Sunday, May 21, 2017

A Woman in Medicine in 2017

I finished medical school in 1999.  My class was about 54% female.  Currently the field of physicians is close to 50/50 men and women.  However, fewer than 20% of cardiologists are women. And, just under 6% of interventional cardiologists, my subspecialty, are women.

When sitting at a meeting of cardiologists, I'm more taken aback when I look across the table to see another woman cardiologist, than I am to walk into a room of all male cardiologists.

I can't say that there is often overt discrimination.  I can say, however, that the female physician experience within my field, and likely others in medicine as well, is different from what a man would experience.

Recently, I attended a session on a new piece of technology for coronary intervention.  As usual, I sat in an audience of all male cardiologists.  I listened intently, and asked a question of the presenter about the availability of the product at other local hospitals that I cover.  On my way out the door, a company representative approached me and asked, "Are you a hospital marketing professional?", not thinking that I just might be, like everyone else in the room, another interventional cardiologist.

A couple years ago, I was in the cardiac catheterization laboratory preparing to scrub a case.  There were two operating suites.  One of my male colleagues was working in the other suite.  A representative for a device company, interestingly a woman, was in the lab that morning to promote her company's stent.  As I was preparing for the procedure, she walked past me, not saying a word, into the lab next door where the male cardiologist was scrubbed.

Did she blow past me not knowing I was the physician?  Did she assume that since I am a woman that I must be a nurse or a tech?  I'll never know.  But, most representatives promoting products will go to the small effort to find out which doctors will be scrubbed in each lab, and then introduce herself to the doctors.

The differences in how male and female physicians are treated tend to be more subtle.  The patient who, just meeting me, feels comfortable addressing me by my first name, who likely would refer to a male physician using the title "doctor".  The patient who refers to me as "hon" or "sweetie", who I promptly, but politely, will correct.  Or, the patient, who upon me walking into the room, in my white coat, heels, and a dress, remarks, "You don't look like a doctor," or "I was expecting someone different", perhaps from the patient who didn't notice my first name on his or her appointment card and expected a more grey-haired man to be their cardiologist.

Or, a typical hospital scene:  A female physician, a male nurse, a male physical therapist, and a male nursing aide are all working at a nursing station.  A patient family member walks up to the nursing station to request a glass of water, another pillow, or something else for the patient.  Who does the family member walk up to?  The female physician.

There are other subtle differences.  I've observed that bad behavior from men is tolerated often when it should not be.  I watched one male cardiologist walk into a cath lab and scream (yes scream) at the staff because a patient was not ready.  After he walked out, I turned to one of the techs and asked, "You put up with that behavior?"  "That's just how he is," she said.  I've seen male physicians chastise medical assistants for the smallest of details being missed and get away with it.  And yet, I've found that I've had to adjust my own fairly direct manner of communication so as not to make others around me feel intimidated.

That said, there are benefits to being a woman physician.  Women tend to be better listeners, and patients tend to be more comfortable opening up to women about their problems. The more comfortable a patient is to share what is going on in his life, the better I can be as a doctor to help him.

Even as women are more prevalent among physicians, old stereotypes, whether conscious or subconscious, still persist.

Monday, April 24, 2017

Passover Seder 2017

I hosted my annual seder.  Twelve years ago when I first went vegan, there were exactly two vegan passover cookbooks, and if you would enter "vegan passover" into a search engine, my blog would be one of the first entries to come up!  But now, there's lot of options, lots of cookbooks, and plenty of great vegan recipes for Passover.

We started with matza ball soup from Nava Atlas, the best vegan matza ball recipe around because the matza balls taste good and don't fall apart in water as they do in some vegan recipes.

 Dinner, buffet style


Gefilte 'Fish' -- Maybe some things just should never be veganized.  I was never a big fan of gefilte fish even as an omnivore.  These actually came out quite good and were polished off, I added about half a cup of whole wheat matzah meal to make these patties a little firmer. 

Spinach, leek and potato matzo gratin -  avocado and cashews make a perfect sauce for between the layers.  Recipe suggests adding Daiya vegan cheese -- no need.



 Squash and roasted potatoes

"Bloody" potatoes -- mashed potatoes with beets, and sweet potato, carrot, and apple kugel


Ratatouille -- from the Vegan Start Passover Cookbook

Salad with candied walnuts and dried cranberries

My Plate

Desserts -- Chocolate matzo loaf, chocolate chip cookies, brownies, and fruit

Happy Passover!!!

Sunday, April 09, 2017

Life After Ironman

It's fun to post about achieving success as an athlete.  But what happens when all that training winds down?

I started in the sport of triathlon in 2005.  With hard work and good coaches, I peaked from 2012-2015.  I worked out twice a day most days, six days a week, long workouts on the weekend.  And I achieved a lot of success -- look back on blog post after blog post about race after race.  And, even though it was hard work, I loved it, the people I've met, the adrenaline rush of racing, great conversations on long bike rides and runs.
I earned all this good stuff

After Ironman Boulder 2015, for several reasons, a bit of burnout and some other personal stuff, I decided to take a step back from all the hard training.  I certainly didn't become a couch potato, but what I do now is a far cry from back then.

And there are consequences of the decreased training load.  Some are good -- I'm less stressed out because I don't have to worry about fitting in my workouts.  I don't have to figure out how to do a four hour bike ride while remaining within twenty minutes of my car in case someone needs an emergency angioplasty.  And, I have more time for things like sleep and weekend brunch.

But, I'm definitely not as fast, particularly as a runner.  I found that out in a big way when I ran a half marathon in December, hoping for one goal and definitely not achieving it.  And my body has changed.  I'm not heavy, but I certainly don't look as ripped as I do in the photo from the frequently circulated article about me on Forks Over Knives.

There's guilt too -- I'm so used to doing morning and evening workouts, am I really exercising enough if I run in the morning and don't do anything else later?  Or if I decide to sleep in past 5:30 am?  And people still ask, "When's your next Ironman?"  Am I still worthy of the reputation I've gained as the VeganHeartDoc who swims/bikes/runs like crazy?

I had a lot of reasons to tone down my training.  I don't regret it.  I still work out six days a week, but most of the time it's just one workout a day, not two.  I'm training for a marathon at the end of May, the Mountains to Beach Marathon.  Initially I thought my goal for the race would be 4:20, but I may be finishing in the high 4's.  And that's ok.

Sunday, February 12, 2017

Living alone -- not an excuse!!!

I hate excuses.  It's always easier to find a reason not to make the right choice than it is to go to the effort to make healthy choices.  Such as, when patients tell me they haven't exercised in a month because it's too hot, it's too cold, it rained.... it's Southern California, give me a break!

But, when it comes to making good food choices, I often hear from patients that they live alone, so it's too hard to shop for one, keep food from going bad, and take the time to prepare a meal.  So, instead, they resort to fast food, restaurants and prepared meals, which nutritionally are poorer quality than most of what you might otherwise prepare in your kitchen.

I can debunk the living alone excuse quite easily, because for most of the past ten years, other than my adorable greyhound companions, I've lived alone.  I prepare most of my meals at home, and it's not that hard to do.

Shopping
I buy much of my produce at the Sherman Oaks Farmers Market on Tuesday evenings.  It's a stop on my way home from work.  For other food, I'll usually shop once a week.  I'll pick up the basics at Trader Joe's, because they offer good prices and plenty of organic options.  I buy a few things in bulk at Costco like organic baby carrots, And, because I can walk down the street to Whole Foods, I pick up odds and ends from there.

Food Prep
Often, I'll spend a weekend morning, or an evening, preparing some staples, so that it's easier during the week.

I love my steaming baskets.  I'll put them on top of a pan of simmering water, add vegetables, and cover with a lid to keep the steam in.  Here I cut up some red peppers.  After these cooked for about ten minutes, I then steamed some purple cabbage and baby carrots.

I like to have a grain on hand as well.  Often it will be quinoa or brown rice, but today I decided on Trader Joe's Harvest Grains Blend with Israeli couscous.

I like to roast a few items in the oven as well.  Today I roasted brussel sprouts in oil, Braggs Organic Sea Kelp Delight, and some sea salt.  I put a couple of large Japanese sweet potatoes in the oven.  And, I roasted a butternut squash, which I'm probably going to turn into a soup by spinning it in my Vitamix with some veggie broth.

After I finished cooking and chopping up some herbs and cucumbers, I put it all in the fridge.

What I Eat
I do not spend a long time preparing meals.  I grab a few items from the fridge and usually put them in a bowl.  I try to keep my meals half vegetable, one quarter grain, and one quarter protein (beans, lentils, cut up tofu, etc).

And, I may have the same thing a few days in a row, because honestly it's easier.  For example, recently I bulk cooked quinoa.  I put some in my salad for dinner, and the next morning, instead of making oatmeal, I put some quinoa in a bowl, added soy milk, frozen mango and berries, and chia seeds, and microwaved it for a delicious hot breakfast bowl.

Eating well when you live alone isn't that hard -- it just takes a bit of planning.



Sunday, January 08, 2017

Doctor Visit Pearls

From my point of view as a doctor, here are a few tips, some obvious and some not so obvious:

What's the quickest way to get in and out for your appointment?  Book the first appointment of the day.  I try my best to be on time, but it can be hard.

Are you a new patient with a complicated history, or have you had a number of tests done with a previous doctor?  Bring in those records, especially if you received care out of town.  We can always have you sign a release in the office, which means we will obtain the records after you leave, but it is so much easier to have the records at the initial consultation.

Know your medications.  And their doses.  If you are unsure of either, bring a list, or bring all the bottles.

Don't just stop your medications on your own without communicating to your doctor who prescribed the medicine.  I've seen some absolutely catastrophic events occur when patients take it upon themselves to decide a medication is not needed -- stents clotting off, congestive heart failure, heart attacks, and strokes, to name just a few.

Skip the excuses.  If you gained five pounds when you were supposed to lose weight, have been eating crap, and haven't exercised, don't tell me how you're busy and stressed out.  We're all busy.  And your heart doesn't care.  There will always be excuses not to do the right things, and your bad habits will catch up with you and your health will suffer.  Own up and make a plan to do better going forward to take care of yourself.

Use your appointment time wisely.  Your doctor does have a limited amount of time, so be focused,  Know why you came and get the answers that you need.  You wouldn't ask a fisherman how to herd cattle, so don't ask me a question better suited for a different specialist.

Be nice to the office staff.  The receptionists, medical assistants, and medical records workers are all critical to the function of any good office practice.  They work hard and deserve respect.  And, you can rest assured that your doctor will know if you were rude, even if you are saccharine-sweet in the exam room.

If you don't understand, ask.  I love questions.  It shows me that a patient is invested in their own health and is motivated.  As doctors we are teachers, and I love to empower my patients to take control of their health.

After the visit, do not be afraid to communicate.  You don't understand your instructions?  The pharmacy didn't receive your prescription?  You're having what could be a reaction to a medicine?  Please call.  Or, e-mail.  My office has a secure email communication system.  Your message goes straight to the doctor.

Thursday, December 01, 2016

Back in Action!

I took some time off from serious training. It was something I needed to do, to take a break from structured fitness, and to try to accomplish a few things in my personal life.

But now I'm back.  I love having a goal, and what better goal than to succeed in a race, right?  I'm training for a half marathon, the Santa to the Sea half marathon on December 11.  Here's how I'm getting back to it:

Set an Attainable Goal
I ran a 5k race in early October, and that was a big wake-up call that my race pace was not where it once was -- that said, it wasn't entirely terrible because I was the third fastest woman overall.  While I could run a 1:48 half marathon when I was in peak shape, that's not realistic right now.  With five weeks to train, my goal is 1:56, which is just under nine minutes per mile. 

Running
I run four days a week, no more than that.  One run is at a tempo pace, or about 15 seconds slower per mile than my projected half marathon time.  One run is a long run, ranging from 8-12 miles. 
A lot of running happens on trails.  Trails are gentler on the joints, provide far better scenery, and include hills and uneven surfaces for challenging muscles more than the repetitive footstrike of a flat surface.  This picture is courtesy of Gerardo Barrios of Fortius Coaching, taken on the trails of Malibu Creek State park.

Strength training
Interval training and weights have always helped me achieve my goals.  My friend Deirdre Hamilton opened up Hamboody Strong, her own group training playground in her backyard.
Exercises include box jumps (shown above) or box step-ups, kettle bell swings, battle ropes, planks, mountain climbers, or whatever Deirdre imagines for the workout of the day.  If you're local to Lake Balboa, it's a great workout for anyone who wants to build strength and fitness, even beginners!  

Swimming
I still swim twice a week with Golden Road Aquatics.  Swimming keeps me limber and stretched out, and is a great way to start a morning.

Rest Days
I rest at least once a week.  During the first couple weeks of half marathon training, I rested two days a week,

I am hoping my training leads to a successful half marathon, and will keep you posted on how that goes!


Sunday, November 20, 2016

Marijuana

With the approval of Proposition 64 here in California, recreational use of marijuana is now legal.  But, what about marijuana from a medical point of view?

To start, for full disclosure -- I am no expert on medical marijuana use, and I do not prescribe marijuana.  This is simply my perspective as a cardiologist.

I have smoked marijuana once in my life, and that was while in medical school.  I choose not to smoke marijuana, simply because I have no interest.  However, I believe people should have the right to choose to purchase and smoke marijuana if they so desire.

I see a lot of patients who admit that they use marijuana.  There are probably many more who use it and don't disclose to me or their other medical medical providers.
Source: istockphoto

There are reasonable medical uses for medical marijuana.  Nausea caused by chemotherapy, poor appetite and weight loss due to chronic illnesses, and muscle spasms from multiple sclerosis are among recommended uses for marijuana.

Often I see patients who are using marijuana to "treat" various aches and pains that in many cases they have never sought care for from a physician in the first place.  I see patients who use marijuana to treat their anxiety and stress, or self-treat other psychiatric illnesses.

There are some possible harms from chronic marijuana use, whether for recreational or medicinal purpose.  Like any substance, or any medication, there are side effects.

First, of course are the "munchies".  Most of my patients are overweight or obese.  The side effect of hunger from smoking marijuana does not help people make good food choices to facilitate their health.

Marijuana is not benign when it comes to the heart, either.  There isn't much research, because marijuana was illegal for so long, so we have no information about what it does to the blood vessels, or even the brain for that matter.  However, it is known to lead to high heart rate and fluctuations in blood pressure.  And, some emerging research suggests that marijuana increases the risk of a heart attack.

If you smoke marijuana regularly, whether for recreational or medicinal purposes, it's probably a good idea to discuss with your physician.

Sunday, October 09, 2016

Retired Triathlete at One Year

What happens when you go from a full schedule of races and hours of endurance training to a more relaxed exercise regimen?

Without endurance-race goals, and without a coach to give me workouts, I'm in charge of my fitness.  For me, that means I work out six days a week, one or two workouts per day, with one day a week for rest.
  • I swim with a masters group Golden Road Aquatics 3-4 times a week, usually in the morning before work
  • One "long" run of 5-7 miles on my own
  • Barry's Bootcamp treadmill/strength hour-long sessions once or twice a week
  • November Project LAX, a Wednesday morning workout at the Hollywood Bowl, consisting of running and bodyweight strength training
  • Other random workouts that sound like fun at the time -- outdoor cycling or open water swimming, a spin class, lifting weights at the gym, yoga.  
Less exercise has led to change in my body and fitness.  While I toed the start line at Ironman Boulder 2015 at 147 pounds, I am carrying ten more pounds on my 5'10" frame.  At a BMI of 23, I am still a healthy, normal-sized person.  And, while I may swim a bit faster, and can competently swim butterfly and backstroke which I couldn't do a year ago, my running and cycling are certainly not as fast as they were, and my endurance in any of the three sports is less.

Barefoot running on the sand, a fun workout I would have never done while training for an event.

I've also learned how to listen to my body.  I no longer have a coach looking at the metrics and heart rate graph from my workouts to tell me that I should go harder or need to rest.  I've found that about five or six days into daily workouts that I need to take a day off to recover.

And then there are my recent labs, during peak training, and now.  This for me is the most startling finding.  While my non-fasting cholesterol numbers look nearly identical, my hs-CRP, a marker of inflammation, which was quite high during training, is completely normal now.

August 2015

And now:

So what's the significance of the elevated high-sensitivity c-reactive protein (HS-CRP)?  It is a marker of inflammation.  The number in studies correlates with increased cardiovascular risk.  I don't think that it in my case it would indicate an increase in my risk of a heart attack or stroke, given my other parameters of no family history of heart disease, a healthy plant-based diet, no hypertension, no diabetes, and the lipid numbers above.

And yet, we know endurance athletes have a five-times increased risk of atrial fibrillation, One study of runners who participated in the Minneapolis Marathon for several years in a row demonstrated increased calcified coronary plaque in the arteries compared to non-marathoner controls.

There is said to be a "U-shaped curve" for exercise -- at one end, there is not enough exercise, which is where most Americans sit.  On the other end, for a very small and growing minority, is too much exercise, and potential consequences of excessive exercise.  There is still much we do not know about exercising this much for years at a time.

My own take-home message -- there's something about Ironman endurance training, for me, that leads to objective evidence of inflammation, and decrease in that inflammation with scaled-back exercise.  It would suggest that, for me, training for long hours year-round is not a good idea.  But, I will race again, maybe even complete another Ironman in a few years.




Monday, September 19, 2016

Plant-Based Diets are Catching On!

I have to admit, at times being a vegan has been a lonely situation.

When I adopted a plant-based diet in 2005 during my cardiology fellowship training in Rochester New York, most people had no idea what vegan meant, most mainstream health care practitioners were unaware of the health benefits of a plant-based diet.  Were it not for the Rochester Area Vegan Society and their monthly potlucks, I would have been entirely lost.

Now in 2016.... vegan diets have become more mainstream.  Documentaries like Forks Over Knives have made people more aware of the power of what they eat.  After watching Forks Over Knives, I know of two cardiologists in the San Fernando Valley who have started recommending plant-based diets to their patients.  And, in turn, patients are more receptive to learning about plant-based diets.

And I was entirely surprised to hear that Dr. Chad Teeters, the chief of cardiology at Rochester's Highland Hospital, who I knew when we were both training at the University of Rochester's Strong Memorial Hospital, has adopted a plant-based diet after hearing Dr. Caldwell Esselstyn speak at the American College of Cardiology conference.

You can hear briefly about how Dr. Teeters made the transition here.  I had the opportunity to listen to Dr. Teeters speak during this podcast, about the worries that he's had about his own health, and how he's lost 60 pounds in six months on a plant-based diet.  Having known him many years ago, I was very surprised that he took this step, but I am so thrilled for him, not just for the benefit that he'll get to his own health, but that he'll be able to impart this advice to his patients as well.

If you're looking for a plant-based doctor, look here.

Saturday, August 13, 2016

Listen to my conversation with Kirk Hamilton PA-C



I had the opportunity to talk to Kirk Hamilton PA-C, who is working hard to spread the message of how potent lifestyle and diet are in preventing illness.

Listen to the podcast here.

Friday, July 15, 2016

Weight Loss -- What Doesn't Work

Obesity leads to increased risk of heart disease, decreased mobility, and shortens life.  Many of my patients are overweight or obese.  Most want to lose weight, and as a doctor, I want to help.

I've seen patients who are successful at losing.  Unfortunately, I see more lack of success.

Here are some well-meaning ideas that may sound like they would work for losing weight, but unfortunately don't.

Juicing
Joe Cross of "Fat, Sick, and Nearly Dead" fame went on a 60-day juice fast, making his own juices from fresh fruits and vegetables.  He lost 100 pounds and was able to come off all his medications.  Unfortunately, in practice, none of my patients who have started juicing have lost weight -- in fact, most have gained weight.

How do you gain weight while drinking juice?  There are a few reasons that might be the case.  Juice as a liquid may not be very filling, without the fiber that comes with the fruits and vegetables.  Also, one might use the excuse of "juicing" to justify dietary splurges..

Garcinia Cambogia
Dr. Oz featured it on his show.  Lots of people bought it.  Many of my patients took it.  None of them lost weight.  Then Dr. Oz got sued.

Big Goals and No Plan
One patient, who weighed in over 300 pounds, told me he had a plan to lose 100 pounds before his next visit in six months.  I asked him how, and he told me that he was determined and he would just do it.  At his return visit, he was 20 pounds heavier.

10,000 Steps
These days, everyone has a fitness tracker, which makes it easier to set an activity goal for the day.  However, those counted steps can inappropriately justify bad food choices, and may not be done at an intensity to build fitness and improve metabolism.

The Subway Diet
Jared Fogle became a celebrity back in 2000 after he lost 225 pounds by eating almost exclusively from the Subway restaurant near his home.  Somehow, eating at Subway is still believed by some to lead to magical weight loss.  Jared lost his weight by eating a six-inch sub for lunch with a bag of chips, and a footlong sub, no snacks, no cheat meals.  There's nothing mystical about Subway's food -- Jared just ate less.

So, what works?  The old tried and true standard -- a healthy diet with plenty of fruits and vegetables and regular exercise.

Saturday, June 18, 2016

Bringing Vegan Food to LA Unified School District

Lila Copeland, a 14-year old who is about to start high school next year, wants LA Unified School District to provide healthy vegan food options to kids.  I was honored when Lila, the founder of Earth Peace Foundation, invited me to join her and others to speak to the school board.

We waited a couple hours, as we were literally the last agenda item for the meeting.  But, when your group is led into a room with Pamela Anderson, you get attention.


You'll see me at four minutes into this video.

I had the opportunity to make my case for offering healthy vegan options to children.  I made the point that the majority of the diseases that I treat are prevented by a healthy lifestyle, including good food choices.  Healthy habits start in childhood, so a school providing vegan food options can help children live longer and healthier.

Other speakers included Dr. Michael Klaper, journalist Jane Velez-Mitchell, bodybuilder Torre Washington, author Kawani Brown, nutritionist Sharon Palmer, and nutrition educator Lisa Karlan.

As the last speakers of a day-long meeting, we had an uphill battle ahead of us to get the attention of the school board.  I think we got our point across.  One of the board members at the end remarked that his own diet wasn't very good, but we certainly gave him some things to think about and maybe even he could change how he eats.  I am hopeful for Lila's Healthy Freedom campaign to provide healthy vegan lunch options to LAUSD's students.

Saturday, May 07, 2016

Forks Over Knives Article

My story has been featured on the Forks Over Knives site!  Check it out.

Sunday, April 24, 2016

Passover Seder 2016

Every year, I host a Passover seder at my home on the first night.  This year was particularly special, now that my parents live in Southern California, our entire family was together for Passover for the first time in ten years.  In addition, I had several friends, and in total there were 25 of us at the table.

We read from the "30 Minute Seder" hagaddah, sang a few Passover songs, and then had a terrific dinner.

 Our seder plate -- a beet in the place of the shankbone, and a flower in place of the egg.  The beet represents the blood spilled in the slaying of the firstborn, and the flower represents life and Spring.

Big crowd for seder!

Matzah Balls for soup





Chocolate chip cookies and chocolate brownies

Chocolate Matzo Loaf

Thursday, April 07, 2016

ACC 16 Conference

I just returned from the ACC.16, the American College of Cardiology's annual conference, in Chicago.

The last time I attended was back in 2007, when I was an interventional cardiology fellow.  With the incentive of $99 for registration (as opposed to the usual pricetag of hundreds) as a first-time attendee as a practicing physician, I decided, why not!

The conference opened with remarks from the current president of the ACC, Dr. Kim Williams, who happens to be a vegan, and proponent of plant-based diets for heart health.  His opening remarks had a lot of focus on prevention.  It's refreshing to hear talk of prevention at such conferences, because that's where we're lacking.  He talked about traditional diets within some cultures which increase heart risk -- "Don't let your culture hold your heart hostage."  
How refreshing to see a focus on prevention!

I saw Dr. Caldwell Esselstyn -- author of Prevent and Reverse Heart disease.  He's one of my heroes.  His research has demonstrated the reversal of even the most severe of coronary disease with a plant-based diet.  On the first morning of the conference, I came running on over to him, like a rock star groupie, introduced myself, and of course took a selfie.  
I could have asked for his autograph too.

More on prevention.  In fact there was an entire session, with a packed room, all chairs taken, on prevention.  Maybe the title was catchy: "Lifestyle Medicine: A Little Less Drug, A Little More Sex, and a Lot More Rock and Roll."  On stage were Dr. Esselstyn, Dr. Williams, Dr. Arthur Agatston of the South Beach Diet fame, and Dr. Emilio Ros, proponent of the Mediterranean Diet.  

The conversation was good, but I have to say, and maybe I'm a wee bit biased, but Esselstyn hit it out of the park!  He spoke convincingly about the strong benefits of a plant-based diet.  His results demonstrate far greater improvement in cardiac health than South Beach or Mediterranean diets could ever claim.  And, he did his usual, "Eat bok choy Swiss chard kale...." song of vegetables that we should eat, though didn't get as much applause with that as he does at the more vegan-oriented conferences.

Again, rather than the bravado of placing stents through fancy techniques, we talked more about prevention.  Loved it. 

Another awesome focus -- women in cardiology.  There was a Women in Cardiology lounge, a great place to network with other women cardiologists, and to refill my coffee.  Did you know that only ten percent of cardiologists are women?  And, of interventional cardiologists, what I do for a living, only four percent of women?  I attended a few sessions here, one on how to use social media to your advantage (psst... follow me on Twitter, I'm @veganheartdoc).


There was even a session on work-life balance.  Being a woman cardiologist has its own unique challenges, from gender bias to making choices regarding family.  I loved these ladies' perspective.

Some important clinical trials were presented.  We now know from the HOPE-3 trial that blood pressure medicines don't benefit intermediate risk patients, but a statin just might.  There is more evidence for use of trans-catheter aortic valve replacement in patients who are not high risk.  Beta-blockers at the time of a heart attack may not be as important as they were in the pre-angioplasty era.  Those patients with a mutation for familial hypercholesterolemia have a much greater risk of heart attack than someone with the same cholesterol level without a mutation.  Rhythm control of atrial fibrillation after cardiothoracic surgery is no better than rate control. 

And much more.  It's exciting to be present for the debut of important information that will shape clinical practice for years to come.

I ran into some familiar faces.
Dr. Akshay Khandelwal, the incoming president president of the Michigan chapter of the ACC.  But I knew him way back when we were interns, and I've been bowling with him before he became really important.

Dr. Shobashalini Chokkalingam, my senior resident from Henry Ford Hospital, smart and funny cardiologist who helped shape my mind as a physician.

And, it's not a trip unless I go running.  I took advantage on the one warm 68 degree day of the trip:

Thursday, March 24, 2016

Change

I'm absolutely fascinated with how people change, how they make lifestyle changes that they can stick with.

In what I do as a cardiologist, motivating people to change is absolutely key.  My goal is to help everyone reduce their risk of cardiovascular disease, whether they've never had a heart problem or they've had bypasses, stents, and heart attacks.

One thing I know, from my own personal life experiences, and from observing my patients -- complete change doesn't happen overnight.  A patient isn't going to leave my office and quit smoking, eat fruits and vegetables, quit eating meat, dairy, and eggs, AND walk an hour a day when these were not prior habits.

My strategy -- I try to focus on the one or two changes that I think will make the most impact on my patient's life.  Some examples, maintaining anonymity of these patients:

--An obese woman in her 50's with diabetes, high blood pressure, heart attack 10 years ago, and a bypass surgery two years ago.  She doesn't exercise, eats a lot of fried meats and white rice, and refuses to eat vegetables because she does not like the taste.  While she clearly has many habits that could improve, I've started by asking her to try new vegetables and incorporate them into her meals, and to walk more.

--A man with atrial fibrillation, sleep apnea, and obesity, who at 6'3" and 270 lbs feels frustrated that he cannot lose weight even though he walks for exercise and tries to make healthy choices at meals.  As it turns out, his meals are mostly at restaurants because his wife is disabled and no longer cooks for them.  We discuss the perils of relying on restaurant food, and he decides he's willing to start cooking for him and his wife, which will hopefully help him burst through his weight loss plateau.

--A man with atrial fibrillation and diabetes, who has successfully lost seven pounds in two months since his initial consultation with me, after eating smaller portions and more fruits and vegetables.  However, he is not exercising because he is afraid to make his heart beat too fast.  After reassuring him that walking for exercise will not be too taxing on his heart, he agrees to start a walking program.

--An obese woman in her 30's sees me because of chest pain that is likely due to reflux.  She has hypertension, is pre-diabetic, and abnormal cholesterol levels.  She exercises by walking on a treadmill or uses an elliptical for 30 minutes a couple of times a week.  She eats a lot of sugary snacks, so we talk about replacing those snacks with fruit, portioned trail mix bags, and Larabars (which are packaged bars made with fruit and nuts and no added sugars or processed ingredients) and eating more meals at home.  The next change for her might be to change the intensity of her workouts to challenge herself more, or to add weights.

We start with making one change successfully, and then move on to the next, with the plan of making these positive changes permanent.

Monday, February 22, 2016

A Cardiologist's Breakfast

After opening up my refrigerator in my last post, I've been asked to share what I eat for breakfast.

Most weekdays, I'm up at 5 am to get ready for 6 am swim practice.  To wake me up, I drink a soy latte.  I mix about 8 oz of brewed coffee with 4 oz of steamed vanilla soy milk (organic/non-GMO of course!)   And here's where the magic happens, with my Breville machine.  This little toy makes a latte to rival any coffee chain, and at a fraction of the price.

Latte magic!

To fuel me for my swim, I drink a big green smoothie.  It takes me about five minutes to whip this up in the Vitamix, a high-powered blender:
My smoothie fruits and vegetables, before they go for a whirl

I blend a cup of unsweetened almond milk, a big handful of green veggies, which could be kale, spinach, swiss chard, or whatever is on hand, a stalk of celery, a handful of carrots, a banana, a pinch of spirulina powder, half a tablespoon of chia seeds (omega-3 power!), and about 5 cubes of ice.  Sometimes, I'll add some apple, a medjool date, or even a couple cubes of sweet potato, all of which add a unique flavor.

It's green and it's delicious!

I pour this into a big cup, drink about 2/3 of it in my car on the way to swim, and have the other third right after I get out of the pool.

If you're new to green smoothies, it might be a good idea to use more fruit and less greens to start, and as you get accustomed to the taste, then add more greens.

Typically, I go straight from the pool to work, arriving around 7:30 am.  I might round on a couple patients, or do a bit of work, and I'll get my second breakfast around 8-8:30 am in the doctors' dining room.
Delicious, healthy oatmeal, and stuff that's not so healthy.  All ready to consume in the doctor's dining room

You can see that there are many options available in the doctors' dining room.  I can't say that they're all good choices, and in fact some cause the diseases that I treat.  I choose the oatmeal.  I fill a bowl with cut up fruit, melons, pineapple, strawberries, pour oatmeal on top, and add a few walnuts (more omega-3's).

That's my typical breakfast, and that will fuel me until lunchtime, around 12:30.

Saturday, January 30, 2016

The Doctor's Fridge

In my daily practice, I advise my patients to make healthy food choices.  Today, I'm going to let you peer into my kitchen.
You'll notice lots of veggies.  I shop the Sherman Oaks Farmers Market every Tuesday evening after work.  That's where I get the majority of my vegetables.  However, you'll notice the big bag of carrots, from Costco, which carries organic carrots and organic bulk greens, among other good bulk produce options.  I have a few baked sweet potatoes ready to go as well, some from the farmers market, and some organic sweet potatoes bought in bulk from Costco.

In addition to my produce, I do have a few processed items, like the soy milk that I add to my morning latte, and the almond milk for my morning smoothies.  I have some hummus from the farmers market, which is great to dip veggies in for snacks.  I have a few protein options, tofu, lentils, a lentil curry that I bought at the farmers market, and tempha which is a fermented brown rice protein from Dave's Korean, another farmers market vendor.  There are a couple of Suja juices, which are delicious to drink on the go.  And, finally, a container of pickled daikon radish from Vinh Loi Tofu, to add to my salads.

There's the inside door.  I have plenty of salad dressings, including my favorite, a miso dressing from Dave's Korean with no oil, coconut oil, tahini, almond butter, macadamia butter, a few jams, salsa, sriracha, and a couple of alcoholic ciders for an occasional celebration.

No meal that I prepare for myself takes more than ten minutes.  That's why I say that when I prepare meals, I "assemble" them, I don't cook.  Here's all my ingredients for my favorite salad:  lettuce, heirloom tomatoes, basil, cabbage, butternut squash, sweet potato, tempha (brown rice protein from Dave's Korean), carrots, avocado, daikon, and kimchi.

This is the final product, my favorite salad.  Mixed up in a big bowl, filling, colorful, delicious, and lots of nutrients.

Another evening's dinner.  I grabbed a few ingredients from the fridge, threw them in a bowl, and this creation came to be in just five minutes:  purple cabbage, extra firm tofu, sweet potato, pureed cauliflower, nutritional yeast, and soy sauce.

So there you are.  My refrigerator is an open door.  This is how I eat healthfully living on my own, working full time, with easy to prepare food.