Insurance wouldn’t cover a GLP-1 for my rheumatoid arthritis. It changed my life.

Cassandra Smith has rheumatoid arthritis (RA) and knows all too well how debilitating the autoimmune condition can be. Her grandmother died of complications from RA, and in the last few months of her life, it was Smith who served as her caregiver, administering doses of methotrexate to treat her pain and inflammation. The drug, a form of chemotherapy also used to treat cancer, is so potent that Smith had to wear gloves to safely give it to her grandmother. So, when Smith’s doctor told her she too would probably have to take methotrexate long-term, her heart sank. “That was so scary for me,” she tells Yahoo.

Smith’s RA and weight — 311 pounds — were “double negatives” against her health, her doctor said. She had to lose the weight. And so Smith started following the Mediterranean diet, losing 5 or 6 pounds in the process. But that wasn’t nearly enough to alleviate the excessive inflammation and pain in her joints during flare-ups, which could last as long as four months. Smith was in constant pain. Some days, she couldn’t go to work. Other times, she was physically incapable of playing with her 4-year-old daughter. “It was stress on top of stress, and those are some of the main triggers of a flare,” Smith says.

GLP-1 weight loss medications haven’t been approved to treat rheumatoid arthritis. But they’ve demonstrated great power to reduce inflammation. While Smith’s insurance wouldn’t cover the medication (deeming it for “cosmetic weight loss”), she got a prescription for compounded semaglutide from a local provider and, later, compounded tirzepatide from an online provider.

Seven months later, Smith, 30, hasn’t had a single arthritis flare-up. “I’ve been able to come off my rheumatoid arthritis medicines — and these are medications that people never come off of,” she says. It’s the biggest way that Smith’s life has changed since starting a GLP-1, but far from the only shift. For this installment of the Yahoo series On My Weigh, Smith explains in her own words how the medication has helped her teach her daughter healthy eating habits and given her the clarity she needed to leave the teaching job that had burned her out. “Since being on a GLP-1, I put myself and my mental and physical health first,” she says.

The weigh-in

• The method: Compounded tirzepatide, 7 milligrams

• The goal: My 4-year-old daughter wanted to do all kinds of things that I wasn’t physically able to do with her. She was missing out, and I just wanted to change that and be able to play with her. And I wanted to get off of methotrexate, the potent medication I was taking for my rheumatoid arthritis.

• Progress report: I feel amazing. My inflammation levels are down, I’m happier and I haven’t had a single arthritis flare-up since I’ve been on tirzepatide. I’m full of energy, I’m back to loving going out and dressing up — I just see myself. I’ve lost 69 pounds in seven months, and the other day I was able to put a towel all the way around me to cover up. I don’t think I’d been able to do that since high school.

• Food noise volume: Before starting tirzepatide, my food noise was an 8 out of 10. Until recently, I was a full-time schoolteacher, plus I’m a full-time mom and girlfriend to a full-time musician. Staying busy kept my food noise at bay. But when I did want to eat, I wanted to eat the wrong way. Now that I’m on a GLP-1, I can’t say my food noise is completely gone. But it’s at about a 3, and when I do have cravings, it’s for taco salad, or soup or broccoli. It’s very weird.

Day in the life

Rise and shine

Prior to my GLP-1 journey, I woke up in pain every morning. I had to wait about 15 minutes before I could physically get up and move out of bed. I was so angry at my body. I felt like I was too young to be waking up in pain.

Now, I just jump up. I wake up at 5:15 a.m., go to the bathroom and jump on the scale. Then I tell my social media followers, “Good morning, this is going to be a good day.” I get my daughter up at about 6:30 a.m. I’m happy, and I go into her room refreshed because I’ve gotten a good night’s rest.

First bites

I used to have a bacon, egg and cheese croissant, hash browns and a large iced coffee from Burger King or McDonald’s.

Now, I might get similar things when I eat breakfast out, but I no longer get full combo meals. I don’t drink coffee or sodas. I just have hydration packets in my water that I bring from home.

At home, I make eggs with some kind of meat or protein. Sometimes I’ll still have a croissant, but I purchase them from Sam’s Club now. They have fewer calories and 16 grams of protein. Even though I’m not always cooking, what I’m eating is better-quality food. And I make sure I’m always getting protein with breakfast. I’m setting myself up for success with that first bite, rather than eating those potatoes and iced coffee that are going to have me crashing by 12 p.m.

Get ready with me

Before, everything I wore was very dark. We all know that black covers up everything. I would just throw on some sweatpants or joggers and just go.

Now, I actually care what I look like. I wake up earlier, because I want to have time to choose colors that I feel good and comfortable in. I like to wear a lot of different patterns. Prior to my major weight gain, I used to be a girl who loved heels. I’m slowly getting back into heels and jewelry, because I feel beautiful again.

Make a move

For about four years, before I started my GLP-1 journey, I had a gym membership that I never used. Now I know that gym life just isn’t for me. I’ll go every now and again, but it’s not a long-term solution because it’s not something that I enjoy.

But now I am in a season where I want to do things that I enjoy and that are good for me. Since starting my GLP-1, I’ve canceled my gym membership. Instead, I’ve been trying to incorporate things that I can maintain into my day-to-day routine — things like taking daily walks with my daughter and going to the park and playing with her. I have weights, a squat machine, a sit-up machine and a foldable elliptical all at home. When I feel like it, I go downstairs and work out. But I don’t want to put myself back in a position where I’m doing things just because people say I should. I want to be the captain of my own boat.

Dose time

I’m actually on a whole peptide stack, which is a set of several injections my doctor prescribed to help optimize my health. So, every Monday, I take my tirzepatide, Lipo-C [an amino acid and vitamin injection that is not approved by the Food and Drug Administration but has shown some promise for weight loss in research] and anti-aging NAD+ injections. Wednesday, I take the NAD+, Friday, I take NAD+ and Lipo-C. I feel like I have a really good stack, and it is prescribed by a real doctor. I think it helps me to feel like the best version of myself.

I consider Sunday nights my cheat night. I’ll eat something more fatty than usual, like a taco salad (but I’ll actually eat the shell), or I’ll have Olive Garden cheese ravioli with marinara sauce. I try to give my body something to eat the night before I take my medications. My cravings are stronger right before my shot days. But I’ve been able to train myself to be disciplined while having grace for myself and understand that it’s OK to eat things that you enjoy. Plus, now I crave things that I love and that are healthy.

Let’s do lunch

My pre-GLP-1 lunch was a burger, some fried chicken nuggets, hot wings — anything fried, that was quick to grab-and-go or pick up from the drive-through. Cooking was just never my concern back then.

Now I actually take the time to cook instead, because I’ve realized that if you fail to plan, you plan to fail. A typical lunch these days is whatever I didn’t eat the night before for dinner. We all know that those of us on GLP-1s don’t eat as much and we always have leftovers. So, I’ve learned to love them. I never used to eat them, because I was going to fast food restaurants a lot — and who wants to eat McDonald’s the next day? Every now and then I’ll splurge and get some sushi.

Happy hour

Before starting tirzepatide, I didn’t really feel like I had free time. I spent a lot of it sleeping. I felt mentally drained from dealing with kids all day (much as I love them) and crashing from what I ate. I would get home and just sleep. I called it hibernation.

Now, I feel like I have more time — and did even before I quit my job. I enjoy going to Ulta and looking at new skin care, or going window-shopping at TJ Maxx. I know I’m still transitioning sizes, so I restrain myself from buying too much.

Any time spent with my child is quality time for me. But now it’s actually quality time for her. She doesn’t have to just sit in bed and watch TV because that’s all I physically can do. We’re going to the park, we go on nature walks, we go to my parents’ house in the middle of the week because I have the energy to drive there, instead of being too drained because I ate potatoes in the morning.

The quantity of time with her hasn’t changed, but the quality of it has changed drastically. It’s more intentional, and she gains more out of it.

Dinner bell

I never had enough time in the day to really focus on what to eat before my GLP-1 journey. It was just, Throw it in the microwave, throw it in the oven. When I went out for dinner, I used to love to get steak. But when I found out that I had rheumatoid arthritis, steak would cause me to flare. So I stopped eating it.

Now, my go-to protein is salmon, with a veggie, and they’re both cooked in my house. As soon as I began taking tirzepatide, I started to make sure protein was in every single thing I was eating. That first month or so, I tracked everything. But I learned how much protein and how many calories were in the things I was eating — as people on GLP-1s, we eat the same things over and over — and it just became second nature.

My doctor taught me to stay on the outside aisles of the store when I go to the grocery store. As long as you stay on those walls, you’re eating fresh fruits, fresh vegetables, fresh meats and fresh eggs. If you’re buying food from the center of the store, the more sodium and calories you’re getting in those processed foods.

Having a 4-year-old daughter, it’s so exciting for me to be able to raise her in a way that I wish I had been raised. Cooking is a whole activity for us, and for her, cooking healthy food will be normal. I get to create that generational knowledge with my daughter and save her from having to be on a GLP-1 later, because she has had the opportunity to learn to eat the right things from the beginning. She asks if we’re having salmon and broccoli for dinner. Today, my sister picked my daughter and my nephew up and they went to McDonald’s. My daughter didn’t want anything. She understands, at 4 years old, that we don’t eat that. My mom makes treats for major events, and sometimes she’ll eat some of the extras. My daughter will be like, “Grandma, you shouldn’t eat that!” My mom says, “Get this little girl, she’s doing too much!” But I love it. I know that, even when I’m not present, the things I taught her still matter.

Let’s get the bill

Before I started taking tirzepatide, I was spending a lot of money eating out every day with my daughter. At Chick-fil-A, we were spending $25 on one meal. It added up to about $800 a month. And on top of that was the junk I was buying at the grocery store to stock up the house. It probably totaled about $1,200 a month.

Luckily, Shed, my provider, has really good prices for GLP-1s. I spend about $300 a month on my medications. Ultimately, I’m saving money. My budget is better, and I’m able to invest more and help the people around me more because I’m not going out every day spending money on food. The bill is amazing. I love the bill.