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Some months, coming up with a newsletter topic is unusually challenging. For the last few weeks, Joanne and I were both scratching our heads, as the ideas we had were for research pieces that would demand more time than either of us is able to dedicate at this point in time. Being silly, I facetiously asked our four-year-old daughter what I should write about this month. “Pancakes,” she responded, “Pancakes and maple syrup.” Joanne and I laughed, and I walked out of the room, but I quickly returned and told them I was going to use her idea.

Our daughter’s suggestion reminded me of a quote from one of my earliest patients many years ago, and what the latter said to me felt significant enough that I wrote it down as soon as she left my office. “One day, you will have a baby boy who will love you,” my patient said, “and then he will grow up to hate you. But then one day he will love you again and say, ‘Hey, Dad, let’s go out to breakfast, just us guys,’ and then you will go to Bickford’s, and you will have an apple pancake, too.”

At that point in my career, I was still doing the kind of work that most people figure dietitians do: putting people on diets in the pursuit of weight loss. My prescribed diets were low in carbohydrates, especially grains, and so restrictive of calories that if my patients were living in a different region of the world, the United Nations would have sent cargo ships full of food to help them. While I did not author these diet plans, which seemed concerning to me at the time because of their restrictive nature and the good/bad food dichotomy they established, I did dole them out as instructed, and for that I have nobody to blame but myself.

These diet plans typically “worked” in the sense that my patients lost weight, but rarely – if ever – did the weight suppression last long term. At the time that I left the medical center where I was working and stopped doing that kind of work, I did have some patients who had maintained their weight loss thus far, but I have no idea what happened to them later. Given that most weight regain happens two to five years after baseline, I can only assume that at least some of these patients, if not all of them, regained weight after I was out of the picture.

Diets fail for a number of reasons. Most significantly, the physiological mechanisms that kept our ancestors alive through periods of starvation kick in when we restrict and promote weight regain. Another factor, the one that my patient was trying to make me aware of via her aforementioned quote, is that diets are incompatible with real life. After all, if I were following the low-carb, low-grain, low-calorie diet that I had put her on, I would be unable to both remain on the plan and partake in her breakfast scenario. The dietary expectations I had set out for her were unrealistic, which was exactly the point she was trying to get me to see. Point taken.

Now that I am a dad myself, I have greater first-hand life experience to reinforce my theoretical understanding. Numerous times over the last few years, I have eaten foods I was not in the mood for because sharing an eating experience with my daughter was more important to me than eating exactly what I wanted. For example, the food at Chick-fil-A rarely sounds good to me, and I certainly would have preferred something else for dinner last Tuesday night, but I took her there because she loves it, she asked me if I would take her, and I prioritized making her happy and sharing one of her favorite meals over eating what I really wanted.

If I was on some diet plan that restricted foods like Chick-fil-A, such as the plan I had given to the patient in question, I would have had to choose between breaking the diet or missing out on a family bonding experience. When I was a young adult and somewhat orthorexic, I prioritized “healthy behaviors” to the detriment of other important areas of my life. 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. If you have ever been on a diet yourself, consider the ways in which sticking to the plan came at the expense of other facets of your life. My guess is that if you look back, you will find examples in your own life similar to the ones I just described.

Furthermore, remember how you felt when you inevitably deviated from your diet. In Reclaiming Body Trust, authors Hilary Kinavey and Dana Sturtevant succinctly describe the pattern of dieting with a diagram that they entitle “The Cycle.” At the 12 o’clock position, the circular diagram begins with “The Problem,” which then leads to “The Shame Shitstorm” at three o’clock, followed by “The Plan” at six o’clock, then “Life” at nine o’clock, and then back to “The Problem” as the pattern indefinitely repeats. Delving into the particulars of these positions is beyond the scope of this blog, but the overall pattern is one to which many of us can relate: We identify a problematic eating behavior, feel bad about it, desperately grab for a plan that will supposedly rescue us from ourselves, abandon the plan when it proves itself to be incompatible with life, and the cycle repeats.

If a diet puts us in a position to choose between (A) sacrificing important parts of life, such as sharing a bonding experience with our kids, in order to remain on the plan, or (B) breaking the diet and perpetuating a cycle of shame and unsustainable attempts to deal with our problems, then perhaps dieting and living a full life are simply incompatible.

The GOAT(’s) Fad Diet

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If you are like me, you wonder what the baserunner and first baseman talk about between pitches. When an athlete meets a peer, the dynamic is presumably different from an interaction with a fan that likely centers around adulation and an autograph.

When dietitians get together, chances are high that at some point we will touch on whatever nutrition-related fads and ridiculousness are currently hindering our work. We laugh, not because we are making fun of anybody, but because misinformation is so pervasive and challenging to our profession that sometimes all we can do is approach our upstream paddle with humor.

The deeper reality, which often goes unspoken but is silently understood, is how terribly harmful nutrition myths, bad information, half truths, and fear mongering are to our patients. All it takes is one meme, 140-character post, headline, hyperlink, or soundbite and the population is led astray in an instant. Just one celebrity endorsement carries more weight in the eyes of many than the educated stances of professionals who have dedicated their careers to the field of nutrition.

Consider Allen Campbell, personal chef for Tom Brady and Gisele Bundchen, and the interview he recently gave to about his clients’ diets and their shared perspectives on nutrition. Initially I chuckled at the absurdity, but I quickly remembered that hundreds if not thousands of people are likely to risk their own health as they assume this, umm, information to be fact and internalize it.

Let’s look at some of the standout excerpts.

“My philosophy starts in my own life, and with my own lifestyle and eating habits. I make conscious decisions to buy local and organic, and to stay away from GMOs, and to think about the future of the planet and the future of humans.”

He hits on nearly every current nutrition buzz phrase except for farmers markets, raw, dairy free, gluten free, and no white foods, but don’t worry, he brings those up later.

“I took a plant-based nutrition course earlier this year. It was an online course through Cornell, and it’s taught by a doctor named T. Colin Campbell, who’s behind ‘The China Study.’ My philosophy is that a plant-based diet has the power to reverse and prevent disease.”

Four or five years ago, a patient came into my office touting “The China Study”which has been largely debunked, by the way – and told me, “A plant-based diet is the only one that heals.” She also stated, “The government puts rat poison in the water, but they just don’t tell us.” Sometimes, apparently, hyperbole and paranoia go hand in hand.

“So, 80 percent of what they [Brady and Bundchen] eat is vegetables. [I buy] the freshest vegetables. If it’s not organic, I don’t use it. And whole grains: brown rice, quinoa, millet, beans. The other 20 percent is lean meats: grass-fed organic steak, duck every now and then, and chicken. As for fish, I mostly cook wild salmon. It’s very different than a traditional American diet. But if you just eat sugar and carbs – which a lot of people do – your body is so acidic, and that causes disease.”

Actually, most Americans get more than enough protein. Someone who ate just sugar and other carbohydrates would likely develop kwashiorkor, marasmus, or a similar problem related to protein malnutrition. We learned about these conditions in the first semester of actual nutrition school, but apparently they were never covered in Campbell’s online course.

If your body is acidic, your medical chart probably lists a diagnosis of metabolic acidosis, respiratory acidosis, or diabetic ketoacidosis – none of which are caused by overconsumption of sugar or other carbohydrates – and you are reading this blog from your hospital bed.

“Tom [Brady] recently outed Frosted Flakes and Coca-Cola on WEEI. I love that he did that. Sugar is the death of people.”

As it turns out, your brain runs on sugar, and without adequate glucose in your system, you risk a myriad of problems, including death. What Brady did was oversimplify a complex problem by scapegoating an ingredient, which plays into the fears that fuel disordered eating and eating disorders.

“No white sugar. No white flour. NO MSG. I’ll use raw olive oil, but I never cook with olive oil. I only cook with coconut oil. Fats like canola oil turn into trans fats.”

People continue to fear canola oil based on myths that run counter to actual science. Trans fats, which occur naturally in only trace amounts, are made in large quantities through a chemical process known as hydrogenation. This reaction, while not terribly complex, involves more than just sticking the substrate in the oven.

“[Tom] doesn’t eat nightshades, because they’re not anti-inflammatory. So no tomatoes, no peppers, mushrooms, or eggplants. Tomatoes trickle in every now and then, but just maybe once a month. I’m very cautious about tomatoes. They cause inflammation.”

The research supporting the notion that tomatoes cause inflammation is spotty at best, with some studies showing the exact opposite effect. The evidence is about as strong as that showing the positive impact that tomatoes might have on eyesight. Maybe if you ate more tomatoes, Tom, you would not have thrown that goal line interception against Philadelphia.

Do the kids eat the same things Tom and Gisele eat? “Yeah, I mean pretty much . . . . For snacks, I make fruit rolls from bananas, pineapple, and spirulina. Spirulina is an algae. It’s a super fruit. I dehydrate it. I dehydrate a lot of things. I have three dehydrators in their kitchen. I also make raw granola and raw chocolate chip cookies.”

I have no idea what a “super fruit” is, but I am assuming that being a fruit is a prerequisite for consideration, which excludes an algae like spirulina. Anyway, my colleagues and I consistently find that children raised in households where food is restricted tend to have significant overeating problems once they reach adulthood. Westgate SuperBooks declared Brady’s New England Patriots 9-2 co-favorites to win next month’s Super Bowl, while I will set the odds of Brady’s children bingeing on college dining hall pizza and soft serve much, much higher.

As the interview continues on, the topics turn away from general nutrition and instead touch upon examples of dishes the chef makes and his typical workday, neither of which are within the scope of this particular blog entry.

People look at Tom Brady, 38 years old and still at the top of his game, and figure his nutrition regimen must be at least partially responsible. That may be true, but as I have written before, both about Brady in particular and professional athletes in general, their upsides for rigidity are unlikely to exist for laymen, and the virtues they bestow upon their diets can be off base.

Consider Dave Scott, six-time winner of the Hawaii Ironman Triathlon, who famously washed off his cottage cheese before consumption in order to remove as much fat as possible because he believed a low-fat, high-carbohydrate diet gave him an edge over the competition. It strikes me as more than mere coincidence that Scott was doing this in the 1980s when fear of dietary fat was at its peak.

Similarly, while I have no doubt that Brady believes his diet enables him to perform his best, let us also recognize that his eating behaviors are reflections of nearly every single one of today’s nutrition fads.

One Step Backward for Dietitian-Kind

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With National Nutrition Month upon us, I have been reflecting upon the work that I and my dietetic peers are doing with our patients. Are we helping to guide our patients toward better health? Are we presenting them with the most accurate, up-to-date, and appropriate nutrition advice based on peer-reviewed, evidence-based research in the field of nutrition and health? Are we acting ethically in our profession? I would like to think that most dietitians would answer yes to the above questions. We entered this field to help people, right? Well, unfortunately, some dietitians really get it wrong. And this can damage the dietetic field as a whole.

Recently, an article came across my radar screen, which illustrates the above point to a tee. In the article, entitled “I’m a Nutritionist. Here is How I Plan to Lose 20 Pounds,” Erica Sawers, a chiropractor and registered dietitian (RD), talks about how after giving birth to two children in the past three years and “indulging in croissants and treats” during both pregnancies, she wants to lose twenty pounds to get back to her pre-pregnancy weight. She then goes on to list seven ways that she plans to achieve her goal.

For the most part, this article is plainly ridiculous. In her first bullet point, Sawers delineates that she is going to set a “realistic goal” of losing one to two pounds per week. In the very next step, however, she says that she plans to “banish the scale,” by focusing on how her clothes fit rather than focusing on a number. She then follows that sentiment with “the most I will allow myself to step on the scale is once a week, and even once a month will do.” Um, ok. I’m totally confused now. So, are you going to weigh yourself or not? Because in my lexicon, banishment means “none.” And if the number isn’t that important to you, why set twenty pounds as your goal? Am I missing something here? Seriously.

Later in the article Sawers advises, “find a diet that works for you.” She then goes on to say that she herself avoids gluten, dairy and refined sugar, but doesn’t deny herself a few squares of dark chocolate or homemade cookies on occasion. Ugh. What she is describing sounds pretty restrictive to me. Honestly, who could stick to that regimen for an extended period of time without feeling horribly deprived? It is unrealistic to think that this way of eating would be sustainable for most people. And while someone might indeed lose some weight following her regimen, I would be willing to bet that the individual would regain the lost weight and then some.

As an RD, Sawers should know better than to write an article like this. As we all have heard many times before, diets fail 95 percent of the time, meaning only 5 percent of weight-loss attempts are sustainable. In fact, most people will end up regaining the lost weight and then some when they go off the diet. Research is also starting to point at yo-yo dieting as being more dangerous than just maintaining a higher weight, as it puts more stress on the body to chronically lose and regain weight. What Sawers is presenting is a diet, pure and simple. How can she publish something like this with the knowledge that the outcome will be failure for most people who try it and could result in increased health risks?

Instead of writing an article about how to lose weight, how about writing one about how to achieve better health? As Jonah and I have written about too many times to count, weight is not an accurate indicator of health – behaviors are. The research shows time and time again that the more healthy habits an individual has (e.g. not smoking, being physically active, eating five servings of fruits and veggies daily, and drinking moderately), the better that person’s health outcomes will be. These findings are independent of weight. Let me repeat that: it’s the behaviors, not the weight!

Unfortunately, Sawers’ article is not unique. I often see these types of nonsense blogs pop up all over the internet. If this was some random person’s article about wanting to lose weight and her strategies to do so, I wouldn’t have as much of a problem with it. But, Sawers is a registered dietitian. That means that many people will take her weight-loss guide as a how-to for themselves. As dietitians, we have a responsibility to present accurate information in an ethical way. This article misses the mark.

The, umm, “power” of carrot cake

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CarrotCakeOn Valentine’s Day, I surprised Joanne by baking her a carrot cake. Just over one week later, I realized half the cake was still in the refrigerator. Although we liked it, we both felt like we had had enough. The cake was getting old and we did not want to take up freezer space with it, so we pitched the remaining portion.

In posting this, I risk the inherent danger of misunderstanding, so let me be clear: Moralizing foods or eating behaviors is a harmful practice that I do not endorse. Carrot cake is not “bad” or “unclean” or a “guilty pleasure,” nor did I “fall off the wagon” when I baked and ate it. We are not “disciplined” for leaving some, nor would I have been “good” if I had never made it in the first place.

Our carrot cake exemplifies a nutrition strategy that Joanne and I oftentimes use with our patients. We often hear people tell us about their trigger foods, i.e. foods they feel must be completely avoided because a little inevitably turns into a lot. They are addicted to these foods, they say, or perhaps they blame themselves and cite a supposed lack of willpower.

The presumed solution is to abstain from these foods at all costs, but the downsides of this approach include missing out on favorite foods, a low likelihood of long-term success, and reinforcing the notion that these foods are taboo, which only serves to make people want them more.

We find that doing quite the opposite works better: Keep large quantities of said trigger foods on hand at all times and give ourselves permission to eat them whenever we want. Patients sometimes bristle when we raise this idea. If we believe a food has control over us, then having it available in abundance feels scary. Furthermore, giving ourselves permission to enjoy it whenever we feel like it sounds ridiculous and counterproductive to the pursuit of health.

I know, I know, we’re crazy, but think about it: Granting ourselves unconditional permission to eat a particular food does not automatically mean we are actually going to eat it regularly or in vast quantities. We may be surprised to find how sharply our desire for a previously-taboo food can drop off once we give ourselves unconditional permission to consume it.

We couple this approach with building intuitive-eating skills, which involves learning to ask ourselves questions about how hungry we are, what food do we really want at the moment (what temperature/color/texture/flavor/etc. do we really feel like), and what quantity of the identified food do we truly need to feel satisfied. If we ask ourselves these questions in a neutral, open-minded, and non-judgmental fashion, the answer is only sometimes going to be the previously-taboo food.

When it is, then we eat it slowly, enjoy it without guilt, and get on with our day. We stop when we have had enough, not when we are overly stuffed, because we know we can have more if and when we want it. The food, in essence, is demystified. Cookies are just cookies. Potato chips are just potato chips. Bread is just bread. We only experience their power over us when we operate in a paradigm that gives them power. When we remove moralization, judgment, and strict rules from the model, the sham of power is exposed for what it is and supposed addictions resolve. The carrot cake is forgotten as it blends in with all of the other foods in the fridge.

Joanne and I keep lots of play foods on hand, much of which we never touch. We have apple crisp ice cream that I bought this past fall in our freezer and Halloween candy in our pantry. We have unopened trays of Newman’s Own cookies and stashes of frozen pastries I made from scratch. We still have Valentine’s Day candy – from last year’s Valentine’s Day.

And none of that makes us “good” or indicates “willpower” or “discipline,” nor are we “bad” or “weak” or “guilty” when we do enjoy these foods. By having play foods on hand at all times, we find that we actually want them less. Remember, carrot cake is just carrot cake. Sometimes it hits the spot, but other times we might just want, well, a carrot.

You Are Not Tom Brady

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Leading up to today’s Super Bowl, a Boston television station aired a piece examining how Tom Brady, the quarterback of the New England Patriots, eats. The segment teaches us that among other eating behaviors, Brady does not consume any added sugar or processed foods and he abstains from alcohol.

Celebrities often influence our own behaviors, which is the driving principle behind sponsorship deals. Lump me in there as well. When Andre Agassi, my all-time favorite athlete, was endorsing Nike, much of my workout apparel bore the “Just Do It” slogan. Later in Agassi’s career when he signed with Adidas, the logo on my sneakers quickly changed from a swoosh to three black stripes.

Whether consciously or subconsciously, the sentiment we tell ourselves is along the lines of, “If those sneakers [or racquet, or sports drink, or watch, etc.] are good enough for him, then they are more than good enough for me,” or perhaps, “If I use those sneakers [or racquet, or sports drink, or watch, etc.] too, then maybe I can play like him.” It is only natural that the same message may extend to our perceptions of how professional athletes eat, but if you are considering emulating Brady’s diet, think again.

With sport being the primary focus of a professional athlete’s life and so much financially riding on performance, they frequently make choices that would not necessarily be prudent for the rest of us. In a recent conversation, a physical therapist pointed out to me how professionals are quick to undergo surgery and rush through their recoveries, while an amateur with the same injury is more likely to opt for a longer, but safer, rehabilitation program rather than an operation.

In other words, the life of the professional athlete is often focused on the here and now while the long-term risks take a back seat. Look no further than how the National Football League dealt with concussions for decades – largely minimizing the significance of brain injuries and rushing concussed players back on the field with little regard for the depression, memory loss, and suicidal urges that often came with retirement – until very recent legal action inspired change.

This philosophy bleeds into nutrition as well. Following rigid food rules comes with upsides for professional athletes, but similar payoffs are unlikely to exist for amateurs. Therefore, while it may make sense for Brady and his peers to follow strict diets, the same does not hold true for the rest of us. In other words, Brady’s diet may serve him at this stage in his life, but if implemented by one of us, the same eating behaviors may be described as orthorexic.

According to the National Collegiate Athletic Association, 6.5% of high school football players will continue the sport in college, and 1.6% of college players will go on to play in a professional league. In other words, only 0.08% of high school football players will ultimately play professionally. The statistics that they report for basketball, baseball, hockey, and soccer are on par with these figures. Given the extremely high probability that student-athletes will have to make their livings in a capacity other than turning pro, they often have backup plans for their lives (well, at least hopefully they do) in the form of academic educations so they have somewhere to turn when school and their athletic careers end.

Similar benefits exist in thinking long-term about nutrition as well. With all due respect to Brady and other professional athletes who are doing what they feel they need to do in order to perform their best, all-or-nothing approaches to eating rarely serve people for too long. When an athlete retires and suddenly the incentive for restriction ends, how will he deal with previously-taboo foods? This is akin to children who grow up in rigid eating environments with strict rules regarding quantities and/or forbidden foods, and then they go off to college and binge on late-night pizza delivery and all-you-can-eat soft serve in the dining hall. Such black-and-white approaches that teach us to ignore our internal cues and rely instead on external constructs will in all likelihood ultimately backfire.

Real life exists in grays, so building healthy relationships with food means both listening to our bodies and being flexible to allow for the complexities and variables that come our way. A professional athlete may have incentive to sacrifice such a relationship and rely instead on external rules because the here-and-now upside is so great, but the rest of us are better off learning a lesson from the 99.92% of high school football players who will never play in the National Football League. In other words, think long and hard before deciding to sacrifice for the here and now, and instead focus on life’s big picture.

No Such Thing as Perfect

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The following piece was written by one of our patients, KC, a 32-year-old female from Wellesley.

Growing up as an athlete encouraged me to develop a commitment and eventually a passion for health and fitness. Over a year ago, that commitment turned into an unhealthy obsession. I lost the balance I once had and quite honestly it happened without me even realizing it. It took control of my life and isolated me from my friends and family and ultimately, it led me down a path of sadness and despair. This is my story of how strict discipline, unwavering dedication and the pursuit of perfection turned my otherwise healthy lifestyle into a battle with Orthorexia and exercise obsession.

I always looked to exercise for stress relief and an outlet when life became challenging and quite honestly, I still do. It was the one thing I could rely on. I felt a sense of calm when I planned strict workouts and meal plans. Sticking to them built my confidence, but failing to do so broke me down. I had to be perfect in order to achieve my goals of being fit. This discipline isolated me, but also made me feel better than everyone else. The more perfect I was, the more I separated myself from the average person. I looked down on everyone that didn’t share my passion for health and fitness.

I eventually developed such strict, unattainable rules failure was the only outcome. Each day I had to eat more cleanly and train harder than the day before. Even if I did achieve this for a period of time, I wasn’t capable of maintaining this intensity and in my mind the only solution was to be more strict. I started a food journal, something I have done my entire life off and on. In order to control my “bad” habits and cravings I felt it was necessary, although it only set me up for more potential for failure. The dieting world promotes food journals as a way to control calorie intake and unnecessary binges. I believe it can be a positive tool for those trying to develop better eating behaviors. However, this only contributed to my perfectionism, obsession and unrealistic ideals for myself. The more I recorded, the more I restricted.

At the time, I was experiencing discomfort with my stomach, which I blamed on my eating habits. It caused sleepless nights and uncomfortable days so I developed another rule, no eating past 8pm. This eventually ruined my social life. I had to rush home after work to eat dinner and declined all invitations to go out. For a while, I was convinced that it made me feel better physically, but the guilt I felt from avoiding parties, friends and anything social greatly affected my self-esteem. I justified it by telling myself I had to stick to the rules and staying out too late would no doubt ruin my workout the next day. The irony was despite following my rules and avoiding social settings my workouts weren’t always perfect. This only added to the growing feeling of failure and ultimately I wasn’t happy.

At this point, my dedication should have given me positive self-reinforcement and contentment. I was nowhere near content. I was exhausted all the time, injuries were creeping up, and I wasn’t enjoying myself at the gym like I once was. In addition, as hard as I was working out, I felt like my body looked awful and therefore I needed to push myself harder. This vicious cycle continued for months. I couldn’t look in mirrors because I felt like I wasn’t getting the results I should be. I avoided anything social because I felt like I needed to reach that level of perfection in order to feel good enough in my clothes to go out and be around people. I was stuck in a rut of failure, frustration and disgust. I found myself constantly comparing myself to others. I felt if I could maintain healthier habits than the people around me, I was ultimately more dedicated to fitness than anyone else.

One temptation that I always tried to control was my love for sweets. I figured if I eliminated eating them altogether I could get even better results at the gym. In reality, I didn’t get better results, I just deprived myself of something I enjoyed for the sake of achieving that perfect image. The interesting thing was I never defined what perfect was. I was constantly chasing something that wasn’t realistic. I just figured I would know what perfect felt like when I got there, but of course I only found sadness and disappointment.

My fitness became my identity. I figured it was the only real reason people liked me. They knew me as the fit girl. If I did overeat and not train hard enough, I wouldn’t be living up to that fit girl image. When I did overeat the punishment I put myself through at the gym was extreme in addition to depriving myself further of the nutrients to get rid of the heavy bloated feeling as a result of the overeating. My meal planning became so structured, I completely lost touch with listening to my body and I didn’t trust my body to make the right decisions. I would force myself to eat things I didn’t even want because they were ‘healthy’ and in my mind would get me closer to my goals. I planned my meals a week in advance and I ate based on the clock, not how my body felt. I had to eat 5-6 meals a day to get all the nutrients in I needed whether I was hungry or not. I realize now, I never enjoyed what I ate or really tasted my food. It took all the pleasure out of eating.

Despite the fact that I was so sad, I was still able to fake a smile. Everyone in my life knows me as a happy person so I had to keep that up. I’ve had people say to me, “You are so happy all the time, I don’t know how you do it”. Honestly, at this point in my life, I didn’t either. I was able to be happy on the outside, but miserable on the inside living a life of solitude. I knew after months of feeling this way something had to change. It was wearing me down physically, emotionally and psychologically. Initially, I was fearful if I got help I would be told that my lifestyle was crazy and obsessive and would be encouraged to drastically reduce my exercise intensity. Reluctantly, I went to therapy.

Talking about my fears and habits helped, but I didn’t change. I realized a lot of our conversations focused on my nutrition, especially when I talked about my stomach pains. My therapist encouraged me to see a nutritionist. I willingly agreed to this because it was such a passion of mine and maybe this person would be able to finally help me reach my goals. I didn’t realize it at the time, but it ended up being a life changing decision that opened my eyes to a severe pattern of disordered eating. I had no clue how much food was controlling my life. My rules and relationship with food took priority over everything in my life. Until I started talking about my feelings toward food and the role they played in my life, I had no idea how much I was under its control.

I was encouraged to read a book called ‘Health Food Junkies’, a book that focused on the eating disorder Orthorexia Nervosa. It was absolutely eye opening. I identified with every story and every statement made about what I now realize to be an unhealthy relationship with food. This really started my journey to truly becoming healthy in my mind and body. I had to relearn how to listen to my body. I had no idea what I felt like eating because I lost touch completely with trusting what my body was telling me. I remember being in the grocery store without my list and recipes for the first time in months and I felt completely lost. Despite feeling lost, I did have a sense of excitement going to the grocery store and shopping based on what I wanted to eat not what I should eat. To relinquish my rules was terrifying and I was afraid to fully trust myself. I wanted to get better, but was fearful that it would have a negative impact on my body. If I sounded conflicted, I was.

I will never forget the session when I was encouraged to eat a cupcake for dinner. Restricting myself from all sweets made me crave them more. I was excited to have this freedom. Within that next day, I bought two huge cupcakes and ate them on the way home in the car for dinner. I was finding sprinkles in my seat for days after. It was the first time I listened to my body in months and it felt empowering. I knew this was the turning point in my recovery. Cupcakes for dinner blew my rules out of the water and it felt pretty awesome.

I started to really believe that listening to my body was the way to achieve the results I wanted all along. It was telling me exactly what it needed to keep me healthy. My body told me when to eat and what to eat. I also started listening when it told me to take a day off from the gym. My social life and relationship with family were becoming strong again. I felt truly happy. For the first time in a long time, I realized being real was a much more fulfilling lifestyle than being perfect. To this day, I carry these valuable lessons with me. I am still one hundred percent committed to my health and fitness. It will always be a passion of mine, but I allow myself the freedoms I never did before because to me this is what it truly means to be healthy.

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