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.

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. 

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!  

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


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.

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


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.

Thursday, January 07, 2016

Retired Triathlete

I've spent 10 years training and competing.  Now I'm taking a break.

My mind isn't in the endurance or the competition right now.  And I am not signed up for any races this year.  While training, I thrived on the structure of planned workouts, logging my miles and feeding back to my coach.  Now, I exercise when I want; I love that I no longer need to adhere to a schedule.

I joined Golden Road Aquatics master swim program, and you'll find me in the pool most mornings of the week.  It's great cardiovascular exercise, gentle on the joints, and it's only a mile from my Burbank office. 
I'm learning so much, improving my backstroke and breast stroke.  I can even do a reasonable butterfly stroke and not feel like a dying fish!  I have even swam in a meet.  I wasn't fast, but it was fun to dive off the blocks.

My focus right now is swimming.  But, when I'm not swimming, I'm often at Barry's Bootcamp for their hourlong workouts consisting of treadmill and floor exercises. I am there about three times a week, and that's about the extent of my running these days.  I'm also doing a little bit of yoga, and a bit of spinning, and every so often a strength training session.

My bikes and my trail shoes are gathering dust from lack of use.  And that's okay.

So, that's where I'm at -- trying to become a swimmer, and exercising for the sake of exercise.  It's awfully relaxing.  I might sign up for a triathlon in a year from now, or a road race, but for now I'm content..

Thursday, December 10, 2015

Why your doctor might not be on time

I wish I could be prompt in seeing all my patients.  I wish I could guarantee that if you have a 9:15 appointment, you will be called back at 9:15, seen by the doctor at 9:16, and on your way out of the office by 9:30.

But, as much as I would like, I can't make that promise.

A follow-up patient, one who has seen me before, has a 15 minute slot on my schedule.  That doesn't mean that is the amount of time you spend with the doctor.  If you're doing great, blood pressure and labs look good, medications are okay, your visit with me might just be a few minutes.  If you aren't doing as well, I may spend more time, getting information, looking at test results, maybe even calling one of your other doctors to discuss the case.  All of that can take well more than the 15 minutes allotted on the schedule.  And that will put me behind. 

If you have an appointment, you will get the time that you need to get the care that you need.  I will promise that to all my patients. 

I'll give you an example of a recent morning in my office.  Names and identifying details have been changed to protect patient identity.

My clinic on this particular day starts at 8:30 am.  But, it is 8:30, and my first patient has not arrived, so I am sitting at my desk, catching up on lab results and renewing medications.  My 8:45 patient has arrived early at 8:40, so I go see her.

Tara, my 8:45 am patient, is a woman in her late 60's who has a lot of medical problems.  But, in spite of her health issues, she's incredibly active and works in her family's day care center.  She is here today because she's been very short of breath and fatigued over the past month, has been using an oxygen tank at home that she usually does not need.  I put a pulse oximeter on her and have her walk around the office to see if her oxygen drops below the normal range.  I examine her, and we talk, and we decide on an echocardiogram to evaluate a murmur that I don't recall hearing before and some lab work.  She's also in tears, frustrated at how ill she feels, and I reassure her that I'm going to help her find out what is going on.

By the time I see my 9:00 patient, it is now 9:15.  Anthony is in his late 70's, has a very weak heart and a severely abnormal heart valve, is very short of breath, and smokes a half of a pack of cigarettes daily.  At past visits we have talked briefly about the possibility of a valve replacement, but he has also had a cancer scare, so until we knew more about whether he had cancer, we did not make any plans for heart surgery.  Fortunately he does not have cancer.  We adjust his medications, and discuss his heart condition and the benefits of surgery.  I refer him to a surgeon.  And of course we discuss quitting smoking.  That visit takes about 20 minutes.

Now it is 9:35, and apparently my 8:30 patient Leann has shown up after all, and is in a room.  She's a lady I saw over a year ago  for a fairly routine clearance for a colonoscopy.  Since I had seen her previously, she was booked as a follow-up appointment, and was only given 15 minutes.  However, in the year since I had seen her, she had had a stroke and a heart attack, and had been told that she needs to undergo heart bypass surgery.  So, before I can go in to see her, I spend ten minutes reviewing hospital records, and pull up the images from her recent coronary angiogram.

When I walk in to see Leann, it is 9:45.  I see a very depressed woman in a wheelchair, her left side limp from her recent stroke.  Her husband sits next to her, expresses his frustration that much of the time she gives him a hard time about taking her medications, and sometimes flat out refuses.  Further, they do not know the full list of medications that she is taking.  It becomes apparent that heart surgery right now is not a good option.  I discuss the importance of taking medicines to keep her recent stent open.  I'm very worried about her, and we make plans for her to return in a month, and for him to call later that day with a complete medication list.

It is now 10 am.  My 9:15, 9:30, and 9:45 patients are in rooms and waiting to see me.  The rest of the morning is behind.  My 10:30 patient, who I do not see until close to 11:45, tells me that she is upset that she has been waiting, and I genuinely feel bad and I apologize.

My morning clinic, which is scheduled to end at noon, finishes at 1:20 pm.  I have ten minutes to walk to the break room and eat lunch before my afternoon clinic begins at 1:30 pm. 

Not all mornings in my clinic are like this.  But, it does happen, a few patients who are in need of attention can set a clinic schedule behind.  And I'm sure every physician can relate.

Please understand, as your doctor, I want to respect your time.  However, I also have to provide the care that my patients need, and that can take more time.

Saturday, November 14, 2015

When I hate my job

I love my job.  I get to save lives.  Whether it's someone in the throes of a massive heart attack, on whom I can perform an angioplasty to open an artery to restore blood flow to the heart, or help someone to control their risk factors to prevent a heart attack in the first place, I make a difference.

On the other side of that, I care for some pretty sick people.  Usually I can help them.  But sometimes I can't.

It is beyond frustrating to do everything in my power to help heal someone, and in spite of this to see him or her die.

I'm often asked, do doctors feel pain when they lose a patient?  I would say absolutely yes.  When we put our own heart and soul, our time, our deep thoughts, into a patient's care, it is hard to see him or her die.

Thankfully, I have far more moments of saving lives and helping my patients to live better.  And, that makes what I do for a living worthwhile.

Sunday, October 11, 2015

Coming Off Medications

Frequently, patients tell me that they feel they are taking too many medications, and in some cases want to come off of all of their medicines.

Remembering to take a medication can be challenging, and a prescription pill can be a stigma that a person is unhealthy.

I am a big proponent of patients taking as few pills as absolutely necessary.  I emphasize food as medicine, exercise and movement as critical for health.  So, for some, it may be possible to stop medications, with appropriate lifestyle changes.  

One patient had a cardiomyopathy (weak heart muscle) which recovered, he switched to a plant-based diet, and at this point he no longer needs blood pressure, cholesterol or diabetes medications.

Another patient who I regularly follow is a man in his mid-30's with hypertension and elevated triglycerides.  When I first met him a few years ago, his blood pressure was wildly uncontrolled and his triglycerides quite high, and I had him on three medications in order to control his blood pressure.  He has gradually improved his diet, eating more fruits and vegetables and less processed foods, has taken up regular exercise including Crossfit three times a week.  I see him every three months in the office, and we've been able to gradually decrease his blood pressure medication.  At this point he is on two low-dose blood pressure medications.  I think that in time he may be able to come off of the blood pressure medication entirely.

A man came to me in his late 30's after having quadruple bypass surgery.  He had a list of eight medications.  At that initial visit, I was able to streamline his medication list down to three, and now about five years later, he is only on two medications, an aspirin and a statin, the appropriate medications that anyone with coronary artery disease should be on.

That said, coming off of medications isn't necessarily an option, and should not be undertaken without a physician's guidance.  For example, a patient with a cardiomyopathy who stopped his medications on his own came back to me months later extremely short of breath due to congestive heart failure.  Or, a patient with uncontrolled diabetes and cholesterol and a history of a heart attack who "doesn't like medicines", this is not someone whose focus should be on stopping medicines, but rather on controlling his risk factors and regaining his health.

Some people should never be off of all of their medications, that simply isn't reasonable.  For example, type 1 diabetics don't produce insulin, and injecting insulin is their lifeline.  Or, a patient with coronary artery disease, whether he's had a heart attack or coronary stents or a very high coronary calcium score, he should remain on an aspirin and a statin likely for the duration.

There are many people who take several medications who may actually be surprised that their list could be shortened.  An obese man on three blood pressure medicines, a medication for high triglycerides, and one medicine for esophageal reflux -- with effective weight loss, his reflux symptoms could resolve, his triglycerides would drop, and he would need far less, if any, blood pressure medication.

It is possible to shorten a list of medications, or even come off of all medications entirely.  But, this needs to be done carefully and with thought, working with a medical provider.

Sunday, October 04, 2015

Foraging Run

I'm not training for anything right now.  Exercise is about being fit, on my own terms.  It's about working out when I want to work out, because I want to do it, not because I have a race to train for or a scheduled workout or time goals to achieve.

Today I knew I wanted to run a bit longer, because I want to keep my endurance.  I'm also on call, so I wanted to keep my run nearby.  

My neighbors have a huge avocado tree.  Based on the quantity of avocados that have fallen on the street, it seems that they do not like to eat avocados.  But I do, and I've been picking them up, rinsing them off, and slicing them into my salads for the past couple of weeks.

I hate to see delicious avocados go to waste!

If there were all these avocados just next door to me, how much available fruit could I find in my neighborhood?  So, today I decided to run with the goal of finding as much fruit as possible.

Now, normally I don't pay attention too much to the trees, or nature.  On a typical run I'm staring at my watch to see if I'm meeting my time goals or if my heart rate is in the correct zone.  Today my focus changed as I looked for fruit.

Once these oranges behind me become ripe, I'll be back!!!

I'm not sure how I never noticed the abundance of fruit, all of which is reachable from the street or sidewalk!!!  I found sweet grapefruit (as opposed to the sour grapefruit growing in my back yard and on most trees in the neighborhood), pomegranates, clementines, limes, pears, hachiya persimmons, and multitudes of oranges that aren't yet ripe.  I stopped at my house twice to drop off my haul, because I couldn't hold everything.

I love being able to change my focus from competition and training to just getting out and putting one foot in front of the other.  And, I love fruit.  Definitely a successful run today ;)

Thursday, August 20, 2015

After the Ironman....

After my first marathon, or my first Ironman race, I remember feeling lost.  I had achieved my goal, and didn't have anything to aim for, to train to achieve.

I don't feel that way after Ironman Boulder.  Actually, I'm happy.  I took three days off from exercising after Ironman, then went swimming.  Three days may seem like a short period of time, but by then, I had no aches.  I felt energetic.

Now that I'm not training for an Ironman race, I can work out on my own terms.  If I want to run, I can run.  If I want to swim, I'll go swim.  If I want to bike... no I don't want to bike, so I haven't touched my bike in 3 weeks.

I still exercise six days a week because that's what makes me happy.  I've been doing a lot more swimming, and more strength training.

I swim with Golden Road Aquatics, a masters swim team in Burbank.  What if I swim five days a week with a team... what will happen?  I've never done that before.  Coach Mike Lucero has given me a few pointers on my swim stroke, and it's a great bunch of folks who show up at the pool.  Maybe one day I could swim in a meet.... we'll see.
photo courtesy of Shiggy Ichinomiya

And, I'm doing more strength training.  Leading up to the Ironman, I curtailed my heavy lifting for about two months, and was doing more functional training in the weeks before the race.  Now, I'm doing more strength training, and getting back to some of the heavier stuff.  

Yesterday at Tru Fit, I did 90 air squats, swung a 35 lb kettlebell 80 times, did 70 pull-ups, 60 burpees, 50 snatches with a 45 lb bar, 40 box jumps, and 30 push-ups.  That's all I got done before time was up, as that wasn't the entire workout, but it kicked my butt.

Did you know.... if you want to get skinny and get in the best shape of your life, an Ironman is NOT the way to do it???  I put on a couple of pounds, and definitely lost some muscle tone.  With weight training, I'm hoping to get some of that muscle back.

Malibu Triathlon is coming up on September 20.  I may put a bit more structure into my training before that, but for now I'm just having a good relaxing time doing what I want.

Tuesday, August 04, 2015

Ironman Boulder -- Race Report

Five years ago, after completing Ironman Lake Placid, I loudly declared myself  "one and done", that I would never race another Ironman distance triathlon.

And yet, one year ago, I signed up quietly for Ironman Boulder.  Outside of my coach and members of my team, I didn't tell anyone.  After so vehemently proclaiming my disdain for the Iron distance, I didn't want the pressure, or the mocking, to distract my training.  So I didn't blog about it, I didn't post on Facebook about it, I didn't tweet it... I just trained.

Why would I put myself through another Ironman race?  I wanted to prove to myself that I am a stronger athlete than I was five years ago.  And, with at least 40 other friends and teammates, and my coach, racing, it seemed like the perfect opportunity. So, not only did I arrive four days in advance to acclimate to the altitude.

Boulder Reservoir.  Day before the race

The Swim

Water temperature was 78 degrees.  When the temperature is above 76 degrees, participants are instructed that wetsuits are permitted, but if you wear a wetsuit you will not be eligible for age group awards or a Kona slot for Ironman World Championships.  I am in contention for neither, and I know I swim fast in the sleeveless wetsuit that I borrowed for the race.  So, I opted to wear the wetsuit.  The vast majority of competitors made the same decision.  The problem is, this was supposed to be a "rolling" start, with people starting based on their anticipated finishing pace.  The minority of participants who were not wearing wetsuits were seeded, but the 1500+ of us who were in wetsuits were not.  

As a result, there was no order to who entered the water when, and I would say the first ten minutes of the swim was utter chaos, with fast and slow swimmers intermingled, and CROWDED!!  I found myself closed in by other swimmers, hyperventilated and panicked like I can't recall having done in a long time, and actually did the breaststroke for about a minute until I could calm myself down.

It took a little over ten minutes to feel normal in the water.  From there onward, I felt comfortable.  Though the water felt a bit warm, I was grateful that I chose to wear the wetsuit, as I passed a lot of people swimming in tri kits.

I hoped to finish in 1:20.  I finished in 1:21, two minutes faster than in Lake Placid five years ago.  Close enough.  I run out of the water, dashing around the folks who are meandering and walking, grab my transition bag, rip it open outside the change tent, grab my helmet and shoes, run to the folks with the sunscreen, let them lather some on me, run to my bike, and off I go.

The Bike

Compared to where we train here in Southern California, this wasn't a hilly course.  Two loops, with a couple of gradual hills, and then a third separate loop with a couple of steep climbs.  Temperature was upward of 90 degrees throughout the bike ride.  My nutrition on the bike consisted of coconut water mixed with water, four Skratch Labs packets of gummy blocks, a peanut butter and jelly sandwich, and a carrot cake LaraBar.  In addition to about 32 ounces of coconut water, I drank about seven bottles of water.  I had some cramping in my toes around mile 80, but those got better with eating another packet of the Skratch blocks and chugging a bottle of water.

Overall, I felt pretty good on the bike.  My shoulders were a bit achey, and I got out of aero position about every 5-10 minutes to stretch.

Photo by Kelly Walsh-Barrios -- thank you Kelly and Vera for the cheers on the bike course!

The course was a little short, about 109 miles instead of 112, and I cruised into transition, left the shoes on my bike and ran in my socks.  Again, people walking their bikes through the transition frustrated me, and after I had my transition bag, I quickly changed socks, threw on my running shoes and hat, and off I went.

Bike time -- 6:24.  A huge improvement from my 7:38 in Lake Placid.

The Run

I dash onto the run course, and there is my friend Rhonda directing traffic at the start of the run, a location that each runner would pass four times during the 26 mile run.  I was so thrilled to see some friendly faces.  I declare, "I feel awesome!!" and off I went on the run.  My first mile was about 9:30, my second just a bit slower, and then the next four miles at about 11 minutes per mile.  Then the legs got heavy.  Really heavy.  Mile pace dropped to about 14-15 minutes per mile.  Nothing specific hurt, my legs just ached.

And my stomach.  I didn't want to eat anything.  I wasn't nauseous, I just felt uncomfortable.  So it was a very good thing that I ate well on the bike  On top of that, I was a little grossed out by the hygiene of the food at the aid stations.  Trays of grapes and fruit that triathletes were dipping their dirty little hands into.  But, at every aid station I did drink a small cup of water and dump another cup over my head.  I had a few sips of Gatorade at one aid station, but that was it, I just don't like the taste.
Getting some much needed encouragement
(Photo courtesy of Jennifer Hochman Urban)

I kept on running.  Or shall I say slogging.  Out toward a river recreational area, with lots of families and kids, occasionally dashing onto the run path.  Fortunately a few volunteers were keeping the kids off the path.

After mile 14, the miles dragged.  Each seemed to last an eternity.  My nutrition from mile 10 onward consisted of a Clif pureed sweet potato packet and some medjool dates from my special needs bag.  I had stashed a bottle of coconut water in the bag, and drank about half before I chucked it in the trash.  My stomach is definitely misbehaving if I'm throwing out coconut water because coconut water is one of my favorites.

Every so often, I walk a little bit, but I know I have to run if I want to keep up a reasonable pace and get this awful run over with.  I see a lot of people walking, but I remind myself, as much as it hurts, even a slow jog is faster than a walk.

At mile 23, I know I have one more out and back to do and the end is sort of in sight.  So I pick up the pace to an astounding 12:30 per mile, which is all my heavy legs could muster.  In the last mile, I couldn't see the turnoff for the finish line, and I asked volunteers, and someone who I thought was a volunteer, did I miss the turn off for the finish line?  None of them knew, so I kept on running, until I saw a clear sign to turn off the path.

Finally!  I run off the bike path, onto the street, see an arch ahead of me, then hear music and people cheering.  I let a couple guys run past me because I want them to have their own moment at the finish line, but more importantly, I wanted mine!  As I approached, I grinned, tears welled in my eyes (yeah, cheesy, I know), I hear, "Heather Shenkman, of Sherman Oaks, California, You are an Ironman!" and I cross the finish line.
Approaching the finish line

The Recap

What a day!  Total time -- 13 hours and 33 minutes, 46th out of 112 finishers in my age group.

I'm thrilled with my swim and bike, but my run was not very good.  At 5:31, I was six minutes SLOWER than I had been in Lake Placid.  What happened?  I'm not entirely sure.  I think I hydrated well enough; other than some brief cramps on the bike, I didn't feel like I was dehydrated.  I drank at every aid station.  I don't think I destroyed myself on the bike either.  Maybe it was just a tough course and the altitude caught up with me.  That said, my rank on the swim was 36th, bike 41st, and run 46th.  So the run wasn't that far off base from the other two disciplines, relatively speaking.

How do I feel?

Two days later as I type this, I feel pretty awesome.  I am walking like a normal person.  My legs are a little achey, but really, nothing hurts.  I am full of energy.

Thank yous!!!

Coach Gerardo Barrios, for saying, "I knew you'd sign up for another one" when I took the leap a year ago, and preparing me for the big day.  Thanks to his training, not only did I have a good race, I'm not in a world of pain and feel like a normal person two days after the race.

Friends/teammates on the course, including Kelly and Vera at mile 102 on the bike when I was so glad to finally see a friendly face, Lori and Shay in the first transition area, and Rhonda on the bike course and in the finisher chute.

When will I do my third Ironman?  The answer to that is never.  And this time I mean it.  I don't love this distance, I feel like I proved what I came back to prove, that I'm faster than my 14:45 time in Lake Placid, on a tougher course, at altitude, and five years older.  Nothing more to prove.

Wednesday, July 22, 2015

The Maligning of Vegetables

Fruits and vegetables, in their natural form, whether fresh or frozen, benefit our health.  They reduce the risk of heart disease, diabetes, several forms of cancer, and help maintain healthy weight.

And yet, they are getting a bad rap.

Is kale toxic?  One alternative medicine researcher published on his web site that he found high levels of thallium in the urine and tissue of patients who consume large amounts of kale.  He then suggested that their ailments were due to thallium accumulation.

As a result, you'll find sensational titles on the web, like "People are getting seriously sick from eating kale"  or, "Sorry Foodies: We're About to Ruin Kale."

Image taken from

But if you look closer, you'll see that for all practical purposes, this was a completely unscientific pursuit, not published in a peer-reviewed journal, and the findings spread by someone who profits from selling "chelation therapy".

Or what about carrots?  "Oh, I don't eat carrots -- they're too high in sugar".  I've head the same from patients about grapes.  I'm still looking to find someone who's obese from eating too many carrots or grapes.  With all the carrots that I eat, I'd be a very large woman.

I'm going to keep on drinking my morning green smoothie, with my handful of kale and a handful of carrots.

Thursday, June 25, 2015

Surround Yourself with Greatness

This evening, I went to Tru Fit Boot Camp, at a time I don't usually work out, but a time when I know a lot of tough athletes show up.  We were asked to split into workout groups after a warm-up run.  During the run, I saw one woman who absolutely flew, could probably run circles around me.  I followed her and joined her group.  Throughout the hourlong workout, I kept my eye on her.  Whenever I felt like stopping, I saw her out of the corner of my eye, and I kept on plugging away.  My workout this evening was awesome.

I don't like to be the slowest or least fit, because that's just not good for the ego.  But I sure don't want to be the fastest.

I like to be pushed, physically and mentally, to my limits, because that's how we get stronger.

I seek out challenge.  I've worked out with personal trainers who have pushed me to the point of sweating, grunting, and cursing (Corey, Rick, Kiki all come to mind).  I ride century cycling events with Ruth, who even though she's 60 years old, can ride circles around me and climb better than most women half her age.  I swim with my team, including Michelle who smacks my feet when I'm going too slow.  And I'll run with Kelly, a 3:33 marathoner, who as I grunt my way through 800 yard repeats, is just ahead of me running effortlessly.

Challenge yourself and get stronger and fitter.

Wednesday, May 27, 2015

Rest Days

When you exercise regularly, it's hard to take a day off, and taking a few days off is even more challenging.

Here is how I often feel about rest days:

But, truth is, the body needs rest.  Rest days allow the body to recover, which ultimately helps to build more strength and improve athletic performance.  Some would argue that the greatest fitness gains are made while the body rests.

I find it challenging to take a rest day.  I feel lazy, because my default for any given day is to have at least one, if not two, workouts to complete.  And, if I'm not working out, I feel more sluggish.

My coach routinely schedules about one rest day per week for me.  I'm not always the best about abiding by my rest, and often I'll move a strength training workout or a swim that didn't get done earlier in the week to a rest day.  I'll rationalize it in my mind that it's not *that* tough a workout, and I'll "rest" for the duration of the day.   And I need to be better about that.

I have a cold.  I don't get sick very often, which I attribute to a healthy diet, exercise, and hand sanitizer.  So, I've taken three days off from training.

My gut feeling would have been to trudge on through and do my two hour run, hour long swim, and all the other workouts on my schedule.  Fortunately, I have level heads advising me, my coach and my personal trainer boyfriend, who have urged me to get some rest.

My three days of rest have done me some good.  I've slept in, something I rarely do.  I'm going to attempt a brick workout this afternoon; I think I'm ready.