Everybody Belongs Somewhere

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“I have chosen to reword and publish the following text that, when I first wrote it, was never intended for posting.”

Our patients come here with all sorts of opportunities for improvement, but the common theme is that virtually all of these conditions require long-term management. Eating disorders can be worked through and overcome, cholesterol levels can be improved and maintained, but nobody accomplishes these or similar feats after a single session. Whatever our challenges, long-term success grows out of patience, perseverance, and finding a sustainable balance that enables us to manage our conditions in the context of our lives.

Practitioners are no different. Taking care of my chronic back woes involves the same sort of day-to-day management and balance that our patients face with their own conditions. Just as many of our patients do, I have my good days and my not so good days, and my motivation oscillates from time to time. Being a health care professional does not exempt me from being human.

Self-disclosure is a tricky issue, and while there are certainly wrong ways to go about it, there is not a singular right way either. My approach has always been that if sharing information about myself enhances patient care, then I am open to it.

For that reason, I have chosen to reword and publish the following text that, when I first wrote it, was never intended for posting. Meant for nobody but myself, it was an internal document, a tool in my decision-making process as I weighed whether or not to have another operation on my back. Writing out the intertwined relationship between my health and the sport that I love helped me to resolve my ambivalence, move from Contemplation to Preparation, and make a decision regarding surgery.


“The sport came naturally to me and I instantly fell in love with it.”

At a young age, I discovered that nowhere feels like home like a tennis court. My brother, four years my senior, was a standout baseball player and I had to go to virtually all of his games, or at least it felt that way. Back then, I appreciated neither the sport of baseball nor the importance of supporting a family member, so I spent the games sulking in boredom. In order to give me something to do, my mom gave me her old wooden tennis racquet and let me hit against a backboard near the baseball diamond. Anybody at my wedding who saw me out on the dance floor with Joanne can attest that I am one of the least coordinated people to ever walk the earth, but for some reason I had a specific talent for hitting a tennis ball. The sport came naturally to me and I instantly fell in love with it.

Hitting against the backboard segued to Park and Rec group lessons and then to private lessons with Ben, a family friend just a few years older than me who was one of the best players in town. My parents, neither of whom had a whole lot of experience with the sport, bought a couple of racquets for themselves so they could hit with me. One summer day when I was probably 13, my father and I finished hitting on the courts next to Needham High School and sat down on the steps that overlook Memorial Field. He told me that if I wanted to play for the team when I got to high school, he thought I could make it. I didn’t believe him.


“Approximately 20 spots later, in next-to-last place, was my name.”

While I had a talent for hitting ground strokes, tennis involves a whole lot more than that. When I got to high school and tried out for the team, I felt overmatched by players with more well-rounded games and experience. After Coach Shea cut my friend Todd, who in my mind was a much better player than I was, I figured I was destined for the same fate. Not until Coach assigned me a locker did I realize I had made the roster. He posted a ladder that ranked everybody on the team relative to each other. Ben was first, a spot he most certainly deserved and would ordinarily have occupied anyway, but in this case it was just symbolic, as he was unable to play due to a brain tumor. Approximately 20 spots later, in next-to-last place, was my name.

My first match was in Walpole on a chilly March day in 1992. I paired with my friend Josh, the sole player on the team ranked behind me, for a doubles match. Our opponents were two disheveled kids who kept on complaining that we had to hurry up because they had to get to some store before it closed. We managed to hold serve once, but that was all as we lost the one-set match 1-6. Before I knew it, we were off the court and back on the bus with our teammates, almost all of whom had won their matches. One of them greeted us with, “Wait, you LOST???”

Tryouts were rough my sophomore year, too. Still one of the weaker players on the team, I now had to compete for a roster spot against the incoming freshman as well. After I lost a “challenge match,” a one-on-one battle that determines who moves up and down the team’s ladder, against one of those freshmen, Coach told me he was considering cutting me. He let me stick around, but I had a tough season and finished with around a .500 record.


“With all of the losses I have had in approximately two decades of playing competitive tennis, this is the one that I wish I could have back.”

During tryouts my junior year, I drilled one of my teammates in the crotch with a two-handed backhand when he came to net. The ball’s direction was a complete accident and I felt bad that my shot put him on the ground in pain. On the other hand, that backhand got Coach’s attention. Every rep of my off-season weight training went into that passing shot. Coach knew I had worked hard coming into the season, and it proved to be the only year out of my four in high school that he gave me a spot on the roster without hesitation.

Early in the season, I played a challenge match against Andy, a very solid player with an excellent game. To the shock of everybody, including Andy and myself, I beat him. Upon leaving the court, Andy asked our Assistant Coach, “What’s he doing on JV?” As a result of my win, I shot up the ladder and played my first varsity match, second doubles, after a teammate was out sick.

A short time later, I was up against Jed, Ben’s younger brother, in another challenge match. Like Ben, Jed was an incredible player and I thought I had no chance. My intimidation showed as I lost the first set 0-6. Coach pulled me aside, calmed me down, and told me to play like I had against Andy. I won the second set. In the third set, I had a 5-3, 40-15 lead on Jed’s serve. Double break point, double match point, double by-far-the-biggest-victory-of-my-life point.

Jed took his time, methodically pacing in small circles behind the baseline before stepping up to serve. As the point evolved, he came to net and slammed an overhead that bounced high above my outstretched racquet. No problem, I thought; I still had match point. Jed again took his time to focus. He came in again and my down-the-line backhand passing shot failed to clear the net. Deuce. The self-doubt returned. Jed won four straight games to take the final set 7-5.

It’s not like I tanked. I tried my best during those last four games, but in my heart I felt that my window of opportunity had closed and that affected my play. To cap it off, I double faulted on Jed’s first match point. None of my teammates or coaches said one word to me after we walked off court. We all knew what had happened: I had choked. I had choked big time. With all of the losses I have had in approximately two decades of playing competitive tennis, this is the one that I wish I could have back, to see how my tennis future would have changed had I beaten a player of Jed’s stature at that point in my career.


“In a short span of time, my lack of confidence had been replaced by an exhibition of arrogance so obnoxious that I am still embarrassed of it to this day.”

Next season, with many great players still ahead of me on the ladder and a coach’s policy against playing seniors in JV matches, I had no spot on the team. Coach pulled me aside and explained that after three years together he felt too badly to cut me, but I should cut myself because I was not going to play. I refused to do so and remained on the roster as a practice player. After one of our best players was kicked off the team, I found a spot on varsity playing first doubles with Andy.

Our games blended nicely. My consistency and his power complemented each other well. Although we had both been on the team for years, we never really got to know each other until we were paired up for doubles. It turned out that we worked exceptionally well together. We each were capable of making the other one laugh, focus, calm down, fire up, whatever was called for in the given moment. Together, we had a swagger that neither one of us had on our own.

By the season’s midpoint, he and I were undefeated together. We were the top-ranked doubles team in our league and considered one of the best in the state. After defeating another highly-ranked doubles team in Brookline one afternoon, we walked off the court with my pointer finger held high in the air so everybody in attendance knew who was number one. In a short span of time, my lack of confidence had been replaced by an exhibition of arrogance so obnoxious that I am still embarrassed of it to this day.

After Andy and I lost a couple of matches, including one to a very weak tandem we should have dominated, Coach thought perhaps it was time to shake things up. While traveling home from a match, he sat across the bus aisle from me and asked what I thought about playing singles. Whatever the team needed, I told him, but my smile gave away the truth that I had badly wanted to be a varsity singles player for years. Coach shuffled the lineup and slotted me in at third singles, which remained my spot for the rest of the season while our team made it all the way to the state quarterfinals.

Playing third singles for Needham High School, 1995

Playing third singles for Needham High School, 1995

The last match of my high school career, I lost 6-1, 4-6, 4-6 on the same Brookline courts where I gave that number-one gesture earlier in the season. Served me right. Karma. However you want to say it, the bottom line was there was some justice in losing a tough match to that team on that court after the stunt I had pulled.

In both the second and third sets, I was serving at 4-4, 30-all. Both times, my opponent won the pivotal fifth point, broke me, and went on to win the set. In tennis, all points are not created equal. One can lose the majority of points or games in a match, yet still win it. In fact, I outscored my opponent in games (14 to 13) this particular day, but he was the one who walked away victorious. The outcome of matches often hinges on how you respond in just a few key situations. Either you rise to the occasion and respond appropriately or you do not. Such is tennis, and such is life.


“I just could not do what they could do; it was like we were playing two different sports.”

Late that summer, I arrived at Tufts University for freshman year and attempted to make the NCAA team as a walk-on. Approximately 60 of us were trying out for two open spots on the roster. I made the first wave of cuts, but did not survive the second. Still, I was not ready to give up on the idea of playing college tennis just yet, so I kept on showing up to the team practices and hit with the guys. Not until Coach Watson gave me a uniform and put me in the lineup for a JV match that spring did I realize he had reconsidered and added me to the roster.

College tennis was an enlightening experience. All of my teammates were better than me, most of them by a lot. Each of them had been the best player in his high school, a status to which I could not relate. Incapable of even holding my own against most of them, I frequently got blown off the court in practice. I just could not do what they could do; it was like we were playing two different sports. The holes in my game that I had been able to work around in high school were routinely exposed at the college level. Coach did not understand how I often failed to execute shots and plays that were so easy for my teammates. His frustration with me showed through sometimes, not in a Bobby Knight sort of way, but more through glares and occasional harsh words, yet he kept me on the team and for that I was grateful.

While I did manage to win some singles and doubles intercollegiate matches, I cannot specifically remember even one of those victories in any sort of detail. By and large, the fragments of matches that I do recall have coalesced into a hazy memory of getting destroyed.

1997 Tufts University NCAA Tennis Team (I am in the center of the back row.)

1997 Tufts University men’s tennis team (I am in the center of the back row.)


“I could not stand at the sink and shave without having to take a break in the middle to stretch.”

During the offseason between sophomore and junior year, I trained like a madman. Although I did not look it, I had gotten myself freakishly strong. In the weight room, guys much bigger than me used to watch with confusion as I bench pressed nearly twice my body weight. I sprinted up hills, ran demanding interval workouts that I remembered from my high school track days, performed footwork drills at a court near my house, and practiced with the Tufts Assistant Coach who lived in a neighboring town. That pre-season, I held my own with, and even beat, some of my teammates who had blown me out of the water the past two years. Playing as well as I was, I thought I had an outside shot at even moving up from JV and playing some varsity matches.

Before the season began, Coach insisted that I see a doctor for my long-standing back pain. Since I was 14, I had lived with chronic pain that often radiated down my right leg. My pediatrician never seemed to see it as a big deal and therefore neither did I. By that pre-season, however, the pain was so bad that I could not walk the two blocks back to my dorm after practice without needing to stop and stretch on the sidewalk. I could not stand at the sink and shave without having to take a break in the middle to stretch against the bathroom wall. When Coach ordered me to see a specialist before he would clear me to play the season, I told him it was a waste of time. I was fine, I insisted.


“My new primary care doctor told me I had post-traumatic stress disorder (PTSD). Although some of my friends could tell I had changed, I largely kept my struggles to myself.”

A sudden look of seriousness spread across said specialist’s face as he held up the x-ray he had ordered and viewed it for the first time. My life has never been the same since that moment. To my complete surprise, it turned out that I had a tumor on my spine. Instead of fretting over whether I would make varsity or again be on JV, I worried about whether the tumor was benign or malignant. While my teammates prepared for the season, I did my best to ready myself for immediate surgery.

I remember looking out the window of my hospital room a day or two after my operation and watching the red line trains ride in and out of the Charles/MGH stop. “Those passengers are participating in life,” I thought, while I was absent. My classes were still going on, my teammates were still practicing, yet I was hospitalized. Back when I was in high school, being home sick from school yielded a sort of unsettling depression and anxiousness because I was not where I belonged; I was not living my life. Being in the hospital generated that same feeling, but to an exponentially-greater magnitude.

Death is a topic to which I had given little thought until I experienced anesthesia. My expectation was that being under would mimic sleep. Instead, there was no dreaming, no indications at all from my vantage point that I was in existence. I closed my eyes, then opened them, and in between was a void of which I had no memory. It was as if for that period of time I wasn’t – period. I thought to myself, “This must be what death is like.”

My hospital roommate was in bad shape. The brain tumor that he previously had removed had grown back and he had to have it removed for a second time. This time, he lost vision in one of his eyes as a result. While my brother and I were going for a short walk down the hospital’s corridor, a dead patient was wheeled past us on a gurney.

After what I witnessed and went through myself, I was scarred, more figuratively than literally, and I felt very, very, very mortal. After I got home, I assumed the worst. A headache meant a brain tumor. Abdominal pain meant colon cancer. My new primary care doctor told me I had post-traumatic stress disorder (PTSD). Although some of my friends could tell I had changed, I largely kept my struggles to myself. Only my doctor and my girlfriend knew the internal turmoil I was experiencing.

In hindsight, I am surprised my doctor did not send me to a therapist, or that I did not figure out on my own that I needed help. Part of me rejects the PTSD diagnosis because there are people out there who truly have PTSD – war veterans, rape survivors, first responders, etc. – and their ordeals should not be disrespected, cheapened, or watered down by my experience. Whether or not I really had PTSD, the fact was that I was struggling and it took me the better part of a decade to get over the emotional toll of my surgery. Years went by before I could ride the red line through that Charles/MGH stop and even look in the direction of Mass General without triggering horrible memories of how it felt to be on the other side of those hospital windows.


“That was no way to live no matter what my abs looked like.”

While I did return to the Tufts tennis team a couple months after my operation, by season’s end it was clear that my back was no longer fit for the sport. The decision I knew I had to make was so difficult for me that I could not even express it to Coach Watson face to face. Instead, I wrote him a letter thanking him for everything and explained why I had to leave the team. I sat out what would have been my senior season.

For the next four years, I played no tennis except for rare occasions when I casually hit around with a friend. Fueled by an intense fear of getting sick and dying, I spent these years doing everything I could to take care of my health. Although I hated swimming, I picked it up on the advice of my neurologist. I performed every core exercise I knew and added new ones along the way. Even though it meant sometimes going to bed when it was still light out, I spent nine hours in bed each night, every night. I paid more attention to my eating than I have at any other time in my life, including now. Guys in the locker room used to talk about my abs.

In the film Across the Universe, Jude says to the Vietnam veteran, “You don’t seem too messed up,” to which he responds, “Well, everything below the neck works fine.” Similarly, even though my emotional health was in disarray, I looked okay from the outside, and my back and body as a whole were getting stronger.

I often talk with my patients about living life in balance. At that point in my life though, I was anything but in balance. After turning down plans with friends so I could exercise after work and go to bed early, some of them began to distance themselves from me and stopped extending invitations. My insistence on only eating food I had brought from home kept me from joining co-workers for lunch and my rapport with them weakened. My stress level was so high that I often woke up nauseous in the middle of the night and sometimes vomited. A bottle of Maalox tablets was a permanent fixture at my bedside. While my physical fitness was fantastic, my life was filled with rigidity, unhappiness, and a whole lot of fear. That was no way to live no matter what my abs looked like.


“They were telling me their game plans without even realizing it.”

After four years away from tennis, my back was feeling well enough where I felt ready to try the sport again. I moved to western Massachusetts, joined a new gym, and saw on the bulletin board an ad looking for players to join a men’s United States Tennis Association (USTA) team. The captain, Scott, and I got together to hit at Hampshire College. Having not played in so long, I was terrible. As if I was playing the sport for the first time, I had no idea where the ball was going when it left my racquet. Still, Scott let me on the team and he introduced me to some very nice teammates with whom I began to regularly practice. The rust wore off.

My time away from playing the sport afforded me an opportunity to see it from a different perspective. Not just to see it, but to really consider it, to experience tennis from a macro vantage point from which I had never viewed it before, to understand the flow of the game, why players do what they do in certain situations, what separates the winner from his or her opponent, and other complexities that I never took the time to examine and absorb when I was too busy focusing on my first-hand experience.

Although I never was again the same player physically that I had been in college, I returned to the sport a much more intelligent player. I was more observant than I ever had been when I was younger. Subtleties often gave away my opponent’s next move. The opening of his racquet face signaled a drop shot. Like a change in arm slot tips a pitch, a slight shift in grip indicated the kind of serve coming my way. A quick peak out the corner of my opponent’s eye revealed his target spot. Other times it might have been what a player did, or did not do, in warm ups to hide a weakness or show off a strength. Small talk before the match or on changeovers, whether he looked me in the eye or not, and his posture, these were all windows into his state of mind. They were telling me their game plans without even realizing it.

That’s not to say that I was always able to take advantage of these insights or that my own game was absent of faults. Certainly, I ran into players who exploited my weaknesses, outsmarted me, or blew me off the court with power, but those were the exceptions rather than the rule. After going 11-1 for Scott’s team, I moved up to a more challenging USTA league the next season. The players could do everything a little bit better than in the previous league: move quicker, hit harder, play more consistently, etc. After losing two matches early in the season, I adjusted and went on a run. Next season, I was undefeated and had more match wins than I did double faults. My baseball-playing brother got a kick out of it when I compared my statistical achievement to Bret Saberhagen’s 1994 season with the Mets when he had more wins than walks. All told, three years went by before I lost again.

Immediately after upsetting one of the best players in the USTA Districts tournament, 2004

Immediately after upsetting one of the best players in the USTA Districts tournament, 2004


“I thought to myself, ‘Someday I will look back on this and laugh.’ When that day comes, I will let you know.”

In the summer of 2006, I rode my bicycle from Seattle to Boston for charity. One morning outside of Eureka, Montana, I fell off my bike and hurt myself. I wish I had a more exciting or heroic story to tell, but the truth is that I was not even moving at the time of my fall. In the process of mounting my bike, I lost my balance and started to lean to my left. As I tried to plant my left foot on the ground, my cleat accidentally glanced the pedal and clipped in. With no way to stop my momentum, I fell over to my left and landed on my back. Because I was wearing a backpack, my spine forcefully hyperextended upon impact. Although I did not know it at the time, I had fractured some bones in my spine near the surgical site.

Standing over Lake Koocanua in Montana a few minutes before my accident, 2006

Standing over Lake Koocanusa in Montana a few minutes before my accident, 2006

In that moment, all I knew was that I was in a tremendous amount of pain and I was having trouble moving because the muscles in my back and hips had completely locked. Reaching Eureka, which was just a few miles down the road from where I fell, was a painful struggle. When I got into town, I found a gas station and went into their bathroom. Only after using the toilet did I realize there was no toilet paper, and my back was so bad that initially I was unable to stand up. There I was, injured, thousands of miles from home, stuck on the toilet, unable to wipe, unable to stand, and I thought to myself, “Someday I will look back on this and laugh.” When that day comes, I will let you know.

Although I managed to finish the trek back to Boston, my back was never quite the same again. When I got home and resumed playing tennis, I knew I was not right physically and my confidence on the court was gone. After starting the season 1-2, I went to the neurologist, then to a couple of surgeons, got the bad news about the fractures, and stopped playing. Because my appreciation for the sport had deepened since college, leaving the sport behind for a second time was even harder than the first time around. To date, I have not played competitive tennis in over seven years.


“Balance is the foundation of a healthy lifestyle. Sometimes it takes going through a period of imbalance to come out on the other side and find a happy medium between taking care of your health and taking care of who you are.”

Others have talked about the parallel between tennis and life much more eloquently than I can. Some mention the loneliness of a tennis player, but there is a harsh beauty about having sole responsibility for your actions. Everything you do right and wrong, every act of sportsmanship and gamesmanship, every sound strategy and dumb idea, every shot made under pressure and choked away, they are all yours. You own them all. Together, they comprise a bouquet that defines you as the player that you are.

Consequently, when you make a mistake, you have to face the fact that nobody else is to blame and accordingly use it as a learning opportunity to grow. Conversely, when you do set out to execute a shot or strategy and you make it a reality, there is a peaceful satisfaction, a sense of well-earned serenity, that comes with knowing that you made it happen. One of the best feelings in the world is launching a topspin lob over your opponent’s head, tracking the ball as it arcs through the air, and, out of the corner of your eye, noticing him turn his back and helplessly slump his shoulders as he discovers what you already knew from the the moment the ball left your strings: It is landing in.

At the same time, the ultimate outcome of a match is sometimes out of our hands. You can do everything in your power to win, dig as deep as you possibly can, and still lose. In this kind of defeat, you learn that there are incidents in life that are not up to us. We are only somewhat in control of our own destiny, and we have to roll with events and outcomes that do not go our way.

This lesson comes into play frequently in my work as a dietitian. Some people act as if they can avoid morbidity and mortality if only they get more strict with their food intakes and more rigid with their lifestyles. In other words, if only they take things up a notch, everything will be okay. It can be hard to accept that we will all die, our bodies are not designed to last forever, and if we are lucky enough to be spared fatal accidents and malicious acts, we will each eventually succumb to a condition of some sort. The truth is that we can minimize our chances of getting sick and dying prematurely, but it is a matter of risk reduction, not risk elimination.

Given our uncertain futures, we need to make sure we do not get so caught up in trying to take care of our health that we lose ourselves and the pleasurable aspects of life in the process. I learned this lesson the hard way in the years after my surgery. Balance is the foundation of a healthy lifestyle. Sometimes it takes going through a period of imbalance to come out on the other side and find a happy medium between taking care of your health and taking care of who you are.

My friend, Ben, who gave me tennis lessons when I was just starting to play, could tell you all about life’s unpredictability, but he eventually died of the tumor that kept him from playing the only season in which our high school careers overlapped. He was only 25 when he passed away 15 years ago. To this day, he remains the single nicest and most considerate person I have ever met. Sitting at his funeral, I felt not just sadness, but an overwhelming sense of unfairness: Not only was Ben cheated out of life, but life was cheated out of Ben. Despite the time that has gone by since Ben’s passing, I still think about him often and how much better I would be to everybody in my own life if only I could be at least a little bit more like him.


“Everybody belongs somewhere; everybody has a home.”

When my back suddenly and dramatically worsened this past fall, the idea of surgery was presented to me. Not only would an operation improve my pain, fix some of my spine’s structural issues, and increase my function, the surgeons said it could also allow me to return to competitive tennis. However, given how awful my first back surgery experience was, my resistance to a second surgery was strong. As rest, physical therapy, medications, injections, and acupuncture showed their inability to fix what is really a structural problem, I knew I had to give surgery more consideration.

In an attempt to work through my ambivalence, I sought opinions from six surgeons, discussed the dilemma with Joanne, and began to write this document. Whether trying out for a team that I thought I had no shot of making, sticking around after I had been cut or told to cut myself, or coming back (twice) after my first back surgery, I have always done whatever I could to stay in the game. The realization that ultimately enabled me to make my decision was discerning that choosing to undergo, not decline, surgery represents a continuation of this long-held personal mission. This turning point marked the resolution of my ambivalence. Today, the day of my surgery, my mission continues.

We are only hard-wired to an extent. If I was born into a different culture, perhaps I would have pursued cricket, or in a different time, jousting. Perhaps I could reinvent myself even now, maybe take up chess or painting or get more involved in music again. However, my efforts to refocus my life in the last seven years have done nothing to fill the hole, which feels just as deep now as it did upon its creation. Without tennis, I am not the same person. It has woven itself into my life’s fabric so tightly that it is part of how I self-identify. I am a tennis player. Everybody belongs somewhere; everybody has a home. I know where I belong, and I hope that with patience, hard work, and the tempered resolve to wake up each morning and inch one day closer, I can make it back there.

Casually hitting with my brother-in-law in Newport, 2012

He Said, She Said: New Year’s Resolutions

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You already know that New Year’s resolutions do not typically last, but you have not yet heard our opinions as to why and what you can do about it.

He Said

A few weeks is not yet enough time for most New Year’s resolutions to have fallen apart, but if past statistics are any indication, by the end of the year only 8% of us will have been successful in achieving our resolutions.  The poor rate of conversion from resolution to reality is partly due to the goals themselves, as Joanne will discuss below, but being honest with ourselves about how ready we are for change is of utmost importance, too.

According to the Transtheoretical Model describing behavior change, individuals can fall into any one of five stages.  The preceding link gives detailed explanations of each stage, which I will concisely summarize below.

  • Precontemplation: The person does not see a problem and therefore has no intention of changing.
  • Contemplation: The person recognizes that a problem may exist but feels ambivalent about what to do.
  • Preparation: The person has decided to make changes and is formulating a plan.
  • Action: The person is implementing changes but has not yet maintained them for six months.
  • Maintenance: The person has maintained the given changes for six months or longer.  (Note: Some versions of the Transtheoretical Model also throw in an additional stage, Termination, but often this stage is considered part of the Maintenance stage.)

Classically, the idea is that a person moves from one stage to the next in the sequence in which I listed them, but in reality someone can jump from any one stage to another at any point in time.  The Model is not perfect, but it expresses an invaluable truth: Not everybody is ready to change.

This truth, by the way, is perfectly fine.  Change is a process, as the Model indicates.  When Joanne describes our counseling approach to people unfamiliar with how we work, she often tells them, “We meet our patients where they are.”  She does not mean that literally as if we make home visits; rather, she is referring to their stage of change.  Recognition of said stage is critical to successful counseling.

What do you think would happen if I counseled a patient on the changes he can make to his eating (thereby treating him as if he is in the Preparation stage) while he does not even see a problem with his diet and came to my office only because his doctor insisted he see a dietitian (which suggests he is in the Precontemplation stage)?  He would not feel heard, the session would be unproductive, in all likelihood he would not return for another session, and whatever health condition he is dealing with would remain a problem.

Conversely, if I listen to him without judgment as he shares his emotions and opinions, acknowledge the validity of his feelings and point of view, and discuss his doctor’s concerns with him, he may transition to the Contemplation stage and move closer to ultimately making and sustaining behavior changes that will improve his health.

Alternatively, perhaps after learning more about his condition and the potential consequences, he decides that he will maintain his current lifestyle anyway, at least for now.  It is his life, he can do what he wants with it, and I respect his choice without judgment.  At least he will have had an opportunity to weigh his options and make an informed decision.

Similarly, we each have to meet ourselves where we are at, too.  In other words, when we make New Year’s resolutions, we have to be honest with ourselves about how ready we are to make the given change happen.  The calendar’s flip from December to January does not automatically transition us to the Action stage.  In all likelihood, if we were truly in the Action stage, we would have implemented the change before New Year’s rather than wait for the holiday.  Willpower can only force change for so long.  Whatever was holding us back before New Year’s will remain and ultimately catch up to us after the holiday and bring an end to the resolution.

Instead of setting yourself up for failure by setting a goal that is unfit for your readiness to change, use the New Year as an opportunity to be honest with yourself about your health and how you feel about it.  In other words, meet yourself where you are instead of forcing yourself to take an action before you are truly ready for it.  Reach out for whatever information or support you need.  Consider the following examples:

  • A husband in the Precontemplation stage might give in to his wife’s urging to finally make an appointment with a dermatologist to have his strange-looking mole examined if for no other reason than to appease her.
  • Perhaps a diabetic in the Contemplation stage might decide to schedule an appointment with his doctor to discuss his ambivalence regarding monitoring his blood sugar at home.
  • An individual in the Preparation stage might meet with me to plan specific and achievable changes to his eating that will improve his cholesterol, then go home and discuss the upcoming changes with his family.
  • An osteoporosis patient in the Action stage might continue to use the package of personal training sessions she bought so she can continue learning how to lift weights safely and preserve her bone structure.

Most important, remember that New Year’s is just an arbitrary point, and one need not wait for a new calendar year to start the process of making change.  Said differently, we do not need an exterior cue to trigger internal change.  When we are truly ready, we will make the change happen no matter what date it is.  One of my favorite quotes is from Andre Agassi’s Hall of Fame induction: “ . . . every journey is epic, every journey is important, every journey begins today.”


She Said

Mid-January through the beginning of February is a tricky time for many of my patients.  Their motivation for keeping all of their nutrition resolutions is starting to dwindle, and many people feel like they have failed in one way or another.  What I often find is that many of my patients had set the bar too high in terms of nutrition goals.  They expect too much from themselves and have no other option than to not meet their goals.  Most of these goals are so overly ambitious that it would be very difficult for almost anyone to follow through with them.

So what’s a person to do?

When my patients ask me for help setting nutrition goals, I tell them to think S.M.A.R.T., as in goals that are Specific, Measurable, Attainable, Relevant, and Time-bound. No, I didn’t invent this clever mnemonic; it has been attributed to George T. Doran who wrote a paper called There’s a S.MA.R.T. way to write management’s goals and objectives in the November 1981 issue of Management Review.  But I really like the simplicity of this handy acronym.

Specific goals are those that are clear-cut and unambiguous.  Examples of specific goals could be “I will make a kale smoothie for breakfast…,” or “I will prepare a new salmon recipe…”  Measurable means that the goal must be quantifiable in some way so that you can clearly assess your progress.  This can be accomplished by adding to the above goals; for example, “I will make a kale smoothie for breakfast 2 times….” and “I will prepare a new salmon recipe one night….”

Attainable goals are those that are ones that realistic for you.  If, for instance, you know that making a kale smoothie for breakfast 5 mornings per week isn’t likely to happen (e.g., you often sleep late and don’t have time, you have difficulty going to the grocery store to get the ingredients, etc.), then shoot for something you absolutely know you can do.  In other words, it’s much better to start with smaller goals and then build on them than to start with goals that are too ambitious for you.

Relevant goals are ones that are worthwhile and applicable to you.  If upping your omega-3 intake isn’t that important to you, then don’t set a goal to eat more salmon.  By the same token, if you are already succeeding at one area of your nutrition (say, getting your leafy greens), then maybe it’s time to focus on something else, like increasing your nut intake.

Finally, it’s important that your goals are time-bound, that there is a particular time frame for achieving them.  You could add on to the examples given above: “I will make a kale smoothie for breakfast 2 times this week,” and “I will prepare a new salmon dish one night per week for two months.”  By giving yourself a deadline, you will be more likely to achieve your goal on or before that deadline.

If the above seems a bit much, the one piece of advice I give all of my patients is to keep it simple.  When goals are overly complicated and ambitious, it can be overwhelming.  And be kind to yourself – you are human, after all!

The Real You Is Sexy

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Aerie, the lingerie branch of American Eagle, is going with a “The Real You Is Sexy” campaign for their spring line.  My understanding is that the ads are not retouched in any way and show the models just as they were when the photographers took their pictures.  Aerie deserves credit for this move, but this change alone does not fix the underlying problem.  The greater problem is with us, not the fashion industry.

Reality is more complex than I am about to make it seem, but the basic premise is that we compare ourselves to models, feel pressure to look like them, feel bad about ourselves for not looking like them, and adopt certain behaviors – healthy or not – in an effort to match them.  Other advertisement campaigns that do retouch photos can dramatically alter a model’s appearance making him or her seem flawless.  When such a picture is held up as the ideal, we are comparing ourselves to someone who does not even exist.  As such, who can possibly live up to that standard?  Aerie deserves credit for at least removing this as a factor from the equation.

The larger problem though is that we compare our bodies to others in the first place, and that is not going to go away even if the fashion industry completely does away with retouching.  For example, I work with a patient who watches women leaner than herself pass by in town and feels bad about herself as a result.  No retouching there; she is comparing herself to people she sees with her own eyes.

We do not know what somebody does to look a certain way.  I do not know any of the Aerie models and I have no idea what they do to maintain their looks, but chances are neither do you.  They might look the way they do because they are genetically predisposed to have that figure and on top of it take excellent care of themselves.  On the other hand, they could also look that way due to eating disorders, overexercise, or other unhealthy behaviors.  One of my patients, a former model who is working to overcome anorexia, tells me of the pressure in the industry to gain a certain look at any costs, healthy or not.  If a model gets his or her frame through an eating disorder, are we really to look up to that image as an ideal just because there is no retouching involved?  In that sense, we still should not be using models – retouched or not – for a point of comparison.   

To further the point, we should not be comparing our bodies to anybody else either.  I discussed with my patient, the one who compared herself to other women in town, that we have no idea what those women do to maintain their looks.  Some of them are probably perfectly healthy, while others might struggle with eating disorders or other unhealthy behaviors.  Some of them are deeply unhappy and live rigid lives in isolation so they can do exactly what they need to do in order to maintain their physiques.  Some of them would laugh if they knew other people look up to them because no matter how great somebody else says they look, they still hate their bodies themselves.  I know all of this because I just described patients of mine.  These problems are much more prevalent than one might think.

It is time to stop comparing our bodies to others.  Weight, waist-to-hip ratio, and other anthropometric measurements do not define us and should not determine our self-worth.  Love and accept yourself the way you are now, not X pounds from now, and focus on leading a healthy lifestyle built on a foundation of balance.


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A friend and I recently got into an email exchange about how rapidly nutrition advice seems to shift and how this often leaves people confused, frustrated, and feeling paralyzed about what to do.

No doubt, guidelines do evolve in response to new research, and in fact the Dietary Guidelines for Americans are updated every five years.  The shifts, while perceived as quite fickle, are much more subtle than most people realize.  However, the reason we perceive nutrition advice to be oscillating like the ever-changing wind is not due to this evolution, but rather because of misinformation.

Take yesterday as an example.  Each day, Joanne and I receive a blast of nutrition-related articles.  For each topic, we are provided with the story geared towards the general public, such as an article in the New York Times or Boston Globe, as well as the research piece or journal article on which the story is based, such as a piece in the New England Journal of Medicine.

Yesterday’s topic read, “Fats and Oils That Can Improve Your Health.”  As soon as I began to read the story, something seemed fishy.  Ghee and coconut oil topped the list of supposedly-healthy fats.  Although alternative medicine touts both of these fats as having health benefits, the research up to this point has not supported these claims.  Therefore, I was surprised to see them headlining the list.  When I got to the bottom of the article, I discovered that sure enough the story was written by a “Holistic Health Counselor,” as opposed to a credentialed and licensed expert in the field.

Next, I read the position statement released by the Academy of Nutrition and Dietetics on which the above story was supposedly based.  The content of the two publications bore little resemblance to each other.  Regarding coconut oil, the Holistic Health Counselor wrote, “This versatile oil goes well with both sweet and savory dishes and boasts many health benefits.  Made up of medium-chain fatty acids, this oil is good for those trying to lose weight because the body can easily use this healthy fat for energy.  A large portion of the fatty acids found in coconut oil are made of lauric acid, which can serve as an antimicrobial, antiviral, and antibacterial, helping to combat viruses and boost the immune system.”  On the other hand, the position statement read, “New food products containing coconut oil and other palm oils (eg, milk, spreads, yogurt) are touting health benefits of MCTs [medium-chain triglycerides, or medium-chain fatty acids].  Given that 44% of coconut oil is 12:0 and 16% is 14:0, and these fatty acids are hypercholesterolemic, consumption of coconut products is not currently recommended.”  Do you see any relationship between these two passages at all?

Omitting a link to the Holistic Health Counselor’s story was a conscious decision on my part in order to avoid further dissemination of misleading information.   If I showed you the article though, you would discover that it is concise, organized into a list with bold headings, and features colorful and attractive photos as well as a head shot of the author.  Compare that to the text-heavy, chemistry-laden, pictureless, 18-page monstrosity that is the position statement.  The former will attract more readers and gain steam and wide circulation due to forwarding to friends, postings on Facebook, etc.  The latter is lost in the dust, only to be read by the likes of me.

Generally speaking, most people never read primary source articles.  They simply trust that the stories they read summarizing said articles do so with a high degree of accuracy.  Unfortunately, just like in the game of telephone, details and facts get lost or skewed with each iteration; the ultimate and initial messages conveyed often do not match.  The mismatch is what makes playing telephone fun and interesting, but in real life the consequences are negative.  A patient comes into my office having read the more popular article and understandably believes the content to be true, but then he or she hears me present the position statement’s stance.  “Have the guidelines already changed?” the patient asks.  “Who should I believe?  What am I supposed to do now?”  No wonder people feel stuck and confused.  Part of our work then becomes to undo this confusion so that the patient can move forward.

In a culture where we have limited time and attention spans, we get a great deal of our news through tweets, scrolling headlines at the bottom of the television, and sound bites.  Media members, fully aware of the small window they have to present an idea and under pressure to break a story first, sometimes sacrifice checking facts and preserving key messages.  The pressure to be first and to accumulate clicks, retweets, and Facebook likes is king while the responsibility to be accurate gets lost in the shuffle.

Somewhere along the line, somebody suggested to me that I should shorten my blogs.  People have neither the time nor attention span for my entries, and who besides my mom reads all the way through to the end?  Shortening my blogs, I am told, could increase our Facebook fans and Twitter followers, thereby making Soolman Nutrition and Wellness LLC more popular.  That could be true, but my position as a source of reliable information is one that I take seriously, and I am not about to sacrifice my credibility for some extra likes and retweets.  Despite today’s be-first-and-keep-it-short media culture, accuracy and completeness are still necessary in order to minimize confusion.

Eating Flowers

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If you are like me, your eating pattern is somewhat repetitive.  Your grocery shopping involves focusing on the usual suspects while consciously or subconsciously dismissing most of the foods in the store due to cost, lack of knowledge about how to prepare them, ethical reasons, bad experiences last time you had them, or a variety of other reasons that can eliminate them from consideration for purchase.

Once upon a time, my shopping trips were so consistent from one to the next that my visits to Whole Foods were showcases of machine-like precision and efficiency.  Within 10 minutes of turning off my car’s ignition in the parking lot, I was buckling my seat belt with a trunk full of groceries in the back.

While routine has its upsides, at some point along the line I realized that I was doing myself a disservice by always eating the same foods.  From a health standpoint, I was missing out on nutrients that were deficient in my regimen.  In terms of enjoyment, I often felt bored with what I was eating.  Food can and should be fun, and as Joanne pointed out, we tend to absorb more nutrients if we enjoy what we are eating.  The grocery store is full of foods that I might have really liked if only I was adventurous enough to give them a chance.

Once I realized that, I decided that each time I went to the store I would purchase one food that was either brand new to me or that I had not had in a very long time.  I tried all sorts of things, some of which probably sound mundane to you, but they were departures from the norm for me: exotic melons, crab cakes, pies, tabouli, strange-looking vegetables I had no idea how to prepare, dairy-free “ice creams,” pumpkin pasta sauce, teff, vegan hot dogs, etc.  Each week I came home with something new.  No, I did not like everything I tried and many of them I never bought again, but there was still value in the experimentation.  I expanded my palette, rediscovered foods I had forgotten, and realized that some foods I used to dislike now hit the spot.

Although I maintained this tradition for years and got a lot out of it, recently I found myself sliding back.  Once again, I gravitated towards particular shelves while ignoring the vast majority of the inventory.  As soon as I caught myself doing this, I reminded myself how much I enjoyed my years of experimentation.  At that moment, I was standing in the produce section in front of a package of edible flowers.  My hesitation reminded me, “I am not someone who eats flowers.”  As I reached for the package and put it in my cart, I thought to myself, “I am now.”


The Lottery

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Ralph Francois, of Quincy, won $1,000,000 playing Mega Millions. Marjorie Teixeira, Frank DiMascio, and Christine Cummings, of Melrose, Watertown, and Dedham, respectively, all won lottery prizes on the same December day. Stanley Goryl of Smithfield, Francis McPherson of Somerville, Marque Scott of Fall River, Patricia Cannata of Attleboro, and Linh Dang of Dorchester are just a few of the 15 locals who won at least $1,000,000 through the lottery last month. Their pictures, smiling and holding up enlarged replicas of their winning tickets and prize checks, are both evidence of their victories as well as enticements to the rest of us suggesting that we can be winners too.

Despite these testimonials that fill us with hope, most people do not walk away a winner.  Massachusetts lottery players, on average, will only win back $0.72 for every $1.00 they spend on lottery tickets. According to a study by Bloomberg, state lotteries “have the worst odds of any form of legal gambling” in the country. To put things in perspective, one reportedly is 1,400 times more likely to die in an asteroid apocalypse than he or she is to win Powerball. As if the odds themselves were not concerning enough, playing the lottery can sometimes spiral out of control. A link on the Massachusetts State Lottery’s website directs people to where they can get help for compulsive gambling.

Some people enjoy gambling, including the lottery, and as one of my friends said to me recently, “You can’t win if you don’t play.” Going about it with a sporting attitude for the sake of entertainment and excitement is one thing, but nobody actually believes that playing the lottery will really net a profit, right? Wrong. According to a couple of 2005 surveys put out by the Consumer Federation of America and the Financial Planning Association, 21% of the surveyed Americans believe that winning the lottery represents the most practical way for them to accumulate several hundred thousand dollars. I imagine one would be hard pressed to find a legitimate financial adviser who would suggest that playing the lottery is a sound investment strategy.

Given the time of year with people around me making all sorts of resolutions, the clear parallel between playing the lottery and resolving to lose weight has been on my mind. Joanne and I have written extensively about the chronic failures of weight-centered dietary approaches. Although the exact outcome depends on the specific parameters of the given study in question, research across the board shows that the chances of keeping off lost weight are poor. According to one group of researchers, “Less than 20% of individuals that have attempted to lose weight are able to achieve and maintain a 10% reduction over a year. Over one-third of lost weight tends to return within the first year, and the majority is gained back within three to five years.”

Joanne and I advocate focusing on health rather than weight. In that sense, weight outcomes are only somewhat interesting to us. However, for programs and approaches that revolve around weight, shouldn’t the results at least be better than this?

However, just like people who play the lottery despite the terrible odds of making a profit, we get sucked in by glamorous testimonials, peer pressure, advertisements, and the like, all encouraging us to lose weight. We enter the weight-loss game with the expectation, whether by delusion, misunderstanding, or overconfidence, that we will be the rare exception who comes out on top. “You can’t win if you don’t play,” right?

The difference is that we are not playing a game; we are playing with our health. At best, the weight-loss-weight-regain cycle postpones behavior change that will actually improve our health. More likely, the cycle itself can leave us in a less healthy state, either physiologically, psychologically, or both. Furthermore, just as the lottery can lead to a gambling addiction, weight loss pursuits can lead to serious eating disorders which add a whole new layer of complexity to one’s health problems.

Instead of entering a game that you are likely to lose, leave weight-centered approaches behind and focus on making healthier choices. No, lifestyle change is neither sexy nor rapid. Lifestyle change does not make for good reality television. What it can do though is increase your chances of getting healthy and staying that way.

The Wrong Idea

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In addition to the many patients I see for eating disorders, I often have individuals come to see me for help with weight loss. This goal is completely understandable in the current context of our society. Most of us have been told by numerous sources that weight loss is essential for health, and only if we are at the “right” weight will we live long and healthy lives. And up until about five years ago, I would have agreed with this assumption.

But, as I have written about in many other blogs, I’ve had a paradigm shift. There is more and more scientific evidence out there that weight and health are not inextricably linked. In fact, it is completely feasible for someone to weigh considerably more than the BMI and weight charts tell her to and to be perfectly healthy. In contrast, I have seen countless patients in my office who are at their “ideal” weights, yet are using extremely unhealthy measures to stay there and have numerous health issues as a result.

Therefore, I am concerned when the New Year comes around, as I know that our office will become busier than ever with people wanting to lose weight. I’m afraid that prospective patients will have the wrong idea about what I will and will not do. As a registered dietitian, I am knowledgeable about nutrition for health promotion. This means I can provide nutrition education for my patients and help them figure out ways to establish some healthier eating habits.  While these healthier eating habits may lead to some weight loss, weight loss will not be the inherent goal of our work together. If any weight loss occurs, it is just the byproduct of the lifestyle changes one instills. It isn’t the primary goal.

Maybe 2014 will be the year that we can all start taking our eyes off of the scale and instead focusing on making healthy lifestyle changes instead.

Be Your Own Best Friend

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It’s the holiday season, a time to spread joy and love to those around you.  Many times this takes place in the form of buying gifts, baking, and cooking for those we care about.  It often involves telling our friends and family how much they mean to us, how loved they are.  This is the time of the year when we show our appreciation and care for others.

So, in the midst of spreading all of this happiness to others, who often gets neglected?  You guessed it – you!  Not only do we often forget or put off taking care of ourselves, many of us are pros at talking especially harshly to ourselves.  Many of my clients have an inner monologue that goes on a continuous loop.  These thoughts include things like, “I can’t believe you missed that workout today – you are so lazy!” or “You have to stop eating like such a pig” or “You are a disgusting, fat person who has no self-control.”

Now, would any of us talk to our best friends the way we talk to ourselves?  Of course not!  Pretty soon, we wouldn’t have any more friends!  Then why do we think it’s okay to talk this way to ourselves?  Whenever a client tells me about her latest bout of self-hate talk, I ask her to think about what she would say to her best friend if the friend was saying these hateful things about herself.  Common answers to the above hate talk include, “You’ve been so tired and run-down lately, it’s probably a good thing you skipped that workout.  You need the rest!” and “You are not a pig!  We all overeat sometimes, and it’s not the end of the world,” and “You are a beautiful, smart, and loving person – self control has nothing to do with how wonderful you are!”

Let’s break the cycle of negative self-talk and start talking to ourselves in a more positive way.  When we are kind and gentle to ourselves, we are more likely to take better care of ourselves, too.  Imagine what a difference that would make!

Fitspiration or Fat-Shaming?

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In fat-shaming news, Maria Kang, a 32-year-old fitness fanatic and mother of 3, posted a photo of herself and her three sons (then aged 3 years, 2 years, and 8 months) on Facebook with the caption “What’s Your Excuse?”  In the photo, Kang is wearing only a sports bra and tiny workout shorts, showing off her toned and sleek body.  Clearly, the photo and caption are meant to be “fitspirational” to all of the new moms out there who haven’t yet made losing weight their top priority and to show them that even with 3 kids under the age of 3, you too can have the body of a fit model.  Needless to say, the internet has been ablaze with both positive and negative feedback on the image.

I actually saw this woman on the Today Show this morning, and she was rather unapologetic about the message her photo is sending.  She reiterated the fact over and over that the photo was meant to be inspirational, not a knock against fat people.  That may have been her intention, but honestly, the caption clearly implies judgment against those who “haven’t lost their baby weight yet.”  That perhaps if these overweight women just tried a little harder, they too could bounce a quarter off their abs.

Kang, who is a former personal trainer and beauty queen, clearly has always been in good shape.  Given this fact, it’s not surprising that she was able to “bounce back” to her original shape after her pregnancies.  But the fact is that she is in the minority.  The average woman in the U.S. does not look like Kang and even if she were to put in all of the extraordinary time and effort to achieve Kang’s physique, it is very unlikely that she would be able to maintain it.

So, yes, I do believe that this image is fat-shaming. Instead of sending the message that if you just try hard enough, you can have a hard body after baby, how about telling new moms that they are beautiful and that they should appreciate what their bodies can do for them (e.g. give birth!).  Now that would be inspirational.

Problems and Privileges

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Thank you to everybody who showed up for the Race Wellesley First 5K and 10K this weekend, including runners, supporters, volunteers, and sponsors!  I love events that bring the community together, and as such I was really happy to both be sponsoring and competing in the race.

I finished the 10K race in 10th place overall and in fourth place in my age group.  I missed out on a third-place medal by 0.9 seconds.  The guy who earned the bronze passed me with about a mile to go.  Rather than keep up with him, I elected to stay back.  My plan was to let him think I was out of gas, but then to take him by surprise and out-sprint him at the end.  The strategy almost worked, but I could not quite catch him at the line.  He ran a great race and definitely deserved the medal.

I have never won a placement medal in my life, so when the standings were announced and I realized that I missed out on one by a single second, I was frustrated and could not believe I let the opportunity slip away.  It is easy to look back on a six-mile course and develop a list of second-saving could-haves, would-haves, and should-haves.  I am sure the guy who beat me could say the exact same thing about his own performance, but the reality is that neither one of us gets a do-over.

This is all pretty out of character for me.  People who know me well know that I care much more about race time than I do placement.  The way I see it, time is a better reflection of my progress because I can compare myself to how I have done in similar races.  We are more in control of our own destiny with time, whereas placement heavily depends on elements that are out of our hands.  If the Kenyan national distance-running team shows up or stays home, for example, I am going to finish in a very different place in the standings regardless of how hard I run.

So, if I do not care that much about placement, why did I care in this race?  I am embarrassed to say it is because we were a sponsor.  There I was wearing my green Soolman Nutrition and Wellness LLC racing jersey, our logo printed on all of the racing bibs and centered on the race T-shirts, and our brochures stuffed into the gift bags that each runner received.  I imagined that in the eyes of everybody who was there, my race performance would make or break their opinion of me as a dietitian.

That is probably the silliest and most off-base notion you have read today.  Furthermore, it is not even in line with my opinion regarding how a practitioner’s life influences (or does not influence) patient care.  I temporarily got caught up in a belief system in which I normally do not include myself.

This morning, I went to supervision group.  That’s the term used for when a small group of dietitians gets together to discuss best practices, difficult cases, and other matters of patient care.  It turned into an emotional meeting or sorts, as people in the group shared some of their own personal struggles as well as their fears regarding what their patients might think if they found out about these issues.  Without disclosing details that might make their identities known, I will tell you that one of the dietitians mentioned a personal history of an eating disorder, another shared her struggles with a debilitating and incurable disease, and another disclosed that she will be undergoing radical surgery this winter and has been overeating due to her increased stress.

I only listened.  Had I contributed, I would have told them about my persistent back problems: the herniated disc, the four fractures that will never heal, and other associated issues.  I remember my physical therapist telling me earlier this summer that she does not get too worked up about MRI reports because almost every scan reveals some sort of structural issue, and by and large these issues are harmless.  She told me she only gets concerned when a report contains the word “severe.”  Then she looked at my report, looked back up at me, and gave me a half-smile.  “Severe” appeared in my report three times.

Dietitians are just like everybody else.  Patients often assume that we are perfectly healthy, have perfect relationships with food, and in general lead the healthiest of healthy lifestyles, but the truth is that we have our problems too.  Like a cancer patient who goes on to become an oncologist, why do you think so many of us chose to pursue a career in health and dietetics?

So, taking myself down from the pedestal that some people seem to put me on, but on which I do not belong, is actually a big relief.  I do not have to live up to extraordinary expectations and feel bad about myself when I fall short.  Instead, I can just enjoy what I have, what I can do, what I have accomplished, and what is ahead of me.

It is a privilege that I have been generally fortunate with my health and that the problems I do have are manageable.  It is a privilege that I can go to physical therapy and work towards getting stronger.  It is a privilege that you, your neighbors, and your friends allow me to help you towards your own goals.  It is a privilege that I got to race in a great community event along a beautiful course on a crisp late summer morning with my wife cheering for me.

And yes, it is absolutely a privilege that I was able to finish one second shy of winning a medal.