Tuesday, 16 July 2019

the HAES® files: An Open Letter to Dr. X, From a Former Fat Child

In the age of “childhood obesity” rhetoric amid the global panic around adiposity, one anonymous writer writes of her experiences as a fat child and adolescent in medical care. Sadly, the physician’s attempts to “control her weight” led not only to disconnection from her body, but also to a dangerous eating disorder. As much of our readership is aware, there is currently a “starvation trial” involving intermittent fasting for adolescents being conducted in Australia. Many Health At Every Size (HAES®) advocates and several professional organizations have spoken out about the potential harms of this trial, giving rise to more global awareness of the negative impacts of restrictive diets on children. Given this context, this is a particularly poignant piece about the very real harms of weight management practices with children and teens.

Dear Dr. “X,”

I hope this letter makes its way to you. It has been many years since I’ve visited your practice and I’m not sure if I have the right address or if a well-meaning assistant might deem this letter ill-suited for your undoubtedly busy schedule. I’ll admit it’s long, and possibly difficult to get through, but I promise it’s worth the read.

I was a patient of yours for most of my later childhood and adolescence. And to my recollection, it seems I came to see you quite a bit: my parents were fairly responsive to even the faintest signs of a cold. I suspect you hardly remember me, and that’s fine given the number of patients you see, but nevertheless you came to play quite a pivotal role in my life.

You see I was a rather large kid, from a pretty early age. I remember being told, probably before the age of 10, that I was somewhere in the 90th percentile of weight. And despite coming to your office many, many times over the years for a variety of reasons, mostly upper-respiratory infections, I always managed to leave with a prescription for weight loss.

Now before I get any further, I want to stress that I fully believe that you were doing what you thought was best and what the medical literature of the time, and even today in many places, would suggest. Nevertheless, the messages I received from you would be some of the most damaging messages I’ve received in my life.

I was young and marinating in a slew of messages from all around – TV stars, magazine covers, the popular kids at school, mannequins at department stores – all telling me that thinness, (and as this was the 90’s and 00’s – extreme thinness) was the ideal. Was cool, was hot, was normal. But, I also had a fair amount of messaging that combated these messages. I knew the models were airbrushed, I knew celebrities were abnormalities. I knew I didn’t look like them, but I didn’t expect to either. But then I heard the science. The news reports. The fears about the obesity epidemic, the idea that one could be too fat and that it wasn’t just an issue of aesthetics, but an issue of health. I could die because I was too fat. I was awash in a sea of confusion.

And then I heard it from you: at the age of probably 10 or 11, on the verge of puberty, my body putting on weight in preparation for a growth spurt. I was too big. My BMI was not in the acceptable range. I saw the charts. I was interrogated about my diet, my exercise. My mom and I. And believe it or not, at the time I was a relatively active kid: I loved swimming and bike riding, and I took dance lessons. My diet wasn’t all that bad either, maybe a little light on the vegetables. But you seemed skeptical. We were told to keep an eye on it, and in later visits, I was told that my weight needed to come down. There was an implied message, whether or not intentional, that I wasn’t taking “it” seriously enough, that I was uncompliant, that I wasn’t trying hard enough.

Again, I grasp that this is/was common medical practice, but can we pause for a moment and consider what happened in this moment? And what happened in the many moments that followed? I was an 11-year-old child – with almost no control over what I could and couldn’t eat, subject to the means of my parents and school. And I get that your intentions were surely more to relate information to my mother – but I was still in the room, learning that I must monitor everything that passed my lips. I was an 11-year-old child – being told that my body was wrong. That it was too big, too much, and that it should be smaller. In context with the world, an exact confirmation of everything it told me every day. In the context, without any further explanation–functionally a verification that the images and messages in the media and external world were right. As a child, I was being told there were good bodies and bad bodies, and that mine was bad. I had looked to the medical community to set me straight on reality, and in that moment, it failed me, and failed me horrifically.

Because an 11-year-old child is incapable of effectively controlling their weight. Because teenagers are incapable of effectively controlling their weight. Because, dammit, adults are nearly incapable of effectively controlling their
weight. How could there be a multi-billion dollar weight loss industry or “obesity-crisis” if they were? The failure rate on attempts to lose weight is between 70-90 percent. And most folks who keep weight off for any period of time are eating less calories in a day than a toddler. These are statistics from peer-reviewed studies that I will include resources to with this letter.

I spent the next 15 years of my life doing everything possible to lose weight and being constantly reminded of my failure. As I’m sure you’re aware, at every doctor’s visit the very first thing that occurs is you get weighed. You cannot imagine the amount of shame I carried at every visit seeing that damn metal slider inch ever farther to the right, despite all my attempts to stop it. I felt dread at every conversation, when it would turn from Bronchitis to BMI.

I know this letter must be difficult to read, and I swear to you my intent is not to cast blame. I know as a physician your calling is to help people. I know that you studied and toiled for years for the privilege of getting to help people. But the standard assumptions of medicine are causing harm and damage, especially to children, and you’re in a prime position to stop it from happening.

Eventually my calorie-counting obsession became an undiagnosed eating disorder. And I was convinced I was healthier than I’d ever been.

Because over the next two years, as an adolescent, I lost 58% of my body weight. With no actual regard to my health – all I cared about was thinness. I was weak, cold all the time, had probably lost most of my muscle mass, was craving food. I grew very close to passing out while doing nothing but standing several times. And of course, I was immensely happy. I had finally done it. I was finally a “proper” BMI, the world accepted me, I had passed my test. I was finally a good person after all these years of struggle. No longer too much. No longer wrong. I waltzed in to your office after a two-year hiatus, with another case of bronchitis, and you barely noticed.

Whereas at every prior visit my weight centered the conversation, this time it was an afterthought. “Oh, I’ve seen you’ve lost some weight.” That was it, perhaps followed by it a “Keep it up.” I was so bewildered. Two years of struggling after a life time of harping on my weight and when I finally did lose weight, there was barely any reaction at all. Today I look back even more incredulously. A teenager loses over half their body weight in two years, and it’s essentially ignored? How does that not raise any red flags? Not even a recommendation for screening for depression, illness, or perhaps an eating disorder? You were talking to a person that at the time was literally starving. Who was dealing with self-harm, who was at serious risk of all manner of serious physical conditions. But it was all rendered invisible because I was a previously fat person who had become the “correct” size. I was a success story.

The thing about this encounter that disheartens me, that fills me with grief, that physically pains me knowing it still must happen every day, is that this isn’t an isolated case. That this isn’t really your fault even, and let me stress again, that for as much a pivotal role you play in my story, that it’s hardly you that bears the brunt of the responsibility. This is a pervasive attitude the runs throughout the medical and science community that seeks to make fat people thin at all costs and, as activists have pointed out, routinely makes the habit of prescribing to fat people what it diagnoses in thin people. My anorexia was invisible because no one would think to look for it in a fat person. My BMI was normal. Even high normal. Therefore, I was healthy. This is despite the fact that people with higher BMI’s are at increased risk for eating disorders compared to thin people.

I struggled with the eating disorder for years – battling the biological urges of my body, gaining weight, losing weight, and then gaining again. I developed intense depression, my self-harm became grave. I felt powerless and at a loss as to why I couldn’t control this one simple thing I had been told all my life that I was supposed to handle. Thankfully, after one terrible night, I scared myself into seeking help. I found a therapist, an eating disorder specialist, and began to heal. I healed, but it took way longer than it might have and caused extra damage along the way. I wasn’t having issues with impulse control, I was quite literally starving. I struggled with bingeing for years until discovering an approach to health that said, “what if your body is how it is, you eat when you’re hungry, stop when you’re full, and let it be.” Miraculously my bingeing behavior virtually stopped overnight.

The approach I ran across is Health at Every Size®. Obviously, I’m a fan of it, and the primary reason I’m writing is to ask you to please investigate it. For the first time in my life, I feel free around food, for the first time in my life, I actually desire both traditionally nutritious foods as well as pleasure foods. My vitals are all great, my weight is stable, I’m seemingly a picture of health. And while my relationship with my body is still very, very strained, I’m finally at a point where I can see a glimmer of a future where that might not be the case. I have difficulty believing any of this would be possible without doctors and health professionals telling me in no uncertain terms that there’s more to health than weight or fat or BMI, and that it in fact, those things matter very little.

Here’s what I see as the important take aways from HAES®:

  1. We don’t know how to make fat people thin. There are no studies where any but a tiny minority of participants keep weight off for more than 5 years, and those that do are often engaging in just as disordered behaviors as I was.
  2. Those that regain weight after losing it, often end up at higher weights than they began at. Every attempt pushes that set point higher.
  3. The intentional pursuit of weight loss harms the body. Those people who have lost and regained a significant amount of weight are at much higher risk for several health conditions. And most people who try to lose weight repeatedly cycle, which is even worse for the body. Weight cycling itself can cause many of the illnesses fatness is usually attributed to.
  4. Similarly, weight stigma, the shame and guilt and social ostracization faced by fat people (as well as other stigmas such as that of those of poverty or racial minorities) contributes to immense amounts of chronic stress, which has been linked again to the same types of diseases and health issues associated with fatness.

Telling patients their bodies are wrong or too much, etc., and framing obesity as some sort of social contagion contributes to stigma. Perhaps, most importantly, kids are vulnerable. They absorb everything they hear. They are bombarded with messages from everyone and everywhere telling them what they should be. The last thing they need to hear from a trusted authority figure is that there is something wrong with them that don’t have the resources to control. The last thing they need to hear is that they need to change. They need the medical professionals in their life to combat the toxic messages pervasive in the media and culture. They need those professionals to tell them the facts– that everyone’s body is different and that’s okay. Kids need to be encouraged to eat a variety of foods, that taste good and make them feel good, and engage in movement they enjoy – completely apart and absent from talk about weight. I can’t stress enough how valuable such a perspective would have been in my life. For myself and my family to hear it.

I’ve attached to this letter some pages from Health at Every Size, the book by Dr. Linda Bacon. It’s a good starting point that can answer questions and point you to more detailed research. I sincerely hope you’ll investigate what it has to say. And if you somehow still find a weight-neutral perspective is not for you, then I implore you to seriously consider and limit your talk about weight and fat with patients, especially children. I don’t want any child to ever go through what I did, or, god forbid, something even worse. You have the power to actually enact change and be on the front lines, helping people become their most healthy best selves.

All my best wishes for the future,
“Mary”

 


Author Biography: Per the author’s request, both herself and the physician addressed here remain anonymous. Art featured in this blog was produced by the author of this piece. This author is a participant in the WINTER Study (Women’s Illness Narratives Through Eating/Disorder and Remission Study), an ongoing HAES®-informed study of eating disorder experiences led by researcher Erin Harrop, MSW, PhD-C. The WINTER Study has been supported by the Association for Size Diversity and Health through a Health at Every Size® Expansion Grant, and through the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number TL1 TR002318.



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Monday, 15 July 2019

Hand Laundry Never Ends

As many women know, hand washing of bras is recommended to keep them in good condition.  This is not necessarily a huge burden!

Hand washing of pantyhose is also recommended. Thank heavens I don’t have to wear pantyhose.

And then came…compression stockings.

Compression stockings drying on towel rack

Compression stockings drying on towel bar

Compression stockings are often recommended for people who are on their feet all the time, who are flying, who have had lymph nodes removed, and to prevent blood clots.

In my case, I eventually realized that part of my left knee pain was actually located below my left knee.  Where there was also swelling, and which felt better if I wore tight leggings. My ARNP diagnosed likely blood flow issues and varicose veins, and referred me to a vascular specialist.

The vascular team did an ultrasound of the veins in my leg. Leg veins have one-way valves which supposed to keep the blood going up my leg, back to the heart. It was confirmed that my valves are not all working well. In particular, the one-way valve just below the knee on my left leg – where I had swelling and pain – wasn’t really one-way anymore.  Compression was recommended to reduce the swelling and help the vein to move the blood to the heart where it belongs.

I didn’t realize at the time that this would mean the hand wash only laundry would never end.

I was prescribed 20-30mmHg, knee-high stockings. The mmHg is “millimeters of mercury” pressure, and 20-30 is about middle of the range.  I did go to a medical supply store to get fitted. I recommend it since you can get some knowledgeable advice on fitting and how to put them on without putting a fingernail through them.  If you wear a common size you may be able to wear them home. My size 14-16 friend got fitted with thigh-highs after her cancer surgery and wore them home.

Initially I didn’t fit anything over-the-counter due to the swelling in my calves; after wearing leggings daily for a week, the swelling reduced enough to fit something made a manufacturer without having to get them custom made. I wear Juzo Max knee-high stockings, which have more of a flare at the top of the calf than the standard knee highs, and which wasn’t in stock but could be ordered. I also pop for the “silicone band” of little silicone beads to keep them up.

Pros:

  • No below-the-knee pain.
  • Much less swelling in calves.
  • Legs feel less tired.

Cons:

  • Stockings are expensive (mine are $78.39 per pair).
  • Stockings require hand washing.
  • Stockings need replacing every N months. Currently N is 2 or 3 months. I know folks who go 6 months, others who buy them monthly.
  • None of my leggings fit right anymore.

All that said, the compression stockings have been a really positive thing for me. The below-the-knee pain is gone.  Walking is more comfortable. I still elevate my feet whenever possible, but my legs and ankles aren’t swelling every evening. These are all terrific.



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Wednesday, 10 July 2019

Is this still on?

Heya!  Just checking that posting still works :)



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Monday, 8 July 2019

Covering Our Tracks, Not Our Rolls!

This past weekend was the annual Big Moves Bay Area dance show by emFATic Dance. It was the seventh year that Tigress & I have performed as a duo, and her eighth as a solo performer. The name of the show was Covering Our Tracks, as most of the songs performed by emFATic Dance were cover songs and they were fantastic! Tigress & I spent months trying to find a perfect cover song that just fit us and well, we didn’t. In the end we went with a song I came across randomly down a YouTube rabbit hole one day, Billie Eilish’s “Bad Guy”. We called our piece, “We are the ones your mother warned you about” and went with a vampy-vibe.

Tigress flew in last Saturday night and stayed with me throughout the week, diligently working on costumes and the choreography for her solo number. We had tech and dress rehearsals in the evenings and it’s almost a 2 hour drive at this point to Oakland from San Jose (Bay Area traffic is no joke!). Any other free time we had we worked on our number together and drank to our heart’s content! She also made our fascinators! So fun!

A lot of this year’s performance, at least for me, felt very chill or almost routine. I didn’t even get nervous once! Wild! We kept our choreography a bit loose and uncomplicated due to the short amount of time we had to practice, as well as the additional stress of her having to travel and stay with me during this time. We looked great, though, for sure! We worked our sassy lil’ outfits and smoked that audience right in their damned seats! It was a blast! I wish you could have seen us! And you really wish you could have seen Tigress solo number, it was electric!

I had watched some YouTube hair style tutorials last year on a simple up do and gave it another shot, despite the fact that I didn’t have all my usual tools for this. It worked out awesome! It’s basically a “pull through braid” at the back, or just a bunch of overhand knots that you keep adding the last set to as you move forward up the back of your head. When I got to my forehead I simply created a fat braid that I then fluffed up and bit before pinning in place.

I like the back to look a bit messy. I’m not a fan of an overly “done” look, ya know? But I really dig how the front turned out!

^^^^ I mean?!?! ^^^^

Oh! And this dress?!?! This dress is Calvin Klein, jersey knit in a size 24 (I’m a 26/28 usually but yay stretch!).

I bought it second hand from one of the dancers in the show and I am in love with it!

It just hugs the right places and feels extra sassy-sexy!

In case you couldn’t tell from my pics alone! Ha-ha!

And then the very next day I receive a package from my bff Mychii in Ohio with a custom made light-up nameplate for my desk at work and this lovely rose gold coffee thermos with “Fierce Fat Femme World Treasure” on it and I am just so blown away!

I needed to re-sync with my fat community. I needed to be surrounded by radical fats. I needed to see all our fat bodies on that stage lit up for the world to see our inner sparkle! It was and always is an incredible experience. To share space with such talented artists, friends, and badasses is like nothing else in this world, I promise you. And every time I think I am done or I can’t go on, one of these shows comes up and for the last 7 years it reminds me why I do it, why we all do the work that we do, for the show and in the world. It is so special.

Rad Fatty Love to ALL,

<3
S

P.S. Check out and use the hashtag: #FatAndFree on Instagram & Facebook!

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Tuesday, 2 July 2019

Church Leader Fat-Shames Teen, Who Fights Back Beautifully

fat shaming naturalJenna went to church to sing and celebrate as a worship leader in the contemporary band at her Methodist Church. But then Sister Bonnie-Better-Than-You of the Church of Fatphobia went to work.

Bonnie somehow believed that being a “Church Leader” involved following a 19 year old into the bathroom (where the girl had gone to see if there were any updates on a hospitalized family member,) to wag a fatphobic finger at her and tell her things like “Don’t come back on that stage with those shorts. I’m warning you.”

People are going to want to see the shorts and I’ll leave a picture, secure in the knowledge that we all understand that any argument that contains “she’s not even that fat” is harmful and fatphobic.

Bonnie’s behavior would never, ever be ok, but is even more inappropriate in this situation because, as another church member pointed out, this is a “contemporary service” that is youth-focused and “guests are encouraged to come as they are.”

But this story takes a turn for the better – quick-thinking Jenna turned on her cellphone video to capture the abuse, and gave herself and her body a full-throated defense. It was emotional, and profanity-laced, and absolutely beautiful (if you’re thinking about tone-policing, rethink, and then don’t.) Despite the power and age differential that Bonnie Busy Body was trying to exploit, through tears and sobs, in a situation that should NEVER have happened to her, Jenna defended herself fiercely and fearlessly. The video can be found here, trigger warnings for fatphobia and abuse of a position of power.

For a horrible story that should never have happened, it has the happiest possible ending. The church issued a letter of apology that was crystal clear that Bonnie was wrong and did “great harm,” Jenna said that her pastor promised her that Bonnie “will never be able to be on any sort of committee/any leadership role in our church ever again. (Jenna has asked that people not attack her church, as they are working to fix the problem.)

Remember that no matter what size someone is, and no matter what they are wearing (looking at you, People of Walmart apologists), fat-shaming is never ok, and being fat is always ok.

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Badasses Need Love, Too!

As I grow and age and learn to appreciate things better, I still find myself fighting things that are innate or natural and just…UGH! It’s so ridiculous! I’m feeling strangely blue today for truly no reason at all. I’m just tired I suppose and very much starved for affection. And that’s the thing, I try really fucking hard to pretend I’m a hard ass bitch who doesn’t need such things when, A) I know better and B) you can be a hard ass bitch and need snuggles, it’s science and science is beautiful! Ha-ha!

True facts though, my single by choice life means that I go weeks without a hug, months without a kiss, years since another human has truly held me in a loving way. Having those facts sort of hit me all at once when I was wondering why I was feeling down today, and yeah, that would be a big fucking reason. So why self shame or hide?! I can’t really say for certain, but somehow I got it in my head that it makes me weak somehow. It does not. I need to get over this shit. (“How to get enough physical affection if you’re single” pay wall, but cute as hell comics in a cheeky tone.)
I have been dating more lately and enjoying that for the most part. I have had more affection in a general sort of way but it seems not in the ways I need to feel fulfilled. So what’s this Bitter-Betty to do?! I guess just accept that this is also part of my nature and communicate my needs to those who may support or assist in my fulfillment. Wow! So mature! Ha-ha!
Image result for affection
I must also note here that growing up with very early sexual trauma and further abuse and sexual trauma throughout my most developmental years has certainly made these things all the more difficult. Not just difficult to live with, but to navigate social situations, dating, all of it. Sometimes my PTSD-C will scream “Hell no! No one is going to touch me! NOPE Not okay!!!” even when that feels like the one thing I need most of all. I’m realizing now how much this affected my marriage back when. Ugh. Like I recall aching and longing for my husband to just hold me and see me but could never in a million years actually say those things. Learn from my life, lovelies, lessons abound!
As an introvert as well, I don’t like being around a lot of people, or noisy people/places, nor do I like being around a stranger. It’s a confusing thing to date because of this. Even if I like someone on the surface, far too many have proven that my trust issues are well earned and keep me fucking safe! At the same time I try to stay open and to push myself out of my comfort zone and all of that, and yet? Here the hell I am! Ha!
I suppose those with close families could ask for a cuddle, but that isn’t the case for me. Nowhere near it. I do have my precious puggo that I wouldn’t trade for all the money or Tom Hardys or anything else in the world! But he’s not a big snuggler, he’s more of a snuggle up against you type o’ guy. This shit is complicated! Ha-ha!
Image result for affection
Now I am a big proponent of self love and self care and all of that good stuff. And I am very pro masturbation as a form of those things, and I believe I even excel at them…but I still have this internal ache for that deeper connection with another human being. I guess there really is no substitution for that. In every other aspect of my life I think I’m in a good place. And hey, I’ve been single by choice for over 2.5 years now so if this is the first of this inner longing, so fucking be it! Ha-ha!
Have you struggled with these feelings, too? How have you helped yourself feel better? Do you have a self soothing thing you do? What am I missing out on here? What other things are on your mind or weighing upon your heart?
(Really liked this sentence I ended my last post with, it’s sticking to me and I love that!)
I’m here for realness and sincerity, honesty and vulnerability, I’m here for the good and juicy bits of life that shine for me when I know I’m heading in the right direction.
Rad Fatty Love to ALL,

<3
S

P.S. Check out and use the hashtag: #FatAndFree on Instagram & Facebook!

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