for awhile, cuz I thought it was cute. It is a safety pin piercing three hearts. I didn’t think it would fit in this space. Bri, my favorite tattoo artist, said nuh, uh, uh, “I’m going to try and make it fit…but you only get one heart.” She made it fit. With one heart. Mine.

This year has been all about me. I have been selfish. I have taken this year to learn what loving myself means. We all get to define what that means to us as individuals. For me, I decided that loving myself means treating myself as lovingly as I treat my own children and the people around me. Acceptance is the goal. Being a loving mother means that you make sure your kids are eating a healthy, balanced diet. You get them involved in sports so that exercise and activity is fun or you sneak it in by making them walk home from school or go outside and ride your bike and they incorporate moving their bodies into everyday. You make them come out of their rooms and be present and part of the world. You make sure they stay hydrated and eat protein and fruit and veggies. I know I’m not alone in this, but I would literally not eat the strawberries cuz I wanted to be sure they had them for breakfast. I wanted them to have the nutritious things they liked, and kept them from myself so they would have enough. More than enough. How dumb is that? So, I’m eating the strawberries now.

My year of selfishness brought me back to me. To giving myself what it needed to heal, from my surgeries, and from life. I lovingly walked everyday like it was my job. I did the normal activities of daily living, that sometimes depressed people just don’t do. Like showering, everyday. Like cooking oatmeal with fresh blueberries and pecans for breakfast. Like brushing your teeth and talking to friends. I still don’t want to wash dishes though.

I chose plastic surgery to change the shape of my body so that I could move with more freedom, and so that I didn’t feel grotesque anymore. So that I could accept this body and not avoid looking at myself. Inside and out. My body is far from being plastic surgery perfect, but I wasn’t going for perfection. I was just going for something other than hatred and shame. When he cut my whole belly off, Dr. Yamahata took the weight of a lifetime with it. It was instant. I wish I had done it sooner.

So this year, and now this life, is all about me. The things I have chosen for myself have pierced that cold black heart of mine and brought me to safety, in my mind. Strong like Mulan. I’m inside my bubble of safety and no one else is allowed inside. Cuz if I don’t love and protect myself by becoming stronger, who will? And so, without realizing it, Bri created this little tattoo with more meaning than I even planned for. I thought I was just getting a tiny little black heart filler tattoo, but I got so much more.

And for the final 50th birthday addition to my midlife crisis aka party arm, I got a big, bold bra that’s on fire. Cuz my tits went viral not once, but twice, maybe more if we count all the cool things that happened this year. From 3.1 million views on TikTok to the Daily Mail, The Sun, and several international online tabloids, to 41.5 MILLION views on Facebook to 43,000 new followers to becoming a paid digital creator. All because of my giant boobs and a plaster cast of them I made with my friends before surgery. I said goodbye to the burden of a lifetime while saying hello to a better life for me and for my family because of all this work. Inside and out.

Plus, after my breast reduction, I don’t have to wear a bra anymore if I don’t want to. They stay where they are supposed to.

So let’s set that bitch on fiyaaahhh!

Let the MFer burn!

Click here to follow Bri aka
Foxey Rose
on Instagram!
(And then FOLOW ME
@anniemd007 )

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Perfectly Imperfect.

How dare I show my imperfect body on the internet.

Does my cellulite make you uncomfortable? Does my body disgust you to the point that you must say something? As if I have never heard the slurs? It’s just the facts, right? It’s just your opinion. It’s not hurtful. I’m just being honest. Why would you show your barrel belly and your man shoulders? Your body is weird. You should keep your clothes on. Pig. People would like you more if you would just shut up and keep your clothes on. Imperfect people shouldn’t show themselves or speak their mind or be offensive.

Or defensive.

Offense is the best defense, right?

I’m not sorry if I offend you. Clearly, you aren’t sorry either.

You should ask yourself why my body offends you.

I fucking love this body. This body has had to fight for every grace it has been given. This body has done the work, in so many ways, so many times. It’s just a body. It’s my body, and it is what it is. I could be where I was a year ago, still feeling like I should be hiding. Like they want me to. But I am not doing this life this way for anyone but me.

And I’m all done hiding. No matter how hard you try, you can never really hide anyway.

Do they think I am full of myself and that I think I have an amazing body now? Or do they realize that all of this has to happen so that I can keep this feeling of lightness going? So that I am willing to keep up the fight for a happy life? Cuz that’s what I’m doing. I’m wearing what I want and I’m constantly trying to be someone on the inside that I have never been able to be.

I walk a tightrope everyday. But like riding a bike, you have to keep pedaling. The second you stop pedaling, when you can’t coast anymore, you are no longer in motion. No longer walking the tightrope. And we all know by now, we have to just keep fucking going no matter what in order to be happy.

Maybe I need to block and delete more often. Bury my head in the sand and maintain my peace. People that really know me are cheering me on. Cuz they know how far I have come, how much I have fought. And maybe just because they live their life by that Golden Rule. The one we all learned in like first grade.

Or if you don’t have something nice to say don’t say anything at all. That’s the equivalent of keep scrolling. You don’t have to state the obvious.

Obviously.

Let me just lock this heart up so the tears only fall for the right reasons. And you don’t have access to the key.

🖤🗝️

Cellulite, Trucker arms, Barrel Belly, and all.

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On Loving Her

Written by Eve Greenlow

I am in love with a girl.
She is kind and strong.
I know what she deserves, which is so much.
She is beautiful and black and proud
and she struggles taking care of her 3c curls
but she knows it's worth it.
She has an unhealthy relationship with crunchy corn puffs
but they're very tasty, so it's ok.
She thinks binge watching british baking shows is all she needs to do to prepare for studying abroad in England.
She is wrong. She knows this.
She has curves and not all of them are in the right places
But because they are her curves
they are in the right places.
Every morning when I look into her
hazel eyes,
the brown from her black father
the blue from her white mother,
I am thankful to have the opportunity
to have another day with her.

I didn’t always feel that way.
Growing up and learning to love
a black girl in a society
screaming at you not to love black girls
is difficult and sometimes, no,
always painful.
Painful the way Stephon Clark was murdered in
my own backyard.
Difficult the way it is to watch a non-black actress
dance around an apology for
singing along to a rap song.

It is even more difficult when the voices
telling you you aren't good enough
are bouncing off the walls of your own house
or are coming from your own friends
who, now that you are physically and temporally
separated, you realize were never actually your friends.
Friends wouldn't tell you your hair looks weird when it's curly,
that those clothes don't really look good on you,
that you're not really black.

It has taken years for me to understand her
to treat her with the care she needs
to reach out for help
when she is drowning, gasping for breath
in a world that seems designed to crush her.
I am there for her.
I will continue to be there for her
to appreciate her
to, hopefully, guide her in the right direction
to love her
to accept her.

Because her love will always
matter the most.

Eve Greenlow is a poet currently living in NYC, writing for Ars Poetica. She is originally from Sacramento, California and studied at Pacific University in Oregon.

Click here to visit
Eve Greenlow’s TikTok Profile

Click here to visit ARS POETICA

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Mum who ‘avoided mirrors for years’ hits back at evil trolls after getting £15,000 makeover

Written By Hannah Dodd for JamPress UK

Mum unrecognisable after £15,000 ‘mummy makeover’ – with two LITRES of fat drained from stomach

A mum who “hated” her belly and avoided looking in mirrors due to her weight has shared the results of a “mummy makeover” – which set her back £15,000 ($17,800).

Annie Anderson, 49, a maternity nurse from Sacramento, California, US, had long been unhappy with her body, weighing 17st 5lbs and wearing a size 18-22.

Sharing her story to help others – and to fight against stigma around plastic surgery for plus-size women – the mum-of-two reveals her transformation.

She’s had three surgeries: tummy tuck, liposuction and breast reduction – also known as a “mummy makeover”.

“The recovery process was brutal,” Annie, who has polycystic ovary syndrome (PCOS), told NeedToKnow.online.

“But I’ve gone from having a huge hanging belly that made me hate my appearance to finally feeling my hip bones.

“I can finally see my feet!

“I used to avoid looking at myself in the plate glass windows I walked by and avoided mirrors, because all I felt when I looked at myself was disgust.

“For years I tried to hide in tunics that hung like tents over my upper body.

“I have learned this body type is often associated with PCOS.

“After the surgery, I don’t have the burden of all that weight holding me back.

“I like what I see in the mirror now and clothes shopping is fun.”

Annie, who has had two caesarean sections, went under the knife for her first two procedures in January 2022, before returning in March for the breast reduction.

Surgeon Dr Yamahata removed 17lbs of skin and subcutaneous fat and a further two litres of fat via liposuction.

During recovery, Annie was in an “extreme amount of pain” but doesn’t regret the operations.

The mum, who has kids with husband Robbie Anderson, 52, said: “The tummy tuck surgery started with me positioned on my belly while they worked on my back and flanks and then they flipped me over onto my back to work on my abdomen.

“I woke up in the recovery room where I was monitored for 90 minutes and then my husband picked me up and took me home.

“Truthfully, that was the worst night of my life.

“I was in so much pain that I passed out twice while trying to go to the bathroom.

“The first week was a drug-induced blur.

“I focused on sleeping, showering, good nutrition and slowly walking a little more each day.

“Getting up and down from bed or chair was brutal and I couldn’t do it without help.

“By the end of week two, I felt human again.”

Annie, now a size 10-12, had spent years unsuccessfully trying to lose weight and keep it off, when she came across TikTok videos of plus-size women sharing their surgical journeys.

She worked additional shifts to earn the $17,800 she needed to pay for the pricey tummy tuck surgery, which was not covered by her medical insurance.

Annie said: “No clothing could hide how I felt inside.

“Now, I feel lighter. I don’t have the back pain I once had.

“This body wants to be active, and exercise has become a daily part of my life.”

While she is happy with the outcome, the mum doesn’t consider her surgery a “quick fix”.

Despite her improved confidence, Annie still faces tough questions about her decision to opt for surgery as a plus-sized person.

She said: “Technically, I didn’t have ‘weight loss surgery’.

“Most plus-size people have gastric bypass surgery or weight loss surgery, and then later have plastic surgery to repair the damage caused by the weight loss.

“I skipped that part. I had plus-size plastic surgery.

“People think the ‘right’ way is to lose the weight through diet and exercise before having skin removal surgery.

“No one close to me has been negative to my face, just some people on the internet in the comments.

“The beauty of it all is that those comments don’t hurt me anymore.

“The opinion of strangers doesn’t matter if I love myself the way I am.

“I feel strongly that whatever it takes to help you find a way to love yourself, you should do that.

“Even if the world thinks you did it wrong.”

In a bid to inspire others, Annie has shared her progress on Facebook and TikTok (@anniemd007) and on her blog (http://www.anniespeaks.com/).

A TikTok clip that has been viewed 21,000 times shows the mum before her surgeries, posing in underwear before flashing forward to a post-op picture of her in a skimpy black swimsuit.

Many viewers were desperate to find out more.

One person said: “I need to know where and how much plz.” [sic]

“You look great what doctor?” said another fan.

Someone else commented: “Here I am self conscious of my tummy tuck after pics. You look fantastic by the way and I think the confidence is what makes you even more beautiful.”

“Awesome,” agreed another user.

Someone else added: “Kicking a**.”

Click Here to see Annie’s
Before and After TikTok Video

Click Here to see Annie’s
Before and After Facebook Reel

Before Annie’s Plus Size Extended Tummy Tuck with repair of the diastasis recti and liposuction to the flanks done by Dr. Wayne Yamahata in Sacramento, California.

After. 11 months post-op for Plus Size Tummy Tuck and 9 months post-op Breast Reduction done by Dr. Wayne Yamahata in Sacramento, California.

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Cut. Cut. Cut. 🖤

I write poems when I sleep. I woke up to words flowing in my dream, but I didn’t write them down in time. They flew away on gossamer wings and then they fell from the sky in cement shoes. Is it worth getting out of bed for this?

My grandpa visits me in my dreams. He talks to me and I know it’s him when I wake. He’s there already. Waiting. My dad is in the in-between, paying for the things no one knew about. I want to tell him to get in line for the wings, it’s never ending, that line. You can choose between feathers and gossamer, both take you where you need to go. Just lose the shoes, dad. Cement. Birds of a feather.

Cotton candy clouds don’t wait for you, but if you get there in time…

I will see you in my dreams.

I’m sensitive, you know. I feel you before I see you. I know you before you know me. I hide and I seek and I know things. They come to me in my dreams. Maybe that’s why I can’t sleep. I wake when it gets too real and I try to keep my eyes closed, to keep it going, but then I know it’s not real anymore.

So I open my eyes. And I carry it with me, if I’m lucky. It flowed better in my half-sleep. In my half-sleep, it was beautiful. The words flowed and made sense and painted a better picture than this. But I will keep trying and hope that someday someone will put all the pieces together and then they will know me. And then I will exist not only in my dreams and then I will take off my wet clothes and my cement shoes and I will float.

The things no one knows about keep you in the in-between. Cement flows through your veins. Get in line for the wings, dad. And lose the shoes. Not much you can do about the veins. Get the feathers, they hold more weight. And be sorry. For so much.

But know you are already forgiven.

And I float.

Like the last time I rocked my baby to sleep or carried her to bed, I can’t remember the last time we drove the cars at Scandia. Or the last time I wasn’t angry. Or hurt. Or sad. Only my sunshine memories of you felt happy. The days that the sun shined on us and I still didn’t know all the things. Even now, I don’t know all the things. Only some. And they are enough.

This one is more for me. Just getting it out. Uh, oh. She’s blathering again. Keep scrolling. There should be a warning label. She’s writing in her half-sleep again. It’s not for you.

He said he will send me a butterfly when he gets to where we are all going. But he didn’t say what kind. I wonder if he will send Golden Lemon Pucker Trucky Ducky. Oh, you haven’t read that one yet? That one makes more sense than this one. To you. But not to me. Or will he send the Spanish Luna Moth I have tattooed on my skin? Too rare, I’m sure.

Or is it?

Do you like the stories with the details? They need to be unraveled, you know. It’s all in the details, so

When I was in 1st grade, or maybe it was 2nd, at a school I can’t remember the name of with a teacher whose face I remember because she made me cry and I was scared of her, we made a construction paper snowman. The instructions were to tear up the thick white paper into small pieces and glue them onto the blue background like a mosaic snow man. The torn edges were meant to make it look like snow. I panicked. I can’t do that. I begged to use my scissors, the ones with the rounded tips that only sometimes cut. My tears and chaos convinced her. While everyone else was tearing and glueing without a care in the world, I cut a hundred tiny squares of thick white snowman through my burning eyes fresh from hot flowing freak-out tears. Maybe that was my first panic attack. Irrational.

So my mosaic snowman had sharp edges. My crisp edges somehow protected me. The corners overlapped and stuck out and mine was the only one. I can’t blend in. That feels like panic to me. I had to be different, not because I wanted to be, but because there was no other way for me. 29 mosaic snowmen, with fluffy, billowy, uneven, imperfect, snow-like edges. And only one with crisp, sharp edges and corners that can make you bleed. Always different. Special. Gifted. Burdened.

In the end, she let me do it my way. She probably sensed how important that was. How a single moment in time can haunt your dreams 40-something years later. Maybe she knew that I needed the sharp edges of protection to keep me safe. Maybe she knew she was teaching me a life skill of adaptation and when one way is too hard you should find another way to make it work. To get through it any way you can, even when everyone else does it with their bare hands. It’s ok to use scissors.

Cut. Cut. Cut.

And burn, burn, burn.

And I float.