Is this really the best we can do?

Day three of the #DDdailygratitude challenge and already, I’m inspired to share one of my posts in a longer blog form! Unfortunately, the motivation stems from all of the frustration and anger that ultimately turned into my gratitude for the day.

I’m scheduled for a resting metabolic rate test (also known as an oxygen uptake exam, or an indirect calorimetry test) next Friday, but I need to get pre-authorization because many health plans won’t cover the exam. I have been at a weight plateau since April despite working out regularly and monitoring my diet, and so my doctor wants to do this test so that we can better calibrate my nutrition. Basically, we’re checking to see the rate at which my body burns calories while I’m completely at rest, to make sure that my metabolism is behaving the way it should be. The results of this test will help me to make sure that I’m eating enough to support my energy output in my workouts, while still maintaining an appropriate calorie deficit to get my weight down.

The pre-authorization turned into a circus. Aetna couldn’t authorize the test without the appropriate CPT code. The doctor’s office didn’t know it, and billing had to transfer me four times before they could answer my question. Spoiler alert: the Google result for the code was correct and I could have saved myself a whole lot of hold time. When I called Aetna a second time, they gave me a benefit policy code to look up, but basically told me “We won’t cover this, unless your doctor says it’s medically necessary.” However, they couldn’t tell me what “medically necessary” means. Last I checked, the very act of referring me for the test could be considered my doctor deciding this was medically necessary… but I digress.

I looked up the benefit policy to better understand what was going on, and that turned out to be a very, very bad idea. You can find it here in full, if you’re interested. Basically, I would qualify for weight loss medication, no questions asked, but they won’t cover this test because it’s still considered “experimental” or “investigational” for weight loss. Mind you, the benefit goes on to acknowledge that medication works in conjunction with calorie restriction and exercise, and also that weight loss from medication is usually temporary…. but it has the studies to back it up, so it’s all good in their book. However, this test apparently isn’t considered sound science, so Aetna’s having none of it.

A quick PubMed search turned up an article titled “Indirect Calorimetry: A practical guide for clinicians,” which

“Measurement of energy expenditure is the most accurate method to assess energy needs. Indirect calorimetry remains a gold standard in measuring energy expenditure in the clinical settings… To achieve the highest quality of patient care, we should strive for patient-specific nutrition support regiments. Indirect calorimetry offers a scientifically-based approach to customize a patient’s energy needs and nutrient delivery to maximize the benefits of nutrition therapy.” [Nutr Clin Pract. 2007 Aug;22(4):377-88]

Meanwhile, a systematic review of energy expenditure studies, published in Obesity Reviews in 2012, turned up this endorsement of using indirect calorimetry to get more accurate information for patients:

“Today, many health professionals including dietitians typically use prediction equations because of ease of use, low cost and decreased participant burden, but emerging evidence is reflecting great disparities between predicted and measured energy values… The level of inaccuracies of prediction equations that are commonly used in clinical practice may potentially impact patient outcomes… As health professionals seek to improve their quality of service and provide appropriate nutrition care to prevent clinical morbidity and mortality, measuring energy requirements through IC [indirect calorimetry] may be the direction of the future.” [Obesity Reviews, 13: 753–765. doi:10.1111/j.1467-789X.2012.01000.x]

(In case you’re wondering, this is what happens when you’re someone who is naturally curious, who enjoys learning about interesting topics, who believes in doing the research on her own health, AND who also happens to work in academic publishing. Doctors either love me or hate me. There’s no in between.)

So, basically, I was in a really bad place when I called my doctor’s office for the third time today. I had a phone number from Aetna, and I needed my physician to call and make the case for medical necessity, so I’m not on the hook for $200. And that’s when today’s moment of gratitude stepped in.

daily gratitude day 3.jpg

The woman I spoke to this third and final time was so kind. She took down all of my information, and she reassured me when she let me know that she processes requests like this all the time. My doctor is at a conference through Monday, so she told me she’d share the message then, and she also promised to follow up with me herself Monday afternoon, even if she didn’t yet have an answer, just so I’d know where things stood at that point. She listened. She cared. It was so unlike every other conversation I had experienced so far today, and I was so grateful to her, I burst into tears. (What can I say? It’s been a long week.)

It’s a sad commentary on the state of our health care in this country that I had to jump through so many hoops today, and an even sadder commentary on human behavior in general that I felt so surprised and relieved to finally experience a little kindness.

We’ll see how this all plays out. I’m probably going to move forward with the test either way, just to know exactly where my metabolism stands, but I’d feel a hell of a lot better if it didn’t set me back $200. More to come!

In the meantime, it’s not too late to jump on this Daily Gratitude plan. Thanks to @thedaydesigner for pulling this together, and for making awesome planners – check out their website here. I love that they offer free printables so you can see how the layout works for you before ordering the full planner. I’ve been using their Daily Planner printable for almost a month and I love it, and I can’t wait to order my 2017 Planner!

Pick your battles

I’ve tried a lot of fitness-y things over the past 3-4 years. One of my personal philosophies in life is that I’ll try anything twice, because one time is just not enough to conclusively decide that you hate something. It’s that second, third, and fourth attempt that pushes you further outside of your comfort zone, past the initial gut reaction to a place where you can actually assess if this is something you might grow to love. (For the record, I feel this way about pretty much everything in life – food, books, travel destinations. That first-time reaction only tells a very small part of the story, and you need to give everything at least a second shot before making a final decision.)

Sometimes this philosophy helps me out. For one example, consider my GHD panic, documented in my last post. I went from actual tears-in-my-eyes panic over the machine, to grudging respect, to now actually loving the equipment. I had a similar moment with handstands last night at Crossfit.

The Crossfit box I go to (Crossfit Iron Spider in Salem, MA – not remotely convenient to where I live or work, but I absolutely adore the coaches and the members, so I’m hooked and I tolerate the traffic. Seriously, it’s that good.) posts the WODs on their website the night before, and on Monday night, I saw that handstands were on the menu for Tuesday’s workout. Bear in mind this was my first day back at the gym after eight days off, so I was already a little skeptical about how the workout would go. Throw in handstands, and I started talking myself out of the workout before it had even started.

Turns out handstands aren’t terrible. Now, I didn’t actually manage a real handstand. I did the modified wall walk-up, which isn’t nearly as awful as it sounds, aside from the fact that I was walking up a whiteboard wall which doesn’t exactly have traction or grip. The problem, though, is that my upper body is my weakest area, and I’m not exactly a petite individual. Supporting my weight on my arms? It’s a tricky situation. I really struggled with getting my body up to near-vertical against the wall, because while I could walk my legs up without any trouble, when the time came to move my hands in closer, I just couldn’t do it. It’s partially a strength issue and partially a mental block – I’m convinced that the second I try to move one hand closer, thereby shifting all my weight to the other hand, I’m going to come crashing down face-first onto the floor. It needs work – a LOT of work. But I’m excited to keep working on it. I expected to hate everything about the handstands, but instead it has become another item to conquer as I keep working out at the box.

Every coin has a flip side, though, and that brings me to the item that I think I need to break up with once and for all: running.

Here’s the thing – when I say I hate running, it’s not because I’m slow, or because I’m not good at it. I genuinely hate everything about it. Nothing causes more knee pain than running. Last night’s WOD incorporated 100ft jogs in between activities, so I probably ran just around a quarter of a mile total over the course of the workout – and today I brought an ice pack to work to keep on my knees because they’re so angry with me. I also just can’t find the mental peace, the “runner’s high,” that so many people claim exists. Most of the time I find workouts almost therapeutic. I zone out, I find peace, I finally shut up all the voices in my head. Yoga class, spin class, alone at the squat rack – you name it, I will find it calming. Except for running. The entire time I’m running, the voices in my head scream at me. “We HATE this. This is TERRIBLE. This HURTS. WHY are you doing this?”

There’s this sense that everyone who wants to be fit should also be a runner. I caved to the pressure, too – witness the great half marathon debacle of 2015. I felt like distance running was something I HAD to do if I was going to legitimately call myself someone who’s interested in fitness.

Guess what? That’s just not true. I could put my running sneakers away and never touch them again and still be fit. I actually GAINED weight while I was training for my half marathon, because running left my body so sore and beat-up that I didn’t have the stamina to cross-train or do any of the things I really loved to do. Give me a Soul Cycle class where I’m actually enjoying pushing myself to improve. Throw me on an erg and let me row a 5K. I’ll happily do incline intervals on the treadmill as long as I don’t have to go over 3mph, and I’ll hike in the great outdoors all day long, as long as you give me a map and some bug spray. But running? Nah. I’m good.

So sorry, running, I’m just not that into you. I’ll have to check in with you from time to time when you end up in a WOD, but I’m not going to seek you out anytime soon. Life’s too short to waste time on something I hate, and there are too many other opportunities that I haven’t tried yet.

I’m baaaaack!

Didja miss me?

I don’t have any good excuse for the lack of posting over the past month. Family issues, holiday stress, and a much-needed vacation all kept me away from this blog, and I’d apologize, but the truth is, I needed some time away from everything. I drafted and discarded multiple attempts at a 2015 resolutions post to kick off the year, but it felt disingenuous to share a resolutions post when I truthfully hadn’t yet gotten myself into the right mindset.

The good news? I’ve spent a lot of time reflecting on the things that I’m doing right, and the things that I need to do better, to continue improving my overall health and wellness in the new year. I finally feel like I’m at a place where I can fully redevote myself to the mission of this blog and, by extension, get back into the flow of blogging.

So what do my 2015 resolutions look like? I only have one: Don’t make any resolutions! 

I’m 29 years old, turning 30 in a few months, and I have a life that is super jam packed and constantly evolving. What seems like it’s a good fit right now may not still work for me in a few months, so a year-long resolution feels like I’m setting myself up to fail. I have the best successes when I’ve got a regular forum to check in with someone else – whether that’s a nutritional counselor, a fitness group during a challenge, or just a friend who agrees to be my accountability partner. Those external check ins really help me to refocus on what I’m trying to achieve, so I’m going to approach 2015 similarly.

On a regular basis – at least monthly – I’ll sit down and reflect on how things feel. What’s been going really well? Where have I been slipping up? Am I bored with any aspects of my fitness routine? What can I do to freshen up my day to day activities to keep myself invested in my own journey? I’m also looking into a therapist who specializes in disordered eating and body image issues. The stress of the past few months made me realize that I’m still very much at war with my impulses toward emotional eating, and this isn’t something I can fix on my own. I’m looking forward to the coming months, and to inviting you all along with me as I continue to figure it all out.

What are some goals you’re currently working toward? Do you make resolutions?

Emotional Eating: Why Can’t I Quit You?

Emotional eating has always been my biggest nemesis in the battle to improve my diet. Food has seemingly always been tied to how I’m feeling. Birthday celebrations centered around decadent cakes covered in sugary icing from the local Italian bakery. Stressful periods meant that stopping for fast food could be excused away by my busy schedule. When someone in my family was sick, or after a death, friends and neighbors would come bearing gifts of food – bags of bagels and cream cheese, trays of lasagna, deli platters to feed an army.

Weight Watchers is capitalizing on this right now with their current ad campaign. I have tried their programs in the past and it didn’t work for me, but I know there are a lot of people who swear by the company. Sharing this video is in no way an endorsement of their methods; it is, however, a great piece of advertising and one that hits home with today’s topic.

I’ve mentioned this a few times recently, but my family’s been going through a rough patch lately. My father had surgery last week, and it’s been difficult to keep up with a sense of normalcy with everything that’s been going on. I tend to internalize things like this, which is not to say that there haven’t been incredible displays of support and friendship from the people I care about; I just tend not to talk much about things like this when they’re going on. So, instead, I go to war with the grocery store. Ice cream? Chips? Homemade chocolate chip cookies? All things that were on the patient’s wish list for recovery snacks, and I had zero mental energy to find the willpower to resist adding my own treats to the cart when shopping last week.

So here we are. It’s been a week since the surgery, and I feel gross. I haven’t been eating well, I’ve been drinking way too much wine, and my body is letting me know that it is displeased. My pants are feeling tight, I have no energy, and I can’t find the willpower to get back to my normal healthy eating and exercising routine.

This latest incidence of emotional eating has helped me to see that I need to focus more on the mental side of all of this. I know what I need to do to lose weight and get in better physical shape, and I am totally capable of doing all of those things. What I need to figure out know is how to maintain those habits and not let outside forces shake me to the core. Life happens and I need to learn that turning to comfort foods not only won’t comfort me, but it will make me feel worse in the long run.

I’m making this one of my priorities for the coming year and I’d love suggestions from others who have dealt with this in the past. Any books that particularly worked for you? Techniques to try? Should I just suck it up and try therapy? Advice is welcome, and much appreciated!

Fitnasty for Life
I’m teaming up with Carolyn over at Fitnasty for Life to get #Fit4Fifteen – check out the linkup!

Do you battle with emotional eating? What has worked for you?

Festive Starbucks Swaps

Confession time: I am a sucker for the Starbucks red cups.

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I anxiously await the rollout of the holiday cups every year, because they signify the return of my favorite indulgences – gingerbread and eggnog lattes. I love these coffee options, but I also know that they are so unspeakably bad for me. This year, I set out to find a way to enjoy the flavors of the season without completely destroying my healthy eating habits.

I always order my gingerbread latte with nonfat milk and request no whipped cream, but the gingerbread syrup still packs a wallop. A grande nonfat, no-whip gingerbread latte clocks in at 200 calories and an insane 36 grams of sugar. WHAT?! My Fitness Pal recommends no more than 50g  of sugar on a daily basis, and I try to avoid anything with added sugar – usually my sugar macros come from natural sources, like fruit.

The good news? The gingerbread syrup is so strongly flavored that you don’t need the full amount to get the flavor of the drink. If you’re at Starbucks, you can request one or two pumps of syrup instead of the full amount, which will dramatically reduce the sugar content. OR, you can ask about buying a bottle of the syrup to take home! The bottles retail for $12.95 and will last you all season. Stores aren’t always able to sell the syrup to customers, as it depends on how much they have in stock, but you can also order the bottles through Starbucks’ online store. I own a Verismo, the Starbucks-branded at-home latte machine, and I make my latte using half a tablespoon of gingerbread syrup. Along with the milk and espresso pods, my latte comes in at only 9 grams of sugar – 75% less than the in-store version, and just as satisfying.

I’m also a huge sucker for the eggnog latte. Starbucks tried to remove these from the menu this year, and the backlash was so strong that they re-added this drink to the holiday options after only a few days. Starbucks makes this drink with a ratio of 2/3 eggnog and 1/3 skim milk; this recipe results in a drink that clocks in at 460 calories and 48 grams of sugar for a grande. Ouch. When I order the drink in the store, I ask them for 1/3 eggnog and 2/3 skim milk, which helps, but the reality is that eggnog is such an unhealthy treat that the drink is still a calorie and sugar bomb. I limit myself to one a season, and enjoy it for all it’s worth.

To enjoy eggnog options at home with less guilt, I turn to So Delicious Vegan Eggnog. I love So Delicious products; their unsweetened coconut milk is a staple in my pantry. This eggnog is coconut milk based. It’s still in the treat category, with 14 grams of sugar in a 1/2 cup serving, but at 90 calories per serving and 3 grams of fat, it’s a significantly better choice than the average dairy-based eggnog. I like to use a splash of this in my coffee and top with a grating of fresh nutmeg to get that holiday vibe without the full indulgence of the Starbucks version.

What are some of your favorite holiday treats? Any other tips for enjoying a holiday indulgence with less guilt? 

Disclaimer: I did not receive payment for any of the products mentioned here – they’re things I love, but no one asked me to write about them!

Thanksgiving Strategy

It should come as no surprise to anyone that I love Thanksgiving. I didn’t get to this place by skipping the stuffing and mashed potatoes, folks. I love food, and Thanksgiving is filled with some of my favorite things to eat. I want to make sure I enjoy the holiday, but I also don’t want to overdo it. I have my #6W2C midway check in on Saturday and I would hate for lingering turkey belly to show up for measurements! I’m sure I’m not alone in this, so I wanted to share some of my ideas for staying on track this week.

surviving thanksgiving

 

Make smart swaps. Wherever possible, I’m looking at our planned menu and identifying ways that I can save calories without sacrificing flavor. Here are a few of the things I’ll be doing on Thursday:

  • We always make spinach dip to eat during the early football game. The traditional dip is loaded with calories – mayo AND sour cream! served in a bread bowl with more bread on the side! – but there are ways to lighten it up. I’ll double the amount of spinach so that more of the bulk comes from veggies than from dip, and I’ll be using greek yogurt in place of the sour cream. I’m also providing cut up veggies alongside the bread for a healthier option to dip.
  • My family’s stuffing recipe is built around Jimmy Dean sausage, because there’s no better way to stuff a turkey than with some dead pig (delicious, delicious dead pig). My father would disown me if I tried to mess with this recipe, so I had to look for other ways to lighten up our family gathering. I decided that rather than pan searing the brussel sprouts in bacon drippings, I would roast them with butternut squash and olive oil. No need to incorporate more unnecessary pork products (though delicious. so, so delicious) into an already caloric meal!
  • I’ll be cutting way back on drinking during the day. I love beer during football as much as any girl, and who doesn’t love a bloody mary when prepping the turkey to go in the oven? But at the end of the day, I don’t want to waste calories on alcohol. I picked out a delicious wine to savor with the meal, but otherwise I’ll be sipping soda water throughout the day.

Get out of the kitchen. It’s really tempting to spend the whole day hanging out in the kitchen. We have an open concept kitchen/family room, so it would be really easy to spend all day either sneaking bites of stuffing from the bird (salmonella? what’s that?) or hanging out on the couch watching football. Instead of giving in to this, I like to plan activities into the day. I will be meeting my cousins for coffee in Boston in the morning before we all head off for our holiday plans, and I’ll take advantage of the opportunity to park away from the coffee shop so I can enjoy a nice walk. I’ll also take the dog out for an extra-long walk midday. This will help both of us – he’ll need to let off his pent up energy, and I’ll walk off some of my football snacks before the big meal. (Let’s just hope Boston weather cooperates and doesn’t rain out these plans!)

Choose a smaller plate. This is my favorite trick, even though it drives my mom absolutely up a wall. Plates have gotten steadily larger over the years, and the average dinner plate is so big that it’s easy to overeat. I really do like to have a little bit of everything from the Thanksgiving table, so if I start with a smaller plate, I can fill it with my favorite foods while forcing myself to use smaller portions. It makes my mom crazy that my plate doesn’t match the rest of her table setting, but it’s a strategy that I use all the time in my regular life. Smaller plates = smaller portions!

Take time to enjoy the day. Yes, the meal is a highlight of the day – but it’s not the only thing to enjoy. Make sure you’re taking time to appreciate the people that you’re spending the day with. Share what you’re grateful for over dinner. Catch up with the family members you haven’t seen in a while, and reflect on the previous year. The more the conversation flows over dinner, the more time you’ll take to eat your meal. You spent all day cooking, so dinner shouldn’t be over in twenty minutes! By taking time to enjoy the company and the experience of the meal, you’ll naturally slow down the pace at which you’re eating, and that will give your body time to realize that you’re full. Wait to take seconds – chances are you don’t actually want the extra portions!

Stay active this week – No excuses!  I planned out my workouts for the week, and I will follow through on every commitment, no matter what. I’ve been battling a sinus infection and it’s really tempting to just drown myself in Sudafed and hide from the world, but this week it is especially important to follow through on my workout plans. I’ve got a good mix of cardio and strength training Monday through Wednesday. I’m kicking Thanksgiving day off with an early spin class, and I’m signed up for Turkey Bootcamp with a group of girlfriends for Friday morning. Staying active this week will help me to think about my long term goals and make the right choices elsewhere in life.

Most importantly, remember that this is only one day out of the year. Practice moderation and make good choices, and remember that this day should be about enjoying the time you get to spend with the people you love. Plan for success, but don’t get so caught up in making healthy choices that you forget to savor the day – and the meal.

How are you setting yourself up for success this holiday season?

Finding the why

As I mentioned last week, I’m doing another Six Weeks to Chic challenge at Studio Poise. I’ve done this challenge twice before, once in Summer 2013 and again in spring of 2014, and I’ve been really happy with the results both times. I’m very excited to be kicking off another challenge and looking forward to holding myself to a higher standard for the coming weeks, in the hopes of resetting my habits on the healthier track.

As I embark on this challenge, I thought about sharing another #MotivationMonday post jammed with Pinterest-worthy quotes and sources of inspiration, but then I realized that I would benefit more from deeper reflection about why I decided to tackle another challenge. For each of the previous sessions, I had a clear goal in mind.

The Summer 2013 session coincided with two weddings. I was motivated to look my best for those events, and participating in the challenge kept me on target while traveling. I even managed to convince some of my friends to rent bikes to ride around Sonoma wine country during one of those wedding trips! We got to see more of the beautiful vineyards this way, and the ride also offset the calories consumed at the vineyards we visited (because you can bet that I wasn’t spitting out those wine tastings!) If you’re ever in Sonoma, I highly recommend this plan – we rented from Sonoma Country Cyclery and had a great time. vineyard bikes

For Spring 2014, the challenge’s conclusion coincided with my 29th birthday. I had planned a big birthday event at Cadillac Ranch and had about 20 friends coming together, so I was super motivated to look and feel my best. I wanted to be in great shape heading into the summer, and that was enough to keep me on target. I loved how I felt after that challenge, and I actually did a pretty good job of continuing to follow the meal plan through most of the summer.

Kindly disregard the wolf wall behind me. My birthday party was at Cadillac Ranch, and this is their standard decor...

Kindly disregard the wolf wall behind me. My birthday party was at Cadillac Ranch, and this is their standard decor…

However, as I head into this challenge, I’m in a very different place. As I’ve previously acknowledged, this fall has been really rocky for me. I’m not maintaining good habits in my diet, I’m not making it to as many classes, and I generally feel like I’ve let my health become less of a priority. I signed up for the challenge to get back on track, but if I’m really going to stick with it, I need to spend some time considering – why do I want to get back on track? 

We all need to find our own why. In the past, I’ll admit, my motivation largely had to do with my physical appearance. I wasn’t happy with how I looked. As I’ve progressed, though, I’ve realized that this is about so much more than the size of my jeans. I’m gaining real benefits from living a healthier lifestyle, and I need to remind myself of those gains so that I can push myself through the times when it’s all to tempting to give up.

So, what’s my why? Good question.

I feel more energized when I’m eating well and exercising regularly. Anyone who knows me will agree that I tend to commit to too many things. I have a demanding full time job, I serve on the board of directors for a youth leadership organization, and I like to fill my free time with adventures, whether that means visiting friends in New York City or trying new fitness classes. It might seem counterintuitive – time spent exercising is time that I can’t devote to these other commitments! – but skipping my healthy habits actually made it harder to keep up with a demanding schedule. I need to take care of my body if I’m going to put such crazy demands on it!

I sleep better when I’m following a healthy living routine. I have had problems with insomnia my entire life. I took ambien for a while, and even did a sleep study a few years back to try to ascertain why I felt tired all the time. When I am exercising regularly and eating healthy meals, I found that my sleep problems basically disappeared. I was falling asleep more easily, I wasn’t waking up multiple times throughout the night, and I felt well rested when my alarm went off in the morning. All that has flown out the window over the past few months. I lay awake for an hour or more trying to fall asleep every night, and I hit the snooze button multiple times every morning because I don’t want to get out of bed. I’m hoping that restoring my wellness habits will also lead to better sleep.

My mental health benefits when I’m taking care of my physical health. The hour a day that I spend working out is one of the very few opportunities I have to unplug and turn off my brain. When I’m on the mat, or riding a spin bike, or shimmying in a Zumba class, I’m not worrying about my clients or thinking about my to do list. I turn everything off and just let myself enjoy the moment. When I don’t work out, I lose that opportunity to tune everything else out, and it has a noticeably negative impact on my overall mental health. Stressful situations impact me to a greater degree, and I had a more negative outlook on life in general. When I’m making healthy choices, though, it has a trickle down effect and dramatically improves my ability to maintain a positive mentality and attitude.

There’s more to all of this than the size of my clothes. I’m going to be constantly warring with myself over this. I can’t deny that it feels good to reach for smaller sizes when I’m shopping, and I do appreciate receiving compliments on how I look, but that can’t be my primary motivation for pursuing fitness and wellness. I honestly don’t consider myself a vain person, and I would like to think that I’m not someone who is overly concerned with appearances, but I can’t deny that my own appearance has been a driving force in fitness endeavors for my entire life. This is the area I really want to personally focus on during this challenge – concentrating on my whys and the benefits of wellness and celebrating those, instead of glorifying the size of my jeans. 

To further help with my accountability through the holidays, I’m joining a linkup hosted by Fitnasty For Life, joining with other bloggers as we work to get #Fit4Fifteen. I’ll update this post with the link up when it’s available at the end of this week!

 

So tell me in the comments… What’s your why?