Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

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Meet Dr. Hakim Said!

May 23rd, 2021 — 8:58am

My last day of surgery was last Friday (5/21/21) and my very last day of practice is June 1st.  My 30 years of private practice have been a pleasure and a privilege.  I thank all of my wonderful patients and my wonderful staff for a great run.

I am very pleased that Dr. Hakim Said will be joining the practice on June 2nd.  He is currently offering consultations and I highly recommend you consider him for your plastic surgery.

My web site will be undergoing a radical pruning in the coming weeks.  I plan to trim it down to my blog which I plan on continuing.  Stay tuned for a wide variety of blog posts now that I have time to pursue my many non-medical interests!

I also plan on continuing my Instagram accounts – @lisalynnsowder, @sowdermd and @ breastimplantsanity.

Onward.  Dr. Lisa Lynn Sowder

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To everything there is a season………………………

December 1st, 2020 — 10:46am

It is with mixed feelings I am announcing my retirement this June, after 30 years of practice.  I know it’s cliche to say that time as flown but it really, really has.  Plastic surgery has offered me everything in a career that I could have asked for.  It allowed a biology geek like me to embrace the science of medicine and surgery and also kept my very restless physical self moving and allowed me the ultimate joy of working with my hands, all while serving a wonderful group of patients and working with incredibly talented staff and colleagues.

Sooo……..if you are a current or past patient, I will be doing my last case in the OR sometime in mid-May.  The office I share with Dr. Shahram Salemy, Madison Tower Plastic Surgery, will be welcoming another plastic surgeon.  This individual will be well trained and experienced and likely taller and much younger and maybe even nicer than me.  Madison Tower Plastic Surgery will maintain all patient records should past patients need access to them.

What about this glorious web site? I know my website is short on style and bells and whistles but have been told many times how helpful the content is.  I have been nurturing my web site for 20 years and it is almost like a child to me. Yeah, I know that’s weird.   I am making the tough decision to whittle my web site down to include only my blog – Notes of a Plastic Surgeon.  I will continue to post on this blog from time to time about all kinds of topics. I suspect my range of topics will expand mightily once I have the time to pursue many interests that have been sidelined during my medical training and career.  I am also planning on keeping my Instagram accounts – @sowdermd, @breastimplantsanity and @lisalynnsowder.

So what’s next for me?  Hmmmmm. I’ll keep you up to date on my blog!

I thank each and every one of you who have supported me in this glorious career!

Dr. Lisa Lynn Sowder

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From the Wall Street Journal, June 10, 2020

June 11th, 2020 — 10:10am

Thank you for reading.  Be kind.  Stay strong. Dr. Lisa Lynn Sowder

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Returning to Elective Surgery in the New World Order of COVID-19.

May 11th, 2020 — 12:41pm

 Washington State is starting to open up following our stay-at-home order.  I am really looking forward to getting back to what I love – taking care of patients.  We have worked very hard along with our national societies and governmental agencies to put in place procedures to keep ourpatients and ourselves as safe as possible.  I am over 60 as are three of our four anesthesiologist and our nurse manager and you will find us here, doing our jobs.  We would be foolish to pretend that there is no increased risk during these times. 

SMALL BUT NASTY

We have put together the following informed consent form for patients during this time.  Like all informed consent forms, it is meant not to frighten but to rather inform patients and remind them that surgery, even elective plastic surgery, is never risk free.  All patients undergoing surgery during this pandemic will be given this form and be required to sign off on it.  And remember, me and my staff are signing off on this increased risk every day we show up for work.  Should you have questions about our protocols, don’t be afraid to ask!  

 

 COVID-19 RISK INFORMED CONSENT

 I                                               (patient name) understand that I am opting for an elective treatment/procedure/surgery that is not urgent and may not be medically necessary.

I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person-to-person contact; and, as a result, federal and state health agencies recommend social distancing.  I recognize that Dr. Shahram Salemy and Dr. Lisa Sowder and all the staff at Madison Tower Plastic Surgery and Madison Tower Surgery Center are closely monitoring this situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with this elective treatment/procedure/surgery. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective treatment/procedure/surgery, and I give my express permission for Dr. Shahram Salemy and Dr. Lisa Sowder and all the staff at Madison Tower Plastic Surgery  and Madison Tower Surgery Center to proceed with the same.

I understand that, even if I have been tested for COVID and received a negative test result, the tests in some cases may fail to detect the virus or I may have contracted COVID after the test. I understand that, if I have a COVID-19 infection, and even if I do not have any symptoms for the same, proceeding with this elective treatment/procedure/surgery can lead to a higher chance of complication and death.

I understand that possible exposure to COVID-19 before/during/after my treatment/procedure/surgery may result in the following: a positive COVID-19 diagnosis, extended quarantine/self-isolation, additional tests, hospitalization that may require medical therapy, Intensive Care treatment, possible need for intubation/ventilator support, short-term or long-term intubation, other potential complications, and the risk of death. In addition, after my elective treatment/procedure/surgery, I may need additional care that may require me to go to an emergency room or a hospital.

I understand that COVID-19 may cause additional risks, some or many of which may not currently be known at this time, in addition to the risks described herein, as well as those risks for the treatment/procedure/surgery itself.

I have been given the option to defer my treatment/procedure/surgery to a later date. However, I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired treatment/procedure/surgery.

 

Thanks for reading and I would be grateful if you followed me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

 

 

 

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A must read article about COVID-19

March 19th, 2020 — 1:52pm

Please read this article for some excellent information of COVID-19.  

My office and ambulatory surgery center is shutting down for at least a month.  We will have a skeleton staff answering the phone and I will be available in person for only those who really need a face to face with me.  I am 63 and thus at high risk despite enjoying excellent health and feeling and sometimes acting like I’m 14.  I thank all my patients who have had to reschedule their surgery and I thank everyone who takes this seriously.  And for those who don’t, get a clue already.

Stay safe, stay strong, stay sane, and stay in touch.

Dr. Lisa Lynn Sowder.   Follow me on Instagram @sowdermd and @breastimplantsanity.

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Can Surgery Be A Placebo?????

February 21st, 2020 — 11:45am

A few weeks ago I listened to an excellent Hidden Brain Podcast about placebos and not just the sugar pill kind of placebo.  This podcast recounted an amazing clinical trial done way back in 2002 which put the very common procedure of arthroscopic knee surgery for osteoarthritis to the test.  I will summarize that study here but I really encourage everyone to listen to the podcast.  There are also some links to the original paper published in the New England Journal of Medicine.

In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.

So here we go with my summary:  180 patients with osteoarthritis of the knee were randomly assigned to one of three groups.  The assignments were controlled for severity of disease.

Group 1 : Routine arthroscopic surgery to wash out and clean up any irregularities in the knee joints

Group 2:  The incision was made, the arthroscope was inserted and the knee joint washed out (lavaged) but nothing else was done.

Group 3:  An incision was made but the arthroscope was never inserted.

The patients did not know which group they were in nor did their families or the nurses who cared for them after surgery.   The surgeon and the operating team did not know which procedure the patient would have until the patient was on the OR table and anesthetized and the randomization envelope was opened.  For groups 2 and 3, a video of standard knee surgery was played and the OR team sort of faked the movements of the surgery and the time in the OR was the same for all groups.  One surgeon did all of the cases.  Group 1 is the real operation, Group 2 is the lavage group and Group 3 is the sham procedure.     Now some commentary on this study.  These patients had honest to goodness osteoarthritis of the knee confirmed by history, exam and X-Rays.  This was not a group of patients with ill defined and subjective complaints.  These were patients with objective disease. .

Follow up at two years showed no statistically significant difference in relief of symptoms as reported by the patients or function as measured by walking and climbing stairs between Group 1 (real surgery), Group 2 (lavage only) and Group 3 (sham surgery).   Think about this for a moment……….An arthroscopic clean out of the knee joint had no more effect than a superficial skin incision.  

I remember the reaction to this study when it was published.  At that time I did a lot of my surgery at Seattle Surgery Center and I had the opportunity to hob nob with a lot of orthopedic surgeons.  The ortho bros often teased me for all the unnecessary surgery I do.  Yeah, it’s true.  The vast majority of cases I do are unnecessary.  This study allowed me to tease them about their “scoping for dollars” practices.  I think a lot of scoping for dollars still goes on (mostly because patients request it) but maybe a little less since this paper smacked everyone upside the head.

Isn’t it just amazing what the human mind can do?  It can convince the body that the sugar pill was the real thing or even that the sham surgery was the real thing!

Thanks for reading and really you should listen to this podcast!   And as usual, I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

 

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Some suggestions for New Year’s Resolutions

December 31st, 2019 — 12:30pm

 

I cannot improve on this list of Woody Guthrie’s.

blog new yearsThanks for reading and Happy New Year!

And I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder

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Opioid Free Surgery

May 20th, 2019 — 9:08am

I am very pleased to introduce our new opioid free surgery protocol.  This has been in the works for several months and we launched it 3 weeks ago with very good feedback from our patients.  Here’s just about everything you need to know.

Why?    The use and abuse of opioids cause a lot of problems not just for patient but society at large.  On the patient level, opioids often cause side effects such as itching, nausea, constipation, fuzzy head, bad dreams and the list goes on.  Having been on opioids myself for various surgical procedures, I personally think they don’t do a very good job at controlling pain but just get you so fuzzy in the head that you just don’t care.   On a societal level, have you heard of the opioid crisis?  The fewer pills out there in people’s medicine cabinet will mean less abuse.

How?   By approaching anesthesia and post operative pain in a different way, pain control can actually be better than what we have achieved in the past with opioids.  The non-opioid medications are started pre-operatively to provide a preemptive strike against the pain cycle.

What?  Here are the medications we use.  Acetaminophen a.k.a. Tylenol:  It’s good for head aches and post op pain.  Celecoxib a.k.a. Celebrex:  this is a non-steroid anti-inflammatory but does not have the blood thinning effects of other NSAIDs such as ibuprofen.  Inflammation is a major factor in pain.  Gabapentin a.k.a. Neurotin:  This is a medication used commonly for nerve pain.  It has a mild sedating effect in some individuals but does not fuzz your head nearly as much as an opioid.  Marcaine and/or Exparel:  These are long acting local anesthetics that are injected into the operative sites that can render the injected area numb for hours or days.  Ice: Oh, yeah, ice packs can help a lot.  My husband got through a gnarly knee operation with virtually nothing more than Tylenol and a gizmo that surrounded his knee with ice slush, provided by his awesome caregiver (that would be me).

When?  We have out patients take a dose of Tylenol, Celebrex and Gabapentin a couple of hours before surgery with a sip of water.  During surgery, the surgeon injects the operative area with local anesthetic.  After surgery, the patient continues with the medication combination.  Ice packs can be added for most types of surgery but check with us first.

Who?  All of us – surgeons, anesthesiologist, nurses, patients and their caregivers.  This protocol requires that we all work together.  The patients must make sure to take their medication before surgery, anesthesia must minimize or eliminate the use of opioids during surgery, the surgeon must be thorough with injection of the local anesthetics, the nurses must be sure the patients and their caregivers understand the pre and post-operative instructions.

So, how’s it working?  So far I have had a dozen patients on this protocol including a tummy tuck patient with very, very favorable results. I am very excited about this plan.  I’m sure we will tweak it here and there a bit but thus far I’m a total fan.

Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @ breastimplantsanity.

Dr. Lisa Lynn Sowder

 

 

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Capsular Contracture 102: Treatment

April 19th, 2018 — 3:59pm

My last blog discussed the difficult and frustrating problem of capsular contracture of breast implants.  As with just about every problem known to mankind, prevention is the best approach. But despite doing everything correctly pre-operatively, intra-operatively and post-operatively, a small number of patients will experience capsular contracture.

First a little history:  Way back when the Earth was cooling and breast implants were the newest and coolest thing, surgeons would treat capsular contracture by “popping” the breast, the so-called manual or closed capsulotomy.  Here is how it worked.  The surgeon would take his great big strong paws and basically mash the poor breast until there was a pop and the breast went soft as the scar capsule ruptured and released its pressure on the implant.   As you can imagine, there was a lot of moaning and screaming in the exam room during this process.  It wasn’t long before surgeons realized that: 1. the capsular contracture always came back, 2. this can rupture a breast implant, 3. this can cause acute bleeding and 4. women don’t like being manhandled this way.  I was just starting my training in plastic surgery just as manual capsulotomy was falling out of favor.  I’m happy to say that I have never done this crude procedure and it is likely that I would not have succeeded had I tried.  I have teeny tiny and not-so-strong hands.  I would have likely ruptured one of my tendons before rupturing a capsule or implant.

Okay, that was then and this is now.  For early capsular contracture, it’s worth trying medication.  A dozen or so years ago it was observed that implant patients on a certain kind of asthma medication has a very low rate of capsular contracture.  These medications are leukotriene receptor antagonists and they work for asthma by reducing inflammation.  And inflammation is thought to be the final common pathway to capsular contracture.  The two medications used are zafirlukast and mohnelukast.   Accolate and Singular are the brand names respectively.  I have had several patients resolve an early capsular contracture with these medications. I have also had a few patients who did not respond to these medications

These implants were 41 years old and had a grade 4 capsular contracture. I removed them and the capsule and inserted new implants. She is shown 18 months after surgery.

Once a capsule is well established, surgical intervention is the only way to resolve it.  Complete capsulectomy removes the scar tissue and then the question  is how to prevent a recurrent capsule.  And does it make sense to just pop in another implant right away?  This is just such a difficult question because none of us has a crystal ball to tell the future.  Sometimes capsulectomy and a new implant works great but sometimes another capsular contracture starts forming despite doing everything right.  Sometimes we create a new pocket and make a pocket under the muscle if the over the muscle implant had a capsular contracture and vice versa.  Adding Accolate or Singular makes some sense.  Sometimes adding a piece of acellular dermal matrix like Strattice (which should be spelled  $$$$trattice) will decrease the chance of another capsule.  And whenever there are several different approaches to a difficult problem, you can be sure that none of them works every time.

The only surgery I know of that will for sure prevent another capsular contracture is implant removal and total capsulectomy without implant replacement.  This definitive treatment is readily accepted by many of my older patients who are sick and tired of their nasty, rock hard and uncomfortable implants.  They look forward to being implant free.  For younger patients, however, this can be a very, very difficult thing to accept, especially if they were really, really flat to begin with.  I have at least one patient that comes to mind who had several capsular contracture related surgeries by me and finally we just threw in the towel and removed her implants along with her capsules.  Her breasts returned pretty much to their preoperative size and shape but let me tell you, her wallet was never the same.  A problem with capsular contracture can be very, very expensive and result in a lot of down time – off work, off exercise, off fun.  This particular patient went on to have some fat transfer several years later and did well.  She and I are both glad to have her implant saga behind us.

Just writing this post makes me feel like I never want to do another breast augmentation!  And then I think of the patient I saw in clinic this morning.  She was very, very flat chested and was too lean to consider fat transfer.  I inserted 250 cc low profile cohesive gel implants last week and this morning I could not wipe the smile off her face.  I think as long as there is Victoria’s Secret, there will be a demand for breast augmentation.  I am just grateful that implant technology keeps improving as does our surgical technique.  Hopefully sometime in the near future capsular contracture will be of historical interest only.

Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.   Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Removal, Breast Implants, Plastic Surgery, Uncategorized

How to lose weight in 4 easy steps by

February 14th, 2018 — 7:39am

I thought I would post this essay for Valentine’s Day.  It’s really not about losing weight.

This is cut and pasted from http://aaronbleyaert.tumblr.com/post/109959086957.  All I added was the cartoon.

HOW TO LOSE WEIGHT IN 4 EASY STEPS

I’ve spent the past year losing 80 lbs and getting in shape. A lot of people have been asking me how I did it; specifics like what diet I was on, how many times a week I worked out, etc etc. So I thought I’d just answer everyone’s questions by giving you guys step by step instructions on how you can achieve everything I have… IN JUST 4 EASY STEPS! Ready? Here we go!!!

1.) NO BEER
This is a big one, and one that you’ve probably heard before. Every time you drink a beer, it’s like eating seven slices of bread. That’s a lot of bread!

2.) PORTION CONTROL

Portion control according to B. Kliban

Portion control according to B. Kliban

This is especially true when you go out to eat at restaurants. A good trick to do is when your meal comes, cut it in half and right away ask for a takeout container, so that you can save the rest for later – and even better, if you start your meal out right by ordering lean meats and veggies, you’ll slim down in no time!

3.) HAVE YOUR HEART BROKEN
And not just broken; shattered. Into itsy bitsy tiny little pieces, by a girl who never loved you and never will. Join the gym at your work. Start going to the gym regularly, and even though you don’t know that much about exercise and you’re way too weak to do pretty much anything but lift 5 lb weights and use the elliptical machines with the old people, do it until your sweat makes a puddle on the floor. Then go home and go to bed early and the next day do it again. And then again. And then again.

Listen to stories of your ex-girlfriend fucking around with gross and terrible people, stories from your friends who think they are doing you a favor. Go to the gym and make more puddles of sweat. Buy books. Learn about different muscle groups and how they work together. Start eating healthy. Learn about nutrition. Plan out your week of meals. Try to forget her.

After work one night, go up up up all the way to the top floor of the parking garage and walk all the way to the back. Look out at the twinkling lights of the skyscrapers of downtown Los Angeles and think about how every single one of those office lights represents a person. Try to imagine how they feel. What they’re doing right then; if they miss someone special, if they wonder if someone special misses them. Then realize that most of those lights are probably shining into offices with no one in them except for a custodian or two. Realize you are alone, that you are staring at no one. Turn your collar up against the cold and drive home to a meal of a single chicken breast and steamed vegetables. Go to sleep. Go back to work. Go to the gym. Sweat.

Buy a scale. Pick a goal weight. Imagine the goal weight as a shining beacon on a hill. You are at the bottom, in the dark. Talk to her at work. Notice the awkward way she walks in high heels and her goofy smile when she looks over at you. Feel something clench inside your chest. Think about the gym and what muscle groups you are going to work that night.

Get on the treadmill. Push yourself to level 3, then level 4. Then 6. Run so fast you feel like you are going to die. Hit level 10. Pray for death. Think of how bad she makes you feel. Find the strength to keep going.

Late one night, make the mistake of looking at her Facebook and Instagram posts. Feel lower than you ever thought possible. Unfriend her and try to forget what you’ve seen. She is doing things with other people that you asked her to do with you. She is having a great time without you, and you are wasting your life listening to Taylor Swift on repeat and making sweat puddles on a gym floor.

Watch as your life shrinks down to four things: 1.) work, 2.) the gym, 3.) the food you eat, 4.) sleep. She wears the necklace you bought her and tells you that she got it “from someone who’s really special”. That night you discover that Slayer’s “Angel of Death” might be the perfect song to do squats to.

Start to make friends at the gym. Vince and you spot each other on Wednesdays; Chase and you spot each other on Fridays. You used to look down on bro nods and fist bumps – but since that’s how gym rats communicate, that’s become the language you speak most often. Work, Gym, Food, Sleep. Over and over. More sweat puddles. More fist bumps. You run hundreds of miles and lift thousands of pounds.

You start to see new people working out here and there and you realize you have done something you once thought impossible: You have become one of the regulars. Once in a while, you are the last one leaving the gym. You make a point to get to the gym earlier, but your workouts start to stretch from one hour to ninety minutes to two hours. You are now routinely the last person at the gym. You run. You lift. You make more puddles.

Your body changes slowly, then all at once – you are suddenly thin and muscular. You hit your goal weight, pick a new one, then hit it again. You go out and buy new clothes. You receive wave after wave of compliments. Your ex tells you that she’s seeing someone else. Your chest clenches. You feel exhausted.

That night you go to the gym. You listen to all her favorite songs. You run farther and lift more than you thought your body was capable of. It is a good workout. It leaves you numb. You go home and eat a single chicken breast and steamed vegetables. You go to sleep. You dream of a bottomless black puddle.

You’ve stopped drinking alcohol months ago, so now when you hang out at bars or parties you don’t talk to anyone new. But with your new body and new clothes, gorgeous women hit on you constantly. One time, a woman literally comes up to you and says she thinks you’d be good in bed and hands you a napkin with her number on it. As she is talking to you, her hand resting on your chest inside your shirt, all you can think of is how badly you need to beat your best time sprinting across the park across from your house the next day. That night when you get home you research the best shoes for trail running and click “buy”. The shoes are a hundred dollars. The phone number goes in the trash.

There is a girl you see a lot at the gym, who always does these weird leg exercises you’ve never seen before. She’s beautiful. You make it a point to not look at her – because you are overly worried about looking creepy like that guy in the blue shirt who never wears underwear and always hangs around the lat pulldown machine – but you notice this girl is always at the gym when you are, and seems to always choose the bench next to you. You turn up the Slayer and concentrate on making your puddles bigger.

Your ex parades her new boyfriend around, flatly ignoring you the entire time. He is taller than you, more ripped than you, better looking than you, and – according to the Greek chorus of your mutual friends – he comes from money. As you watch her introduce him to everyone but you, you remember how her blue eyes lit up underneath the ferris wheel on her birthday when you gave her those bracelets she’s wearing. In your pocket, your hand makes itself into a fist.

That night, you deadlift your body weight. You sneak a photo of yourself in the mirror and email it to yourself with the subject heading “You Are A Warrior”. The next day you are disgusted with yourself and delete it.

You make puddle after puddle after puddle and eat single chicken breasts and work and sleep and the weather gets warm and then gets cold and you know all of Taylor Swift’s songs by heart and the only things that exist in the entire universe are you and The Gym and then something different happens: a night comes where you are not the last person in the gym.

It is you and the girl who does the weird leg exercises. You end up walking out at the same time.

Her name is Melissa and she works in the building next to you. She’s worked there for two years. She asks you out to dinner on Friday, promising it’ll be healthy. The leg exercises are Pivoting Curtsy Lunges.

You start seeing Melissa a lot, both inside the gym and out. You tell no one. You add a couple cheat days to your week – for when you two get dinner and share dessert – and you start getting a lot less sleep. You phase out Slayer in favor of Springsteen. Vince and Chase note that you’ve stopped looking like you’re praying for death when you run. Your ex texts you late at night to ask you out to coffee, but you don’t write her back. You can’t remember the last time you fantasized about puddles.

One night you’re walking Melissa to her car in the parking garage and she is parked up up up all the way on the top floor. She says she wants to show you something and she takes your hand and leads you all the way to the back. You both stand there in the dark looking out over the twinkling lights of the skyscrapers of downtown Los Angeles.

“Isn’t it beautiful?” She says. “All those lights.”

You tell her that yes, it’s beautiful, but it makes you sad. All those pretty lights mean nothing; they’re just shining into cold lonely offices with nobody in them. Melissa squeezes your hand and says yes, each light is an empty office – but they’re only empty because the people have all gone home for the day. All those twinkling lights aren’t sad; each one is a person who’s at home, happy with the one they love. And how romantic is that?

You look at her in the lights and she smiles. Something in your chest expands.

Late one Sunday afternoon you are writing out your rent check and realize it’s been exactly a year since you started working out. You think of all those miles you’ve run and those pounds you’ve lifted and chicken you’ve eaten and puddles you’ve made. It doesn’t seem that bad. You realize that it’s not about hitting a goal weight, or lifting a weight. It’s about being able to wait. Waiting, being patient, and trusting that life will slowly inch along and things will eventually get better. After all, change takes time.

But time is all it takes.

4.) NO FRUIT JUICE
Too much sugar!!!

 

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Let’s be friends, eh?

IT WAS ALL A DREAM 

Thanks for reading and I bet Aaron thanks you too.  I’d be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

 

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