Resilience Is Resistance: Running with Grief

One of the things I’m learning because of grief is that it’s not only possible, but an inescapable reality that deep hurt and astonishing beauty co-exist. Demoralizing political news that pops up in my timeline is often followed by a picture of a new baby or a vacation selfie and followed again by more news of violence or injustice.

Sometimes, even when I do my best to protect myself from pain by doing a social media blackout or focusing on what’s good in the world, it finds me anyway. Yesterday, I was sprinting on the treadmill, and a commercial for a drug to treat the disease that killed my father-in-law started playing on one of the gym TVs. I wanted to burn the world down.

I stopped running because I could feel the tears coming hot and fast. I jumped off to the side and cried for a little while. The good thing about crying in the gym is that sweat and tears are indistinguishable. Then I hopped back on and finished the mile at my usual pace because I know this will not be the last time that grief will literally stop me in my tracks, and I’ll need to know how to deal with that.

A day is made up of so many moments marked by so many experiences and feelings. I stopped trying to determine whether a day has been good or bad a long time ago.

The day was what it needed to be.

It’s okay to find some beauty, peace, or joy in your world despite horrific injustices and pain in the world at large. Self-care is survival, and we need you here to resist, stand up to hate, fight AND to review rolling eyeliner or go on vacation or enjoy a fancy dessert or celebrate your kid’s first day of school. We need it all, because it’s all part of our messy, tragic, delightful day.

When I came home from the gym, I put my kid to bed and read him “Blue Hat, Green Hat,” which is a book about a turkey who puts its clothes on the wrong way. I laughed so much my kid insisted that we read it again.

Sometimes resilience is resistance, and it’s all in a day’s work.

An Open Letter to Cigna

Dear Cigna,

My name is Kate Browne, and I am a Cigna policyholder through the third party payer Benefit Administrative Systems.

I am also a runner, and I am training for the 2018 25th Anniversary #runDisney Dopey Challenge, which will be my biggest running milestone to date.

In 2016, I was diagnosed with Stage II/III lipedema, a chronic, progressive disease characterized by bilateral, symmetrical fatty tissue excess, mainly in the hip region, upper and lower leg areas and combined with a tendency for leg swelling that worsens with standing (more info at http://www.fatdisorders.org/). When I first noticed pain and swelling symptoms were affecting my quality of life in 2012, both my primary care physician and gynecologist prescribed treatment protocols for general edema and obesity. My primary care doctor also recommended a very extensive, very expensive battery of tests to rule out heart disease that would explain the swelling. My heart was found to be in perfect working order. The prescribed treatments—wear compression and lose weight—had no effect on my leg pain, which actually worsened after pregnancy.

In 2016, I sought treatment for pain and swelling in my legs again, and the same primary care physician now diagnosed the swelling as lymphedema and prescribed physical therapy. You may not know this—I did not at the time—but lipedema is a condition regularly addressed in physical therapy training due to its effect on the lymphatic system. My physical therapist diagnosed lipedema on my first visit. This new information led me to the office of Dr. Donald Buck, a respected expert in fat disorder research and plastic surgery. He confirmed that my symptoms, medical history, and clinical presentation were consistent with the lipedema diagnosis, and subsequently recommended tumescent liposuction as an appropriate treatment. Due to my advanced stage, I was quickly approaching a severity at which conservative and surgical treatments would be less effective or have no effect on slowing or stopping its progression.

At this point, I’d like to mention that when Cigna claims representatives and the external appeal board reviewed my case, they stated that I had been misdiagnosed with lipedema. However, the research they cited to define the clinical presentation and proper diagnostic protocol was co-written by Dr. Buck, which betrays both faulty logic and a lack of attention to detail.

Although I sought medical treatment for pain and swelling in my legs beginning in 2012, I received no relief due to improper diagnosis. When I made the decision to pursue surgical treatment, my lipedema had already progressed to the point where my inability to do everyday tasks began to interfere with my quality of life. I woke up every day with a burning pain in my calves, and could not stand for more than 30 minutes. At the end of the day, my legs would swell so much that I could not wear pants comfortably. Running became impossible due to the physical disfigurement caused by lipomas around my knees as well as heaviness, pain, and swelling exacerbated by even small amounts of physical activity. I severely limited my social activities due to fatigue and pain. My clinical depression worsened and began to affect my ability to work. Tumescent liposuction offered a solution not only to alleviate pain and relieve pressure on my lymphatic system, but also to restore my hope for the healthy, active life I wanted. Considering that other treatments had not been effective in slowing the progression of this disease, moving forward with the surgeries as soon as possible emerged as a clear next step.

A reduction in pain occurred almost immediately after my first surgery on July 5, 2016. I maintained the prescribed protocol of physical therapy and compression during my recovery period, and went on to have two additional surgeries recommended by Dr. Buck on August 16 and September 27. Even though Dr. Buck is an in-network Cigna provider with a plastic surgery specialization, Cigna denied coverage for these procedures according to policy document 0470—Redundant Skin Surgery based on the determination that all liposuction is a cosmetic procedure. My attempts at an appeal have been unsuccessful because Cigna representatives have neglected to review my employer’s policy language that covers cosmetic surgery “if the surgery is required to correct a condition that results from an illness.” The disfigurement and subsequent loss of mobility that occurred because of my lipomas should have been reason enough to consider these surgeries covered as a treatment for an illness according to my employer’s policy, but I was continually denied based only on Cigna’s policy 0470.

While my ultimate goal is to receive coverage for the benefits to which I am entitled, I did not write this letter only to challenge the appeal decision made by Cigna’s representatives. There is a bigger issue at stake that I would also like to address in my letter today.

Since I have fully recovered from my surgeries, the pain associated with my lipedema has been completely resolved, and I successfully treat my edema with rest and compression. In other words, my life has been restored. I have resumed all of my everyday activities without pain, and serve as a leader in many athletic communities as a mentor for beginner athletes. I model a healthy, active lifestyle for my son and I can participate in the swimming, running, and gymnastics activities that have become an important part of his life. Also, as I mentioned previously, I am training for my first half and full marathon.

I need you to understand that having these surgeries is what makes it possible for me to participate in the 2018 Walt Disney World® Marathon Weekend, but I cannot stay silent in the face of the irony that is Cigna’s denial of coverage.

Cigna is the official sponsor of the 2018 Walt Disney World® Marathon Weekend. According to your website (https://www.cigna.com/about-us/events-and-sponsorships/), this is what you say this sponsorship stands for:

“Cigna is intently focused on helping people improve their health and well-being. Presenting this event with Disney enables us to reach thousands of people and celebrate their efforts to adopt a healthy lifestyle.”

 

“Cigna understands that meeting a fitness milestone — whether it’s running a race for the first time or meeting personal race goals at any length — is cause for celebration.”

 

“To us, health is intertwined with a sense of well-being and security. Our relationship with the people we serve goes deeper than coverage and claims.

 

It’s about understanding the obstacles people face in trying to lead a healthier life, then helping them overcome those barriers and change their habits.

 

It’s about understanding that healthier people are more productive, enjoy a better quality of life and lower costs for everyone within the health care system.”

I am now asking you to prove it.

Prove that you truly do care about serving your customers and helping them live a healthy, active lifestyle. Prove that when the barrier to an active lifestyle is coverage and claims that you will put your money where your website copy is.

It is estimated that 11% of women in the U.S. live with lipedema, and Cigna regularly denies coverage for liposuction procedures that would restore mobility and improve quality of life, which would lead to better overall health outcomes and lower insurance costs. In my case, I am eligible for coverage through a clause in my employer’s policy, and because Cigna claims representatives did not take information into account at any point when determining my coverage eligibility, I have waited over a year to receive the benefits to which I am entitled.

Now, I am training for the Marathon Weekend, an event that my brother and several of my friends participate in annually. My brother’s participation in past years and my participation this year has inspired other members of our family to also join for some of the races—an unprecedented commitment by our family to make exercise not just a hobby, but a true family activity that we never would have imagined being a part of our story 25 years ago when we first went to Walt Disney World. Yes, our first time at Disney was the same year as the first Marathon Weekend.

My family shares your goal for Marathon Weekend as we “combine fun, family and physical activity in a magical way” this January. But the unconscionable denial of coverage for my surgeries is a gross insult, and has negatively impacted my training experience and my perception of Cigna’s sponsorship of this event.

I hope that we can come to a resolution that will allow me to train for and participate in Marathon Weekend secure in the knowledge that Cigna keeps its promises to “meet people’s emotional, physical and financial needs—for a lifetime.”

I am the founder of Taking Up Space, a platform I use to advocate for body positive, inclusive fitness through access to meaningful resources that allow for the most participation in exercise activities for as many people as possible. My work has been featured in US News & World Report and Refinery29, and I regularly engage with brands to change policies and marketing practices that deny access to fitness based on body size, shape, or configuration. Most recently, I worked with the LifeTime Fitness and Geico to rewrite biased print advertising, which improved the reputation of both companies for my followers and the thousands of people reached by my message.

I am offering you an opportunity to make this situation right. I would much prefer to tell my followers that contrary to the perception of insurance companies as uncaring, faceless corporations that use a rhetoric of compassion to masquerade a singular, demonic focus on profit, that Cigna does care about its customers and supports personal journeys that lead to active, healthy lifestyles. I want to be an example of how health care and health habits can work together to change lives for the better. But I cannot do that while the obstacle of inhumane policy documents, ineffective customer service, and stoic rejection letters continue to deny me the coverage to which I am entitled.

In case it was not very clear, I am not trying to receive fraudulent benefits; I am seeking coverage for the benefits to which I am entitled according to provisions in my employer’s policy. Like the conservative treatments for lipedema that have been prescribed by my primary care physician, physical therapist, and Dr. Buck including wearing compression garments, using a pneumatic pump, and physical therapy that I continue to utilize to treat my lipedema, the surgeries represent a legitimate medical expense. As such, I should be reimbursed according to the covered benefits provided to me by my employer’s policy.

I am ready and willing to work with Cigna not only to provide the information necessary to reach a positive resolution for my claims, but also to be a public supporter of Cigna’s sponsorship of the 2018 Walt Disney World® Marathon Weekend. Once I receive full reimbursements for my claims, I will gladly include a Disney-worthy happily ever after in which Cigna heroically steps up and fulfills its promise to support its customers. I hope you mean it when you say “when people are…managing a chronic disease…we are at their side, around the world, helping them improve their health and well-being.”

Starting today, any training-related post I make on Instagram (@takeupspacewithkate) or on my Facebook page (https://www.facebook.com/takeupspacewithkate/) will reference the fact that my coverage continues to be denied and that my experience preparing for Marathon Weekend has been negatively impacted by this denial until such time as my appeal has been overturned.

My entire case file contains more than 250 pages, but I can provide any additional information required to move forward with this appeal. If you would like to speak with me personally, you can reach me at kate [at] katebrowne.net or by phone at the number on file.

I look forward to a day in the very near future when I can start to train for the Dopey Challenge with wholehearted and joyful enthusiasm, and prove to myself, my family, and my followers that putting health first is work worth doing. Thank you for your attention and careful consideration of my story. I trust that I will hear from one of your representatives soon.

 

Sincerely,

Dr. Kate Browne

Founder, Taking Up Space

Love and Other Monsters: Raising the Bar on Self-Worth

Think love doesn’t matter when it comes to your body image?

heart-shaped love tree in a field with red flowers

Imagine if the next wedding you went to sounded like this:

Friends, family, co-workers, obligatory guests, and casual acquaintances—

We are gathered here today to witness the contractual commitment of two people who grudgingly admitted that their mutual tolerance for each other was marginally preferable to living alone. As they combine domestic responsibilities, we nod in agreement that this is a valid choice, and wish them a minimal amount of success in their new joint venture.

Think about your reaction if a real estate agent introduced a piece of property this way:

Here we have a house. The asking price reflects the median amount of money required for a residential building in this area. The features are adequate, and it contains all the walls, windows, and doors necessary to distinguish it from a livestock barn. You will be sheltered from the elements if you live in this house, and I recommend doing so because winter is coming.

The Problematic Problem of Self-Love

I’ve come across several articles recently that suggest that this is the best we can hope for when it comes to loving our bodies. Self-love, I’m told, is flawed at best and harmful at worst because individual solutions to systemic oppression does not lead to liberation, and mental illness can make the struggle to simply provide basic self-care as survival next to impossible.

And I don’t disagree with either stance.

I also support with the idea, argued by both of the authors above in different ways, that the kind of self-love espoused by consumer body positivity and mainstream media is NOT its definition, an end goal to aspire to, or the ultimate measure of “love your body” success.

I used to think that ACCEPTANCE was the best we could hope for when it comes to body confidence. I assumed that self-love was too lofty and too mysterious and too individual to be able to say that it’s a good way to approach health and wellness decisions.

Self-acceptance may be a good place to start especially if “love” feels too intimate or impossible, but is it enough?

I don’t think so.

If we want to get academic about it, love as an action can range from being defined as “to feel a deep romantic or sexual attachment to” or “to like very much.” Is that too much to ask of ourselves, that we like our bodies enough to care for them?

animated gif of women with different body types as superheroes flying away

Self-love is a way to think about health and wellness (broadly defined) that supports the kind of life you want to It’s time to raise our expectations of what it means to relate to our bodies in a loving way.

To be clear, I’m not talking about self-care practices when you’re dealing with an active mental illness like depression, anxiety, or an eating disorder. I’m talking about the general malaise many women have come to expect when thinking about body image and body confidence—the ho hum, “I guess I can learn to love my thighs,” shrug—as better because it doesn’t mean you hate yourself. I reject the idea of self-love as resigned tolerance.

Loving You Is Easy ‘Cause You’re Beautiful

Go find your favorite meditation on love. Maybe it’s 1 Corinthians 13:4-8 or a poem by Rumi or a pop song. Put yourself in it just for a second. How would your life be different if you loved yourself like that? What choices would you make in all areas of your life that honor the love you have to share with the world?

Carole King’s song “Beautiful” is my favorite meditation on love right now.

You’ve got to get up every morning

With a smile on your face

And show the world all the love in your heart

https://www.youtube.com/watch?v=Y77HwJzOv0o

 

Because that’s what it’s all about, right? Self-love is an expression of your spirit, and that spirit is good and righteous and worthy of space. Let’s say YES to wholehearted and joyful living that starts with basic respect and care for our bodies and the bodies of others.

Self-love makes it possible to do things like ask for what you need, set boundaries, take your medication consistently, wear your seatbelt, exercise, ask for a hug when you need one, get a message, smile more often, choose clothes that fit well (and get them tailored if they don’t), do meaningful work, eat food without judgment, sit comfortably in public spaces, get out of your comfort zone, and just plain enjoy being alive.

Because as my spiritual advisor Pitbull says, “Every day above ground is a great day, remember that.”

With love,
Kate

 

Want to work with me to level up your body image? My Self Love Squad is committed to the nitty gritty of practicing body confidence as a way to show up wholeheartedly, and we have fun doing it. Find out more about how you can join us at katebrowne.net/squad

On Being Fat and Pregnant

In 10 weeks or less, I’m going to be the mother of a son. I always assumed the likelihood of that phrase as a reality of my life was statistically the same as “I just bought an island.” But here we are. Though my pregnancy has been textbook perfect from a physical standpoint, I’ve certainly experienced some of the abnormalities of being a fat pregnant lady:

Thin Privilege in the Maternity Store

Thanks to some rubber band improvisation, I was able to stay in my regular pants for about 6 months. Then I hit up Motherhood Maternity for a few items to get me through winter. It’s a store of typical size for a strip mall. Looks something like this:

But this view is deceiving. This is the view for straight sizes. The actual plus size section for my store consists of a measly two sections of pants, and bland shirts that take up one rack and three shelves. Thankfully, I was able to buy two pairs of jeans and can still fit in a straight size XL for shirts, but I did wonder how ladies bigger than me fare when trying to find maternity clothing. Pre-preggo, I was pretty well an in between fatty. Sometimes I could fit into straight size 18 pants if the cut was right. But now I’m unequivocally plus size. Target, my first choice for affordable clothing, does not carry plus size maternity wear nor do any other of my “go to” straight size stores. Lane Bryant doesn’t carry a maternity line. Rock, meet hard place.

Assumptions at the OB’s Office

Last week, I crossed into the “deathfat” weight category. You know what I mean–the threshold that prompts most people to capitalize Fat. Keel over and die Fat. Disgrace to humanity Fat. Hyperbole Fat. I’ve only gained about 30lbs, which I’m told is “average,” but that means I was fat when this pregnancy started. During my first five OB appointments, each nurse that took my weight and blood pressure made mention of being surprised by my low blood pressure but cautioned me about gestational diabetes. “I hope you’re going to breastfeed,” one said. “It makes the weight come right off.” Sigh. They don’t say anything about my weight anymore and must have been put at ease by my consistently low BP and negative diabetes test. But most pregnant women don’t have to “prove” they’re capable of a healthy pregnancy in that way.

Fear and Loathing in Life Insurance

I’m sure that most mothers experience some fear about their child’s life and all the potential perils of living in a big, scary world. That’s why my husband and I applied for life insurance. Just in case. After the underwriting team made their decision, I was told I classify as “high risk” due to my pre-pregnancy weight. Penalty for that comes with a 50% premium increase my family cannot afford.

How am I supposed to explain to my son that according to actuarial experts, I’m 25% more likely to die than other moms at the playground? I won’t even have to use those words. He’ll find out he has a fat mom soon enough.

My son might even be fat. In fact, he’s likely to be due to his genetic make-up. How do I explain that people will hate him for that? How can I tell him that people will look at him and make judgements about his health, hobbies, life span, and general worth as a human being for being fat? Will I have to tell him that whenever he hears something about the “childhood obesity epidemic,” they’re talking about him? And to be clear, I’m not going to do anything to “make sure” my son isn’t fat. The best I can do is help him develop a compassionate, shame-free attitude about his body and the bodies of others. Even if he’s not a fat kid, with a name like Duncan (Donuts) Browne (Brownie) he’s sure to experience some food-based teasing. I’ll just keep reminding him we chose his name because he’s so sweet, and that haters gonna hate.

Extra-Scary Internet Research

I have first time mom questions in the middle of the night that are quickly answered by the internet before I can call my OB to confirm. I didn’t realize how many myths about pregnant fat ladies exist. Of course I heard the one about fat women not being able to get pregnant due to being generally unfuckable and then having fertility problems. I don’t know anything about that because my pregnancy was unplanned. But there are so many more! There’s an idea that fat pregnant ladies can’t feel fetal movement. Don’t forget all the scary risks for fat pregnant ladies. At this stage of pregnancy I’m worried about childbirth myths such as the Fat Vagina theory. Even The Baby Books have scary messages about too much weight gain for pregnant fat ladies and constantly refer to gaining pregnancy weight pejoratively. Thankfully, I like my OB and she’s never said anything to me about weight being a complicating factor in my pregnancy, but I’m so angry for the women who have to deal with this fat bias personally.

Pregnant Marks

Now that I’m almost 8 months pregnant, my body is pretty clearly marked as pregnant. This is the only bright spot I’ve found in being fat and pregnant: strangers do not touch my belly. In a perplexing mix of fat stigma and politeness, it seems people do not assume I am pregnant and do not want to offend someone who might very well just be really, really fat, so no one has engaged me in unsolicited pregnancy talk. I’m fine with this. It’s very confusing to be a woman who has been taught to be ashamed of her body in public (belly in particular) then suddenly be prompted to “show it off” for joyous, pregnant virtue.