Why Your Self-Diagnosis of a Gluten Sensitivity Is Probably Wrong

Posted on May 21, 2014 by Jonah Soolman

I have a fear of needles. Before my surgery, I went for an MRI and the technician told me she would be using contrast dye. Great. Because even the sight of needles freaks me out, I looked away as she inserted the IV. Although I could feel the IV in my arm the entire time I was in the tube, I managed to never once glance at it, as I knew that would send me into a panic.

As soon as the scan ended, I anxiously asked the technician to please hurry and take out the IV. She looked at me confused, then gently explained that I did not have an IV. She had given me a shot, not an IV, and the needle was long gone before the test even started. The sensation of an IV in my arm during the MRI was concocted by my own imagination based on my belief that such an IV existed.

Our susceptibility to the power of suggestion is not a source of embarrassment or shame. Although I am no expert in the field of psychology, my life experience suggests to me that virtually all (if not literally all) of us experience placebo/nocebo effects in one way or another. Seems to me it is just part of what makes us human.

This element of our nature is a major confounding factor with elimination diets and self-diagnoses of food sensitivities. Your perceived gluten sensitivity is probably off base, just like the sensation I felt in my arm from a non-existent IV, because of your expectations.

Before I continue, I want to interject that despite the Business Insider article that came out recently entitled “Researchers Who Provided Key Evidence for Gluten Sensitivity Have Now Thoroughly Shown That It Doesn’t Exist,” gluten sensitivities do seem to exist. One of our colleagues, for example, was having such terrible migraines that her medical team wondered if she might have a brain tumor, but she came to find out that a sensitivity to gluten was causing the attacks. Since going gluten-free seven years ago, her migraines have completely disappeared.

So while the article’s title is an overstatement, the research study behind it hints at an important point: Gluten sensitivities are much more rare than today’s culture would lead us to believe.

Patients of mine have blamed their symptoms on gluten. After they made an effort to eliminate gluten, their symptoms resolved. Here’s the thing though: They were still eating gluten; they just did not realize it. For example, some patients correctly knew that wheat contains gluten, yet they continued to consume certain wheat-free grains and products not realizing they still contained gluten.

A very common and specific example is Ezekiel bread. Because of the bread’s marketing, some consumers associate the bread with health. Because of misinformation (According to research reported in the October 2013 issue of the Tufts Health and Nutrition Newsletter, 35% of people who buy gluten-free products do so because they believe them to be “generally healthier” than their gluten-containing counterparts, while 27% believe going gluten-free will help them lose weight. Both of these generalizations are incorrect.), they also associate health with gluten-free. Therefore, by the transitive property, they assume Ezekiel bread is gluten-free. But it isn’t; Ezekiel bread is loaded with gluten. The first ingredient is wheat, the second ingredient is barley, and the manufacturer even adds extra gluten, presumably for a protein boost or for texture reasons.

It seems, therefore, that these patients felt better because they expected to feel better or for some other reason, but not because of gluten itself.

If you are concerned that gluten might be problematic for you, make an appointment to see your doctor to discuss your concerns and legitimate methods of testing. In the meantime, continue consuming gluten, as eliminating gluten prematurely can make diagnosing a real gluten issue more difficult.

If it turns out your self-diagnosis was wrong, don’t feel bad. Remember, we all imagine that proverbial needle sometimes.

Beef and Broccoli

Posted on May 13, 2014 by Jonah Soolman

As a dietitian, I am neither for nor against vegetarian and vegan lifestyles. I have seen too many people take different paths to health to pretend that one road is right for everybody. I am for whatever works for the patient sitting with me at any given time. What I am against though are misleading oversimplifications, such as a meme I saw that posed the question, “Do you really need to eat meat to get protein?” followed by single bites of beef and broccoli and the accompanying statistics that beef contains 6.4 grams of protein per 100 calories in comparison to broccoli, which contains 11.1 grams of protein per 100 calories.

Let’s look closer at the numbers. According to the USDA National Nutrient Database, 100 calories worth of raw broccoli contains 8.31 grams of protein (or 6.83 grams if cooked), not the 11.1 grams reported in the above meme, but let us pretend that the protein content in the graphic is correct and go with it. Broccoli is so low in caloric density that it would take eating 3.25 cups of raw broccoli in order to ingest 100 calories of the vegetable. That means that a 150-pound individual, whose protein needs are likely at least 68 grams per day, would need to consume 20 cups or more of raw broccoli in a single day in order to meet his or her protein needs. Good luck.

In comparison, one would only have to consume 1.75 ounces of steak to reach 100 calories. According to the USDA Nutrient Database, that amount of steak would provide 13.66 grams of protein, not the 6.4 grams reported, although I can imagine that variables like the specific cut of beef and utilized preparation method are possible explanations for the two-fold discrepancy. Either way, the math shows that steak is a much more concentrated source of protein than is broccoli.

By showing one bite each of steak and broccoli side by side, the picture leads one to assume that the protein contents being compared are found in those two forkfuls of food. Think of how fast we breeze through our social media feeds. Honestly, how many people do you think pay attention long enough to disconnect the text from the graphics and realize that grams per calorie are being compared, not grams per bite? Conversely, how many viewers do you think take a quick glance and then move on, left only with the false impression that broccoli is a source of concentrated protein?

Changing the illustration to one that shows a piece of steak approximately half the size of a deck of cards next to a pile of raw broccoli almost the size of two Ben & Jerry’s pints would better represent reality, but that would not look so good for the vegan argument. I think we can safely assume that the creators of the meme realized this, hence their decision to instead opt for the misleading fork graphics.

The issue at hand is not one of animal versus vegetable. The point is that in our culture of fast-paced memes, Tweets, headlines, and soundbites, true meaning often gets skewed, either unintentionally or purposefully in order to fit an agenda. Despite the inconvenience of vigilance, taking the time to really consider and understand a post before clicking the share button can spare ourselves and our connections a great deal of confusion and misunderstanding.

Looking the Part

Posted on May 7, 2014 by Jonah Soolman

Wow, I am hard pressed to remember an instance when something I read made me as angry as Juliann Schaeffer’s article in Today’s Dietitian entitled “Dietitians and Their Weight Struggles.”

In summary, the article contains quotes from dietitians who offer their opinions as to whether or not a dietitian’s weight and appearance should matter. Although the piece improves at the end when some sanity and rationality is injected into it, the beginning quotes from one of my fellow dietitians are so shamefully off base that I feel deeply embarrassed to be associated with her.

“If someone has a weight issue, then in my opinion, they should choose a specialty that does not conflict with being overweight.”

“If you can’t make it work for you, how can you make the case for someone else?”

“. . . the reality is that health care is a business, and people do judge you by appearance. Is it right or wrong? That doesn’t make a difference. It’s a business, and it is what it is whether we like it or not.”

“I wouldn’t think much of advice from a cardiologist if I knew he had had a heart attack.”

So wait, are we dietitians supposed to list our BMIs on our resumes and websites now, or how does this work?

It is one thing for some personal trainers, chiropractors, life coaches, “nutritionists,” therapists, doctors, and other dietitian wannabes to go outside the scope of their expertise and give harmful dietary guidance, but when an actual dietitian represents the profession the way she has there is just no excuse for it. This is our wheelhouse. We should be better than that.

When I was an intern, I had a rotation in a bariatric surgery clinic where two dietitians worked. One was heavier, one was leaner. Some patients did not want to work with the heavier one because they questioned, “Look how heavy she is; how can she possibly help me?” Yet other patients did not want to work with the leaner dietitian because they worried, “Look how skinny she is; how can she possibly relate to what it is like to be fat?”

Last year, a new patient told me she almost cancelled her appointment because she was intimidated by what a “great athlete” I was. Just a few months ago, another new patient came to me all impressed that I had “beaten cancer.” Well, no, I did no such thing. She had misunderstood my online autobiography. When I told her that, she deflated like a balloon.

Let’s get real for a moment. The whole notion that a practitioner has to look or behave a certain way in order to help patients is incorrect. Out of all the questions I asked the surgeons I met with before my most recent back surgery, I never thought to ask who among them has back problems. But I should have because if a surgeon has back problems then it is logical to conclude he or she cannot help me with my issues, right? Or wait, I want a surgeon with back problems because he or she can relate to my experience, is that how it goes?

How about just finding the surgeon whose approach, experience, and demeanor made me feel most comfortable and confident? I know, crazy me and my outlandish notions.

During my first year as a personal trainer, few members were interested in my services. Although I had good relationships with many of them and they routinely asked me questions about exercise, few were willing to cross the line of actually hiring me. However, after I took two months off to ride my bike across the country, suddenly members were booking sessions with me left and right and my boss began to refer new clients my way, too. Other trainers treated me and my opinions with more respect. The gym even gave me a raise without me asking for it.

Come on.

Sure, more money and clients were great, but the driving force behind the upturn in business was so ridiculous that I felt insulted. It took riding my bicycle 4,000 miles, up and down mountain ranges, through all sorts of weather, for my expertise to be recognized and taken seriously? The ride did not make me a better trainer. If anything, I was a worse trainer after my trip because I was rusty from not having worked in two months. But hey, perception is all that matters to some people.

Right now, I have a patient who wants to be a CrossFit coach and feels she needs to lose 15-25 pounds in order to be taken seriously by potential clients. Sure, she has room for changes in her lifestyle, just like we all do, but she generally eats well and takes great care of herself. As disappointing as it is for her to hear, it seems her body just naturally belongs 15-25 pounds heavier than she would like it to be. Do I push her further down the path she feels obligated to follow, risking perhaps disordered eating or an eating disorder, as she sacrifices health for a number and a look, or do I guide her towards the reality that she can be a great trainer no matter her weight and appearance?

Due to my surgery, it has been seven weeks since I lifted weights and did any physical activity in earnest. Muscle atrophy is setting in. My shoulders and chest are smaller. My six pack is gone.

Am I a worse dietitian now than I was two months ago?

What if you did not know that major surgery had affected my fitness and you came in here and saw a scrawny dietitian without any context? Would you have less confidence in me than if you knew about my operation?

What if I had not undergone surgery and I just decided to take two months off from working out?

What if I had a healthy relationship with both physical activity and food, but my body just happened to be thinner, less muscular, or heavier than society feels its dietitians should look? Would you go elsewhere?

I have blogged about my athletic accomplishments, such as my mountain running, on a small handful of occasions because it can enhance patient care for them to understand that I am a human being with a life outside of this office and I face challenges just like everybody else. Perhaps patients garner some inspiration from those postings, but if anybody reads one and then comes to see me with the mindset, “Jonah is thin and Jonah is an athlete; therefore, he can help me,” God, that would just make me want to take all of the posts down. I just cannot be part of that act.

The purpose of self-disclosure is to enhance patient care, not to serve as an advertisement, not to capitalize on misconstrued ideas, and certainly not for a practitioner to defend or justify his or her behaviors or body shape.

I disagree with the notion that health care is a business. The first priority should be patient care, not money. If the dietitian I quoted earlier had her priorities in order, she would be helping to reeducate her patients and change a culture of misunderstanding rather than playing into it for profit. Giving people what they want and expect for the sake of financial reward does not justify providing poor care and perpetuating a myth.

Or maybe I should just play along and take up steroids, lest patients go elsewhere because I no longer look the part, right?

Come on.

He Said, She Said: Meal Plans

Posted on April 17, 2014 by Jonah Soolman

Creating meal plans based on calorie needs has been a staple of nutrition counseling for years. Is it time to say good-bye?

He Said

“The first session is about food. Every session after that is about why they [the patient] are not doing what I told them to do.”

That is how a seasoned colleague explained her work as a nutrition counselor to me when I was just starting out as a dietitian. With all due respect, the quote illustrates nutrition counseling gone awry, the result of an outdated, archaic, and ineffective approach that puts too much emphasis on information and too little on individuality and motivation.

A popular tool in dysfunctional nutrition counseling is the meal plan. While meal plans can take on different forms, the kind that I am referring to is based on an estimation of the patient’s calorie needs; those calories are then broken down into numbers of servings that said patient should consume from various food groups over the course of the day.

In theory, meal plans sound like a useful tool. From a dietitian’s standpoint, meal plans are easy to create, they give patients flexibility, and they put the responsibility for execution entirely on the patient’s shoulders. From a patient’s perspective, meal plans give a welcome sense of certainty and control, thereby temporarily relieving feelings of confusion and powerlessness. Just follow the meal plan and everything will be okay, right?

Unfortunately, the problems with these meal plans are extensive:

Estimates of the patient’s nutritional needs are not tremendously accurate. The most accurate means of measuring one’s resting metabolic rate is through direct calorimetry, which involves spending time in a chamber that measures the heat he or she generates. To my knowledge, direct calorimetry never happens outside of a research setting. Even direct calorimetry has its problems, and every other method available has larger sources of error. Practitioners like us use algorithms that estimate calorie needs based on height, weight, age, gender, and similar data. Attempts to quantify calories expended through physical activity introduce additional error. Calculations of one’s calorie needs are at best just rough ballpark estimates. Therefore, the whole foundation of the meal plan is shaky.

The reported calorie content of different foods can also be inaccurate. Whether due to faulty assumptions used in the calculations or labeling laws that allow for rounding off, what we believe to be the nutritional content of a given food is sometimes not quite true. Yet the numbers are taken too literally, and patients exhaust themselves with kitchen scales and measuring cups trying in vain to consume the exact number of prescribed calories, a goal that is virtually impossible to achieve.

The expectations put on meal plans are unrealistic. With genetics, environment, stress, and other variables heavily influencing health and weight outcomes, the notion that a meal plan can guarantee virtually any measure of success is nonsense and misleads patients.

Meal plans fuel the inaccurate “good food, bad food” dichotomy. Foods present on the plan are seen as “good,” while those that are absent are considered “bad.” One meal plan form that I used to use omitted some fruits for no other reason than space did not allow for a complete list, yet countless patients expressed criticism and fear of the fruits that did not appear on the plan.

Meal plans focus heavily on individual foods, but much of the foods we consume in real life are combined with other foods in unknown quantities. Even when we prepare foods at home, estimating, for example, the volume of beans in minestrone soup, or cheese on pizza, or oil used in a stir-fry with any degree of accuracy is a time-consuming and tedious challenge. When eating in a restaurant or buying prepared foods, forget it; there is virtually, or in many cases literally, no way to know. The meal plan paradigm of tracking portion sizes fails when portion sizes are uncertain.

Meal plans teach patients to follow external cues for their eating. This may work in the short term, but not in the long run. At best, relying on a meal plan delays the development of mindful-eating skills. If long-term change is to occur, it is virtually inevitable that one must learn to eat in response to internal cues.

Following in the footsteps of my more experienced colleagues, I put hundreds of patients on meal plans at the beginning of my career. Some of these patients saw short-term improvements in their health or weight, but I cannot recall even a single instance of a meal plan approach spawning long-term behavior change. When things inevitably fell apart, patients blamed themselves, but really the problem was the approach. For that reason, I recognized meal planning as the dated and ineffective technique that it is and almost entirely removed it from my counseling tool box.

The only exception is that I still use meal plans for some patients with eating disorders. Sometimes the stakes are so high that inadequate nutrition risks hospitalization or admission to an inpatient program, so in these cases I temporarily use meal plans in an effort to keep the patient safe. In the long run though, as the eating disorder is overcome, we leave the meal plan behind and work on mindful eating.

There are times I do devise lists of meal and snack ideas with my patients, but do not confuse these with the meal plans that I have discussed up to this point. Working together with my patients to devise individualized ideas for what they can eat in certain situations can be very helpful due to the customization and collaboration. The utility is quite different than just writing in some numbers on a meal plan sheet, handing it over to them, and then getting together next session to discuss why they are not following it.

She Said

To meal plan or not to meal plan, that is the question. A lot of people assume that since the majority of my patients are those with eating disorders, that I must use meal plans with all of my patients. This most definitely is not the case. When a patient first comes to see me, I spend the initial session (or two) learning about that patient: Why are they coming to see me? How have they been eating? At what point in their recovery are they? These are all questions that can help me decide whether a meal plan is indicated or not.

Meal plans, in my opinion, are training wheels for those struggling with feeding themselves adequately. Usually, if a patient has just left an inpatient or residential eating disorder treatment facility and is having a hard time eating all of her meals and snacks at home, I find that a meal plan can be very helpful to get her back on track. But, just like training wheels, the meal plan should not be permanent, and eventually the patient should be weaned off of it.

The ultimate goal that I want to help my patients achieve is the ability to engage in intuitive eating. In a nutshell, intuitive eating is eating when you are hungry, stopping eating when you are satiated, and eating what feels best to your body. This also means not eating according to external rules, but rather listening to your body and honoring its cues.

As I’ve mentioned before in other blogs, we are born with the innate ability to regulate our food intake. When a baby is hungry, she will cry until she is fed. When she is full, she will turn away from the offer of more food. Even toddlers still use internal cues to determine when and how much they want to eat. But, eventually, we begin to lose the ability to listen to our body’s cues when we start placing external regulations on our eating (e.g., eating according to a strict schedule, dieting, being a member of the clean plate club, etc.). This behavior causes us to lose touch with our body’s innate wisdom and can lead to disordered eating.

I rarely, if ever, use meal plans with my non-ED patients, although I’ve had many of them ask for one. I find that those patients who ask for meal plans are the ones that want to be told what, when and how much to eat and don’t trust themselves to feed themselves appropriately. They want to rely on external regulations around their eating, as they feel that if left to their own devices, they would devour an entire sheet cake in one sitting. In these instances, using a meal plan is not a good idea, as it just reaffirms in that patient’s mind that she is incapable of feeding herself solely by using her internal wisdom.

In sum, while I think meal plans can be a useful tool in ED recovery, they are not indicated in every instance. The ultimate goal is to relearn how to eat intuitively, and that means not relying on a meal plan, but instead listening to one’s gut.

Day 26: Mindful Movement

Posted on April 14, 2014 by Jonah Soolman

This morning I went for a 14-mile walk, which was miles farther than I had intended when I left home. Carrying my MBTA pass with me, my plan was to walk from station to station in Newton and then take the green line home whenever I got tired. But the fatigue never came, so I ended up walking home instead.

This afternoon, I called my surgeon’s office just to make sure it is okay that I am walking that kind of distance at this point in my recovery. They told me that 14 miles has to be some sort of record for this soon after major back surgery, but as long as I am feeling good (which I am) then they see no problem with it.

Joanne and I talk about mindful eating with our patients, but the concept of mindfulness extends beyond just dietary habits. Adjusting mode, frequency, duration, and intensity of physical activity yields all sorts of permutations of movements, and our bodies are great at giving us feedback regarding which ones work for us. We just need to make sure we listen.

Approaching physical activity with a spirit of mindfulness means paying attention to and honoring the feedback that our bodies give us in response to our movement choices. Today, for example, I was fully prepared to end my walk as soon as my body told me it was time to stop, but instead I felt great so I honored that and kept going. Yesterday, in contrast, I was hoping to go for a long walk, but my left heel felt uncomfortable just a couple of blocks from home, so I turned around and called it a day. Although I was disappointed to go home early, better to nip whatever it was in the bud and let it heal immediately, rather than push it and risk a long-term injury.

Besides injuries, other consequences can arise from not being mindful with our movements. We risk increased stress, overtraining, undertraining, burnout, and simply not enjoying ourselves. Although I was never the type of personal trainer to push my clients past the point where their bodies were telling them to stop, holding myself to the same standard and listening to my own body’s feedback has been a challenge at times, and I have paid the price via overuse injuries and getting sick of activities I once enjoyed. Moving our bodies can, and should, be fun.

Given my personal challenges, I consider yesterday’s aborted walk a greater accomplishment than today’s 14-mile trek. By listening to my body and honoring its signals, even as it was telling me something I did not want to hear, I put myself in a position that made today’s walk possible.

Body Image and Self-Acceptance

Posted on April 8, 2014 by Jonah Soolman

Between the blogs Joanne and I have written, as well entries by others that we have shared, we have posted quite a bit lately about body image and self-acceptance. While the link between these topics and nutrition is likely obvious to some readers, it occurs to me that it might not be so apparent to others and an explanation is probably in order.

The driving force behind our food choices is multifaceted. When I gave a talk to the FDA last month, the participants and I brainstormed a list of factors that influence our eating: perceived nutritional value, health concerns, availability, cultural norms, emotions, ethics, allergies, culinary expertise, previous experiences, finances, taste, time, and personal goals, just to name a few.

Within personal goals often lies a desire to look different. Consider the following examples: A model severely restricts his or her eating, becoming anorexic in the process, in order to gain a certain look. A naturally-slender man, convinced that his lean frame is responsible for him still being single, forces himself to overeat in hopes of gaining weight and finding a partner. A husband tells his wife that she is “not ready for that dress yet” and so she diets, convinced that he will not be attracted to her until she loses four more pounds. A young lifeguard, self-conscious about being in a bathing suit all day, becomes bulimic.

Those are all real people who we know, either through our work or our personal lives, and they are all examples of individuals adapting unhealthy eating behaviors because of how they feel about their appearances. Therein lies the problem: More often than not, dissatisfaction with how we look leads not to healthier lifestyles, but to harmful behaviors.

Oftentimes, a deep issue is being displaced and playing itself out through one’s food choices. Therefore, in addition to working together with us on their eating, we encourage our patients, when appropriate, to work with a qualified therapist on severing any link they may have between their appearance or weight and their self-worth, and to love and accept themselves the way they are regardless of their size or shape.

As these issues fade away, space is created for a healthier, simpler, and more satisfying relationship with food.

The Best Way I Know How

Posted on April 4, 2014 by Jonah Soolman

Q: Hey, whatever happened to your stated intention of running the Boston Marathon this April to raise money for the victims of last year’s bombings?

A: Back surgery put an end to those plans. Although I am disappointed that I am unable to participate in the race in the fashion that I envisioned, my intention to form a fundraising team to benefit the victims had nothing to do with putting myself in the spotlight and little do with running. Rather, I was just trying to help in the best way that I knew how.

My ability to run might be temporarily on hold, but the spirit of my intentions and my desire to help the victims still holds true. Out of all the important charities that are fielding marathon teams, at least two, The One Fund and Team Collier Strong, directly grew out of last year’s tragedies, so I have thrown my support behind them and the One Run for Boston event.

As time elapses after an event that once gripped us so tightly, new stories and circumstances phase it out from the forefront of our minds. Most of us have the luxury of moving on, while those directly impacted by the event follow a much different trajectory. To the credit of people all around the world, The One Fund successfully raised millions of dollars for the victims in the immediate aftermath of the tragedy. However, because their costs are ongoing, so should our support.

In addition to our financial support, Joanne and I look forward to cheering on runners as they finish the Haunted Mile and make their turn onto Beacon Street. Back surgery or not, I can still help in the best way that I know how.

Day 15: Acceleration

Posted on April 3, 2014 by Jonah Soolman

A few years ago, I spoke with a woman at the gym about the time she had to take off from work for cancer treatment. Upon her return, some of her co-workers treated her as if she had been on vacation, which infuriated her. As she explained to me, and I know first-hand, there is a big difference between using vacation time and going on medical leave.

Spending all day on the couch watching television might be fun and relaxing when you do it by choice, but being forced into it because there is virtually nothing else you are capable of doing is an entirely different matter. My first week home from the hospital was the slowest seven-day span I can remember.

As that first week came to a close, I made the decision to focus less on what I could not do and to instead emphasize the small indicators of progress that came with each passing day. Each evening right before going to bed, I wrote myself a quick note about what I had accomplished that day.

My whole perspective shifted. Powered by a more positive outlook, I have nudged myself to do just a little bit more each and every day, and the results have come at a rate so accelerated that I never would have expected it. Just one week ago, for example, I went outside for the first time after my operation and slowly shuffled around the block with Joanne’s help. Today, I walked six miles by myself.

Yesterday was my first post-operative appointment with my surgical team and they could not believe how well I am doing. They were floored that (1) I am already off of all of my pain medications, and (2) that I have been off of them for a week already. My baseline fitness going into the operation and my generally-healthy diet, they said, are likely significant factors into why I am recuperating so quickly.

That is probably true, but I like to think that my resolve to get off the couch and do something productive with my days also has something to do with it.

Day 11: Small Victories

Posted on March 30, 2014 by Jonah Soolman

My spirits have been pretty dismal, to be honest. As somebody who values independence and taking care of myself, being stuck at home and needing my wife’s help for nearly everything I do has been sad and depressing.

On the other hand, I am mindful of my own advice: long-term success grows out of patience, perseverance, and the tempered resolve to wake up each morning and inch just one day closer to the goal. With that in mind, rather than focus on what I cannot do right now, a much more positive mindset is to focus on the small indicators of progress that have come with each passing day:

Day 7: I was able to get up and sit at my computer for the first time since my surgery.

Day 8: I was able to step outside for the first time since getting home from the hospital.

Day 9: I was able to walk around the block by myself.

Day 10: I was able to go for two walks in a single day.

These are basic activities of daily living that never would have crossed my mind as anything special before my surgery, but now they are small victories showing me that I am well on my way to regaining my freedom and independence.

Day 7: Picking My Poison

Posted on March 26, 2014 by Jonah Soolman

Given the dearth of diversity in the NHL, I was surprised to turn on the Boston/Montreal game the other night and see two players of color skating side by side. Upon further inspection though, I realized I was not seeing two teammates; rather, I was seeing a single player twice due to double vision.

The days since my surgery have been a constant struggle of picking my poison between the direct effects of the surgery itself versus the side effects of the drugs designed to cover up the former. These side effects go well beyond just double vision. My constipation was so awful that the hospital staff felt compelled to pursue it aggressively, which resulted in overtreatment and approximately 30 bouts of diarrhea in a 24-hour span. The nausea was so stubborn that one of the most powerful oral medications they could give me did little more than to turn down the volume just a little bit. My sleep and concentration were both so disrupted that I had difficulty discerning actions that happened in real life from those that occurred in a dream state. Dizziness kept me in bed. A lack of appetite kept me from consuming the nutrition my body needs to heal.

Given these side effects, yesterday I made the decision to stop all of my pain medications except for over-the-counter Tylenol. My clarity and nausea have both improved somewhat (Although later I will likely realize that this entry is filled with typos and lines that make no sense.), but now I am dealing more directly with the aftermath of the surgery itself. The pain keeps me horizontal and unable to sit or stand for more than a few minutes at a time. As a result of a chronic low-grade fever, which the surgeon tells me is fairly typical after an operation like mine, I alternate between bouts of chills and sweats. When I’m really lucky, I simultaneously experience both.

Joanne is right when she tells me that my first experience with back surgery probably set me up for false expectations this time around. Although the aftermath of my first surgery was long and difficult from a psychological standpoint, physically my recovery was rapid. After just a couple of days in the hospital, I was discharged to my parents’ house. Just one week later, I was back on campus at Tufts and resuming classes.

This time around, my recovery seems to be on a much different trajectory. Then again, the procedures themselves, while on the same part of my back, were quite different. Last time, the surgery was little more than a resection of the tumor. This time, the surgeon used rods, screws, and bone grafts to reconstruct a portion of my spine.

I need to keep my expectations in check and remember to heed my own advice about patience, perseverance, and waking up each day with nothing more than the simple goal of getting one day better before going back to bed and doing it all over again.