18663 Ventura Blvd, Suite 202, Tarzana CA 91356

Tuesday, October 12, 2021

Aspirin in the News..... Again

Aspirin is a common generic medication.  While it is potent in reducing the risk of heart attack and stroke in those who have already had such events, it can also provide some benefit to those who want to prevent a first heart attack or stroke.  However, even a daily baby 81-mg dose of aspirin can cause bleeding.

The U.S. Preventive Services Task Force (USPSTF) has issued a draft recommendation updating its previous guidance from 2016, based on new evidence.  The suggestion is that those who are between the ages of 40-59 and are at risk for atherosclerotic cardiovascular disease should have a conversation with their physician about whether or not they should be on aspirin, due to the risks of bleeding.

Source: Adobe Stock

Sometimes, these messages are lost in translation.  At times, that message is interpreted as "aspirin isn't necessary for anyone".  With previous similar recommendation updates on aspirin, I've had patients with previous heart attacks and strokes, and even patients with brand new stents, stop their aspirin.  In particular, stopping aspirin with a brand new coronary stent can be absolutely catastrophic, increasing the risk of thrombosis or clotting in the stent.

I anticipate at least a half dozen phone calls to my office from my patients on this topic in the next few days.  And I welcome those calls.  I'd rather take a few minutes of my time to clarify an individual patient's need for aspirin than to see him or her stop aspirin inappropriately.

As always, my blog is not a substitute for medical advice.  Please don't be afraid to talk to your doctor if you aren't sure if you should be taking aspirin.

Tuesday, December 15, 2020

Pandemic Practice Update

The experience of practicing medicine during a global pandemic has challenged us all.  Most practices, including my own, have adopted telemedicine as a patient care option.

I've found that many patients prefer to come in to see me in person.  As a result we've taken precautions:

  • Acrylic shields are located at the check-in desk and the desk inside the office
  • Patients are being brought straight back to exam rooms, as opposed to spending time in the waiting room
  • Exam rooms are cleaned before and after each patient

With COVID cases rising again, please do not neglect your health!  This week we are offering all follow-up patients the opportunity to be seen either in person or via telemedicine.This will be the case for the indefinite future.

If you have an appointment and you prefer to be seen by telemedicine, please let us know.

Thursday, June 18, 2020

Feeding my Little One

With all the stress in the world, I felt like putting out a lighter post -- feeding a baby.

I've been asked often about whether or not my ten month-old daughter will follow a vegan diet.  At some point that will be her own decision.  For now, though, she eats what I eat, which is plant-based.

If there were any concern that a vegetarian diet is not appropriate for a baby, the Academy of Nutirition and Dietetics has a position paper that clearly states that plant-based diets are "appropriate for all stages of the life cycle, including... infancy"

I will admit, though, in order to make sure that she does not have allergies to dairy or egg, she has had a taste of dairy yogurt and egg, without any reaction.

There is always a protein and a food rich in iron at each meal.  We also eat in the spirit of baby-led weaning, which basically means I put food on her tray and she eats with her hands.  Spoons tend to be thrown on the floor, but she also seems happier using her hands.

This was a recent lunch:  The top glass contianer is hers, the bottom bowl mine.
The bowl is my salad for lunch.  The glass container is just about the same, but with smaller sized pieces.  There are shaved carrots and cucumbers, Japanese sweet potatoes, avocado, tomato, and cut-up tofu.  

Often meals are messy.  Here, she has guacamole and black beans.  

Here's a breakfast: Cheerios and mango.  Often breakfast is whole wheat bread with nut butter, cashew yogurt with fruit, banana (not too much because it's very constipating), or a smoothie with fruits and veggies (which she is a rare occasion when I will give her a spoon)..

Tofu, broccoli, and orange peppers:

So far, things are going well.  Ava definitely has her favorite foods -- guacamole, tofu, tempha (from Dave's Korean), sweet potatoes, and applesauce.  But she's prety easy at meal time, she'll eat just about anything I give her. And, she's getting enough iron, based on her hemoglobin measurement at her last check-up.

Thursday, April 30, 2020


With the COVID-19 pandemic, medicine has changed dramatically.  Now that going out of the home and mingling with others carries risk, gatherings that were once in person have now shifted to video conferencing.  And that goes for physician visits as well.

Telemedicine, conducting a visit with a patient from a computer or smartphone screen, was one of those concepts that I always appreciated, but never embraced, due to logistics and difficulty in getting paid.  It has now become a necessitiy, and fortunately insurers are reimbursing more generously for telemedicine than ever before (though likely not quite to the same level as an in person visit, but that will be seen).
Telemedicine isn't that hard, see?

I am using a website called for telemedicine appointments.  It's very straightforward.  You log in to the web site from your browser on a smartphone or computer with web cam.  No need to download anything.  Details are here.

If that seems too daunting, then FaceTime is also an option.  While it is not HIPAA-compliant, exceptions have been made during the pandemic to permit doctor-patient communication via other platforms such as FaceTime, Skype, and Facebook Messenger.

One silver lining of the pandemic and telemedicine is that insurers in many cases will pay for a telemedicine visit with a physician in another state.  So, if you wanted to get a consultation from a plant-based cardiologist in California, and you live far away, here's your chance.

As an absolute last resort, a phone visit is an option.  I don't like these because I think that a face-to-face conversation is a better way to practice medicine.

Adventures in Telemedicine
While I miss seeing my patients in person, telemedicine brings me into my patients' homes.  I've met family members and pets.  I even met a dog who sings "Happy Birthday".

I am a stickler for knowing exactly what medications my patients are taking -- on a telemedicine visit from home, my medical assistant can ask them to gather up their pill bottles, while often when I see a patient in the office they've forgotten their list or assume that I know what they're taking.

Another advantage of telemedicine is that I am often working from home.  This gives me the opportunity to spend more time with my daughter -- the nanny is taking care of her while I'm working, but I get to eat lunch with her and play with her when I have a break.

Need to be seen by your cardiologist, and don't want to leave your home?  Call my office at 818-938-9505 and we'll get you in for a telemedicine visit!

Wednesday, March 25, 2020

COVID 19 -- Unique Challenges

None of us has ever encountered anything like what we are experiencing.  This is just the beginning, and there will be more who are vulnerable and will get ill.

As a cardiologist, I'm worried, and I'm fearful for my own health, and the health of my family.  I'm being as careful as I can -- mask when near patients in the hospital, change clothes and shoes before coming home, no jewelry, washing and sanitizing my hands even more than I already do.

As a business owner, I've had to contemplate how to change my practice model.  In many ways, I wish I was still an employee -- I would not have to worry so much about finances in that I would have a salary, and wouldn't have to concern myself with the logistics of setting up telemedicine, or finding the correct codes to use to bill for that service.

I think telemedicine is key right now.  I can't in good conscience ask the majority of my patients, most of who have multiple medical issues, to come to my office.  I've been doing phone calls with patients who are due for follow up, and next week I'll be ready to do telemedicine, where I can see and hear my patients.

I thought initially that it would just be follow-up patients, and I would push the new patients to when the pandemic is over.  Unfortunately, I don't think that's any time soon, so I will make do with telemedicine to provide the best service that I can in these times.

If you have an upcoming appointment, or you wish to schedule an appointment, call my office.  My staff will be able to help you.

Monday, March 16, 2020

Coronavirus Update from the Office

To my patients:

The office is open.  We are here to help you.

If you are feeling unwell, or otherwise do not wish to come in, please call and reschedule, 818-938-9505

If you are a current patient, we can do a telephone check-up or portal email exchange in lieu of an in-person appointment.  Call us for details, 818-938-9505.

Please know that we are taking extra precautions to clean and sanitize all surfaces in the office.

Be well,
-Dr. S.

Thursday, January 30, 2020

Time and Exercise (and a baby)

I've always challenged my patients who tell me they don't have time to exercise.  After all, there's always time somewhere.  Carve out your lunch hour.  Wake up early.  Stop at the gym on the way home from work.

Having my daughter Ava, which is rewarding and fun beyond what I could even express, has definitely challenged my own ability to get to the gym.

Ava, tummy time champion

Many years ago, workouts would happen in the evenings.  Then, once in my interventional cardiology fellowship, I realized that the days could go very long, and that if I wanted to know that I'd get in that workout, it had to happen early in the morning, before work.  And, that's a habit I continued for more than another decade -- I'd run, spin, bike, swim, go to Barry's, or whatever workout for the day, in the morning.  While there was an occasional evening workout (well, more frequent than "occasional" when I was in triathlon training), morning was the time I knew was mine.

Now with a baby, who is nearly six months old, it's harder to work out.  I remember coming home after my four week check-up with my OB, once "cleared" to exercise.  I asked Ray to watch Ava while I went to boot camp from 7-8 pm.  That didn't work out so well as I came home to a crying baby who wanted to breastfeed.

The first few months were tough, because even though I physically could work out, Ava needed to nurse.  I would need a block of time when she wasn't nursing, I wasn't working, and time was left to shower.  As a result, not much exercising happened until about three months post partum.

I'm still challenged to find time, even as she approaches six months of age.  In the mornings, I am waking up with Ava and feeding her.  Sometimes I can get in a morning workout, but only if I know I have a later start to my work day.  And in the evening, I am watching Ava until my partner gets home and often that's close to 7 pm.

I've gone to some creative lengths to exercise lately.  One evening, I set Ava in her music bouncer (see below) and went through a ten minute workout on an app on my phone.  I did squats, pushups, and other exercises while Ava entertained herself in the bouncer and squealing at our dogs (she's fascinated with dogs, but that's a story for another time).

Musical bouncer, with a view of the dogs

 On a busy Saturday morning, I walked with Ava, in her stroller, to the market, loaded the stroller up with heavy groceries, and rather than walking home, I power walked with the weighted down stroller, up and down the hills in my neighborhood for the next forty-five minutes, while Ava napped.

I have a membership at LA Fitness now, which includes child care.  About three weeks ago, I dropped Ava off at the gym child care.  About 40 minutes into working out, I was paged overhead to my crying daughter who was not enjoying her time with strangers.

So, I would definitely have to say, I have a new appreciation for finding time to exercise.  I'm still trying to figure it out.

Thursday, October 17, 2019

No need to cut back on red meat? Really?

That's the message from the authors of this paper in the Annals of Internal Medicine.

Their message:  There is no need to cut back on red and processed meat, because it doesn't reduce risk that much, and people like meat a lot.

As you would imagine, there was a lot of pushback when this was published.  There were responses from the Plantrician Project, the True Health Initiative featuring former president of the American College of Cardiology Kim Williams MD,  Neal Barnard of the Physicians Committee, and David Katz, and even one of the co-investigators objected to the final publication.

What are the problems with this study?  I'll summarize here, and more thorough reviews as highlighted above go into more details.

*The methods used here were not suited to studies on nutrition.
*Studies that compared a standard diet to a vegetarian or plant-based diet were not included.
*The authors DID find that red meat increases risk of disease -- they just argued that people like red and processed meat so much that they're not willing to give them up.

Red meat is a known carcinogen, labeled as such by the World Health Organization.  Further, the places in the world where people live the longest, these places have very low meat consumption.

Monday, September 16, 2019

Cardiologist Mom / Maternity Leave

Ava was born on August 10, after a very good and uneventful pregnancy, after years of trying to make her, without success, and getting just plain lucky.

And here she is at 8 days:

And here.  Look at that smile, oh my gosh!

This is my first day back at work at 16 days.  Baby came to the office while I saw patients over a couple of hours.
Why back at work so soon?  Because, it's my practice.  It's hard to step back, and not lose patients.

I did take a full two weeks off.  I had carefully planned over the months of my pregnancy to schedule the majority of follow ups in October and November so that this time wouldn't be so busy.  Also, I was fortunate to have Dr. Alice Perlowski fill in at the office a couple of days, to see patients who had urgent issues and needed to be cared for.

I'm back in the office on a part time basis, for now just the mornings.  Baby is at home with our nanny while I'm at work at this point, she has a bottle of breast milk while I'm gone.  I feed her right before I leave, and right as I get back home from work.

While I love having my own practice, and I don't regret for one second going solo nearly two years ago, this would be one big down side.  I don't have the luxury of being able to take two or three months off completely.  

That said, I've done my best with the situation, to strike a balance between feeding and raising my baby, and keeping my business going.

Sunday, July 07, 2019

I don't think that cheese is vegan....

We ordered pizza for a special occasion from a local pizza place.  The restaurant is not all vegan, but they do pride themselves on providing vegan options.  And, I've had their pizza before, and it's been pretty good. 

(Yes I'm a cardiologist, and no I don't eat pizza all too often.  This was a special occasion.)

There were several pizzas with the order, and only one that was ordered as vegan, as I was the only vegan among the group.  Someone had even gone to the effort to write "vegan" on the box, so I didn't think twice when I helped myself to a slice.

Something seemed odd about the pizza, a taste and a consistency that was unfamiliar.  As I continued to eat, I noticed the consistency of the cheese didn't seem like that of the Daiya non-dairy cheese that I'm accustomed to on pizza, and I began to suspect that this might have been dairy.  Rather than say anything, I stopped eating the pizza and helped myself to some salad.

About 30 minutes later, my stomach felt quite upset, and without providing graphic detail, it became clear that all was not well.

From the website of Cruzer, the only all-vegan pizzeria in Los Angeles.  I wish they were closer to where I live.

Maybe I'm just imagining things... and it really was vegan cheese?  So, I brought the leftover pizza home that evening to my lactose-intolerant boyfriend and showed it to him without saying anything.  His response:  "That looks like dairy cheese."

I called the restaurant, and the owner was the one who picked up.  I explained that I think that a vegan pizza that we ordered probably was made with dairy cheese.  She was skeptical, explained that they cater to the vegan community and that would not happen.  I said, "I'm about 99% sure this is dairy."  She asked me to take a photo and send it to her cell phone.

Upon sending the picture, I received a call back almost immediately.  As it turned out, our order came in at the same time as an order that included a vegetable pizza with dairy cheese.  The group that had ordered the vegetable pizza had called earlier, upset about the "funny" cheese on their pizza.  It looks like the pizzas from the two orders had gotten mixed up.

The owner sounded beside herself.  She was very apologetic, wanted to know what she could do to make it up to me.  I said I understood, it was an honest mistake, and the next time we visit, a pizza on the house would be great.

Now, I could see someone getting far more upset over this.  One could have posted a nasty one-star review to Yelp, or a long-winded social media post naming the restaurant and suggesting that vegans should boycott.  

I don't think that would be a good way to deal with this.  Even though the restaurant isn't all vegan, they do have many vegan choices, and as a result I want their business to do well for making the choice to provide vegan pizza.  Further, it does no one any good for vegans to come off as mean and self-righteous.  While I probably won't order from this restaurant again any time soon, I do want them to continue to have vegan offerings and view the vegan community positively.

What would you have done?

Sunday, May 12, 2019

Working Out Pregnant -- up to 25 weeks

Big news -- I'm pregnant, and due on August 23!

There are so many misconceptions about exercise and pregnancy, that I want to share what I've learned.  My doctor was a good resource of information, but there is valuable information online as well.

Exercise is Important During Pregnancy
There are so many benefits -- exercise during pregnancy makes the stress of labor easier, decreases lower extremity swelling, and reduces the risk of gestational diabetes and preeclampsia.

My experience:
I have continued to work out, averaging about 5 days a week.  Most workouts are at Barry's Bootcamp, which is less than a mile from my home.  Sometimes I go for a jog on my own, or I go to a spin class, but my favorite workout remains Barry's.  Barry's is a one hour workout, half treadmill running, and half strength training.  It's not easy, especially pregnant.  To keep up with the running, I drop the speeds a bit.  My jogging speed is 4.5 mph instead of 5, and I subtract one mile an hour from any speed that is called out.  If I feel like I can run faster than that one mph handicap that I give myself, I'll pick it up.

Today, at 25 weeks of pregnancy, I ran successive 30-second sprints at 10.2, 10.3, and 10.4 mph.

What I've Noticed:
Up to week 8 -- Working out was a bit tougher.  But doable.
Weeks 9-13 -- Morning sickness!  Fatigue definitely set in, but worse than that was the nausea.  I'd have to stop periodically to dry-heave, but once that would pass, I could keep going
Weeks 14-25 -- The morning sickness let up by about week 16.  With a few modifications, I can still keep up with class.

This is me with trainer Scott Haddock, whose leg classes I take on Tuesdays and Thursdays.  I finished off a "Face Yourself Challenge" by taking 19 classes in 30 days.  A tough feat, more challenging doing it during second trimester of pregnancy.  The card sort-of covers my growing belly.

What I've Learned:
There's so much nonsense online.  I look to sources like this, from ACOG, the American College of OB-GYN, for good information.

It's safe to get your heart rate up.  Even as recent as a couple years ago, pregnant women were told not to get their heart rate above 140 beats per minute.  This is no longer the case.   As a vigorous exerciser, I continue to push my limits when I run on the treadmill.

You can do sit-ups.  I made the mistake of trusting Google before talking to my doctor.  All sorts of articles caution about sit-ups, some going as far as to say a sit-up should never be done during pregnancy, for fear of a condition called diastasis recti, or separation of the abdominal muscles along the midline.  As this is my first pregnancy, my doctor didn't feel that I am at significant risk with doing abdominal exercises.  She advised me that I can do sit ups until my belly is too big.  Even now at 25 weeks, I find myself still able to do full sit ups.

You can lift weights.  Data is mixed.  There's a suggestion that lifting heavy can lead to pre-term birth and intrauterine growth restriction.  This study from Denmark suggests slight increased risk of preterm labor in those who lift more than 20 kg more than ten times a day.  At Barry's, the workouts are with higher repetitions, and prior to pregnancy my "heavy" weights would be two 20-lb dumbbells.  I've stuck with this weight.

Be careful lying on your back.  When lying flat, the uterus compresses the inferior vena cava, the vein responsible for returning fluid to the heart.   There's no real exact guideline of how long you can lie on your back.   If there's a flat exercise where I'm lying on my back for longer than a minute, I'll sit up for a few seconds an then lie back down and continue.

This girl is jumping on my bladder!  The uterus compresses the bladder as well.  I definitely can't make it through an hour class without stopping in the restroom (embarrassingly, at least once....)

And finally... workout clothes!!!
I had to invest in some new sports bras around week 9, and then again around week 16.  Pants were fine... up until recently.  Now they squeeze my belly too much.  I found a great pair of workout pants on Amazon.  And, I've continued to wear some of my stretchier tops

As I get more pregnant, I'll post more about working out.  I'm hoping to do Barry's, and run at Barry's, as long as I can.  But I anticipate transitioning to more walking and water workouts.

Thursday, January 10, 2019

The Veganification of Fast Food

The market for vegan food has never been better -- according to Nielsen, 6% of Americans consider themselves vegetarian, 3% consider themselves vegan, and 39% are looking to eat more plant-based.
This is great news for the animals, and should be good news for our health.  And it's great news for those of us looking for vegan food options.

Vegan options now abound at fast food restaurants:
Carl's Jr now carries the Beyond Burger.  But, be sure that when you order your "Beyond Famous Star" that you hold the mayo and the cheese.  I've been amused by the social media posts of various vegan friends who have never stepped foot in a Carl's Jr but suddenly have the urge.  I've heard good reviews.
Del Taco now makes Beyond Tacos with Beyond Meat.  They're only available at select locations for now.  My father is a connoisseur of Del Taco and eagerly awaits the arrival of the Beyond Taco in the Conejo Valley.
Taco Bell is rolling out a vegetarian menu.  It's been well known for years amongst the vegan community that Taco Bell is an easy place to eat vegan -- just sub the beans for meat in any item, ask for it "Fresca style" which means you get a salsa-type topping instead of cheese, and you have a vegan meal!

In addition, Chipotle has beans that are vegan, both black beans and pinto beans, much thanks to a class-action lawsuit, along with Sofritas which is a marinated spicy tofu blend.  Subway offers a Veggie Delite sub with veggies and Italian dressing which is vegan.  Many pizzerias, even chains like Blaze Pizza or Pieology, offer vegan cheese as an option.  Just about every restaurant has a vegan option on the menu, and if there isn't something obviously vegan then there's likely something that can easily be made vegan.

That makes it easier to find food options when we're dining out..... but it won't necessarily make use healthier.  Meat and cheese aren't health foods, but neither are the vegan analogues of meat and cheese. 

I'm not a purist when it comes to diet -- I advocate whole, plant-based foods for my patients, and for the most part that's how I eat.  But, I do go out for a restaurant meal, usually once or twice on the weekend, and I expect that many people like me will enjoy an occasional restaurant meal.

I worry that there will be a new generation of fast-food vegans, those who eat vegan for the sake of the animals, but don't necessarily think much about their health.  These fast-food vegans may down the road end up with the same health issues that we associate with a meat-laden diet.  And then, people will look at us vegans and say, oh your diet isn't so healthy after all, now is it?  When the perception of vegan is not a healthy one, then fewer people will gravitate to a vegan or plant-based diet, and the animals will suffer.

In the meantime, I'm looking forward to trying out a vegan Carl's Jr "Beyond Meat Star" since I'm curious.

Thursday, October 25, 2018


In the course of my career as a cardiologist, pitching a plant-based diet to patients has become easier over time.

It's easier now that plant-based diets are more mainstream.  From movies like Forks Over Knives, What the Health, or Cowspiracy, people are learning about the health benefits of plant based eating.  And, as there are more vegans, there are then more vegan options in grocery stores and restaurants, making a plant-based diet seem more attainable.

But I think that over time I've also become a better, more comfortable advocate for plant-based eating.

The most effective time to make the pitch for plant-based eating is at the hospital, at the time of a health crisis like a heart attack.  After all, diet is a major reason why people have heart attacks.

Sometimes the conversation actually happens while the patient is on the cardiac cath lab table, having just received a coronary stent.  Other times it may happen in the patient's room the next day, or maybe in the office on the first follow-up visit.  We talk about his or her current diet, what might be good in it, and what might not be so good.  Next, I explain, "The best diet for the heart is a plant-based diet, as it has been demonstrated to reverse plaque in the arteries.  Would you like to try that type of eating here in the hospital?"  I'll also recommend watching Forks Over Knives, if the patient and his or her family has access to a mobile device at the hospital.

I've found great success with this approach.  With one patient, I came back to his room to find a copy of Michael Greger's How Not To Die on his bedside table, thanks to enthusiastic family members.  Many patients even convince their entire immediate family to start eating plant-based as well.

I have a large number of plant-based patients, some who sought me out because I am a vegan cardiologist, and others whom I've convinced of the benefits of plant-based eating.  And I stand by this statement -- in over 11 years of practice as a cardiologist, not a single plant-based patient under my care has gone on to have another heart attack, need another stent, or need a bypass surgery.

Tuesday, August 14, 2018

That Time I Stented A Vegan

A whole food, plant-based diet will help you live longer and reduce your risk of heart disease, heart attack, stroke, diabetes, and perhaps some types of cancers.

However, it's not a magic bullet -- just because you eat a vegan diet, this does not mean you are immune from all health ailments.

A couple of years ago, I was consulted on a man in his early 50's with chest pain.  He was concerned enough about the pain to come to the emergency room, but upon talking to me, he was trying to play it off.  "Oh, it's not that bad, I have reflux, I'm okay now."  

He's a vegan, he tells me, after watching Forks Over Knives a couple years ago.  He eats a fair amount of restaurant food and certainly likes french fries.  And at that time, I'd classify his body size as modestly overweight.

I wanted to be able to tell him that his heart was fine, but there were a few things that just didn't sit right -- his EKG had some abnormalities that suggested ischemia, or a lack of blood flow to part of his heart.  He had risk factors as well, a family history of heart disease, abnormal cholesterol levels particularly with a low HDL, and high blood pressure.

I ordered an echocardiogram, which is an ultrasound of his heart.  I had the chance to look at it immediately after it was done.  It was quite abnormal.  The front wall of his heart was not moving at all, suggesting an acute plaque that could be sitting in the left anterior descending.  

I showed the echocardiogram images to my vegan patient.  He looked on, stunned, as I explained that his chest pain was probably unstable angina.  We planned a coronary angiogram for the following day.

The angiogram demonstrated a severe narrowing of the left anterior descending coronary artery, which is the artery that runs down the front wall of the heart.  I placed a stent to open the artery.  As he was suffering from unstable angina, this is a situation in which placing a stent does save lives.

This is what a severe narrowing of the left-anterior descending looks like

He's doing great now.  He's adopted an Esselstyn-style whole-food plant-based vegan diet.  He's lost a significant amount of weight.  He also exercises regularly.  As a result, he's been able to come off his blood pressure medications.  At present, his only medicines are a baby aspirin and a statin.

So what happened, why did a vegan have an unstable angina event?  He had risk factors for heart disease, which included a family history, high blood pressure and abnormal cholesterol.  Also, while he was a vegan at the time of his event, he had spent most of his life on a standard American diet, and his vegan diet probably wasn't the healthiest.  Remember, Oreos, potato chips, Twizzlers, and Pepsi are all vegan, but they're certainly not health foods.

I believe that with continuing a whole-food plant-based diet and regular exercise that his heart will remain healthy for years to come.

Sunday, July 08, 2018

On Private Practice

I'm now more than 6 months into this adventure of private practice.  It's been a lot of hard work, but well worth it.

The toughest part -- learning the business of medicine.  As an employee first of one local practice, and then as an employee of Lakeside for nine years, I saw patients, did procedures, and submitted the codes for my work, and that was it.  I never had to worry about insurers and contracts.  I had no idea of the difference between fee-for-service and capitation, and certainly not a clue of what an EOB (explanation of benefits) is.

There's also running a business.  Medical school, residency, and fellowship don't teach business.  I had good advice from people who know more than I do about business.  My sister-in-law Mary Ruth helped to put together documents to set up the corporation.  Laurence Kinzler of MGMA helped start me on the process, from my rough ideas of what I wanted to do, to a specific timeline of opening the practice.  Jill Freiberg helped me with my insurance contracts and with plenty of advice from her years of experience.  And conversations with a few local cardiologists were quite helpful as well.
One of my exam rooms
The office opened on January 2.  Things were slow initially, which allowed enough time to fine-tune our operations, and for us to learn how to use our new electronic medical record.  Business gradually has picked up.  By the end of February, money started to come in, at the end of March the practice was breaking even, and thereafter the practice is definitely thriving financially.

I've set up a practice to provide a more personal experience.  We're a small office, so if you call during business hours we pick up the phone, you don't get a recording.  If you feel you need an appointment ASAP, we can make that happen, there's no waiting for weeks to see the doctor.
My waiting room
I have no regrets, other than I wished I'd ventured out on my own sooner.

If you're a former patient, give us a call and see if we take your insurance, we probably do.  If you need a cardiologist, or know someone who needs a cardiologist, call us at 818-938-9505.

Tuesday, May 22, 2018

New Research on Eggs -- Beware the Details

Eggs are in the news again.

A recent study from the American Journal of Clinical Nutrition comes to the conclusion that there is no risk from eating up to twelve eggs a week.  Look closer.  There are some important details --
-- The study was paid for by the Australian Egg Corporation.
-- The "low egg" group ate two eggs per week, BUT ate more meat to make up for eating fewer eggs.

Another recent study has led to headlines like, "An egg a day to keep the doctor away"  The article, "Associations of egg consumption with cardiovascular disease in a cohort study of 0.5 millon Chinese adults," was featured in BMJ Heart.  Issues with this study:
-- This was an observational study. You can't make definitive cause and effect conclusions from observational studies.
-- People in China who consume more eggs tend to be more affluent
-- The study relied solely on dietary recall, a questionnaire asking people what they eat, not observing what they eat.

I'm not about to start recommending eggs to my patients.  Eggs do contain a large amount of cholesterol, and while dietary cholesterol is not the sole cause of high cholesterol in humans, it definitely contributes.  Eggs also have choline which increases the risk of developing and dying from several kinds of cancers.  PCRM's The Exam Room Podcast from last week does a great job of tackling the subject of eggs and health.

Some people may suggest that the egg itself isn't the problem, but rather the foods that often accompany eggs -- ham, bacon, sausage, butter, and cheese, for example.

There are so many healthier foods to enjoy for breakfast.  Oatmeal is my favorite easy go-to breakfast, but if you want something hearty with the consistency of eggs, a tofu scramble is a filling and healthier choice.  One of my first blog posts twelve years ago featured a tofu scramble, or you can check out my book on Amazon for a great tofu scramble recipe, along with many other recipes.

Wednesday, April 18, 2018

Heart U -- Weight Loss, featuring Lori Manby

As part of my mission to educate and empower my patients, I am holding monthly Heart-U educational sessions.  This month's session, coming  up on Monday, April 23 at 6:30 pm in my office will feature the topic of weight loss.
I've had countless discussions with my patients about weight loss.  Losing weight, and then maintaining a healthy weight for the long term, is a goal that eludes many.

Lori Manby has succeeded.  She lost 80 lbs and had maintained that weight loss.  She uses the Weight Watchers program to guide her food choices. She has used her experience to pay it forward by founding the support group Vegans of Weight Watchers.

Her story is compelling.  And if you're struggling with weight loss, she's the perfect person for your to hear from.

Please attend her talk this coming Monday, April 23.  You can RSVP here, or call my office at 818-938-9505.

Read more about Lori here in Weight Watchers' online magazine

Sunday, March 25, 2018

The ones we don't save

One of the most rewarding parts of my job is saving lives.  I can open a blocked coronary artery in the setting of a heart attack.  Or I can help prevent that heart attack by guiding my patients to good lifestyle choices, and when necessary, prescribing medication.

Everyone knows I'm passionate about lifestyle and the power of food and movement.  I will admit, though, as an interventional cardiologist, I enjoy procedures, and I take call at a few local hospitals to care for those in the throes of a major heart attack.

Far more often than not, my team and I work together, open an artery, and save a life.  The gracious patient who no longer has chest pain thanks me and my team, and goes home in a day or two.

It's the patients who don't have that outcome that haunt me, especially when they are young.  I was called emergently for a man in his 30's.  When I arrived, he was sweating profusely, clearly in pain.  His blood pressure was low, so I knew we needed to start working immediately.

I got some brief information from him -- he'd had pain for several days.  He smoked.  He had a strong family history of heart disease.  He hadn't been to a doctor in a long time.

I had one of the best scrub techs at my side, as we worked hard first to get access into his artery and vein.  I worked as quickly as I could, advanced a catheter to his left main, injected it to see that the left anterior descending, the widow-maker artery, was completely blocked at its origin.

His blood pressure was dropping, and we gave medication to support that blood pressure.  I knew I needed to open that artery.  I managed to get a wire into that artery, inflate balloons within the artery, saw blood start to trickle through.  But there was so much clot that had organized in that artery.

Then his heart stopped.  We did cpr, we shocked him, we provided every intervention at our disposal that we could to save his life.

He didn't survive.

I think about this patient often.  I remember telling his wife who sobbed, absolutely shocked and devastated.

I also think, this didn't need to happen.  What if he had come in a few days earlier when his pain started?  What if he hadn't smoked?  What if he had been to a doctor, who may have been able to treat high blood pressure or high cholesterol?  What if someone had gotten through to him to convince him to eat better, to exercise?

I think about what I could have done differently as well.  He was so sick on arrival, I just don't know that I could have done anything differently that would have saved him.

What's my point?  Heart disease can be deadly.  Even if you have no symptoms, but you have risks -- high blood pressure, cholesterol, family history -- manage those risk factors.  Eat right, exercise, if you have high blood pressure get it under control, if you have diabetes, get it under control.  Quit smoking if you're a smoker.  See your doctor and listen to your doctor.

Sunday, January 21, 2018

On Starting a New Practice

I opened my new practice three weeks ago.  After ten and a half years as an employed cardiologist,  I'm now an employer.  A solo physician.  A business owner.

In medical school, residency and fellowship training, I never thought I'd work on my own.  I learned the science of medicine and cardiology.  I paid little attention to the business of medicine, up until a bit less than a year ago, when the gears in in my head started turning.  Before that, I never thought that I would go it on my own.  I brushed off any suggestion of being independent -- the expenses are so high.  It's so hard to fight for patients, and would my established patients even come with me?  And all the work of starting and maintaining a practice -- is it worth it?

Room 4.  Of course that's a greyhound on the wall!

As I thought more, the potential of independence appealed more and more to me.  The ability to practice in my own setting, in the way that I want, during the hours that I want, without approval from management.  The independence to run a cardiology practice in a way that suits my philosophy of health.

Starting a medical practice is tough.  I have an incredible respect for anyone who runs his or her own medical practice, or any business for that matter.  But, I've found that even if the hours are long, it's work for a purpose -- to build something that is mine.  And that is rewarding.

I'm grateful for all the advice and support I've received.  I'm grateful to have two talented staff members, Diane and Sylvia, who make my job easier.  And I'm grateful for the many loyal and terrific patients who've chosen to follow me in my new adventure.

I'm inviting patients, friends, family, friends of patient, and anyone curious to come see my practice.  Come to my open house on Thursday, January 25, 5:30-7:30 pm.  I'm proud of what I've created and I welcome you to take a look yourself.

Thursday, January 04, 2018

Meet my office staff!

The office opened this week, and we are up and running seeing patients!!!

Let me introduce you to my staff members:

Diane Shockcor - Medical Assistant
Diane worked with me at Lakeside for over three years, and I can't be happier to have her join me at my new practice.  She's smart, works hard, and gets along well with patients.  Diane is a dog lover and has a boxer named Harley.  Her major flaw is that she is a Buckeye fan.

Sylvia Tadeo - Front Office 
Sylvia has over ten years of experience in the medical field, including as a medical assistant and a phlebotomist.  I met Sylvia a couple years ago at Tru Fit Bootcamp, where I was impressed by her dedication and the fact that she can do burpees far faster than I can.  Sylvia is also fluent in Spanish.

Call us for an appointment at 818-938-9505.  Or, come to our OPEN HOUSE on January 25, to say hi and see the new office!

Saturday, December 23, 2017

For my Lakeside and Regal Patients

I have fantastic news -- I can continue to be your cardiologist!

Many of you whom I've spoken with have asked if I can continue to be your cardiologist.  My answer was that I was in the process of contracting and to call me in January, because I was hopeful that I could continue to be your cardiologist, but I could not make that promise.

In the meantime, I have signed a contract with Regal and Lakeside for my new solo practice.  If you are a Regal or Lakeside patient who has been seeing me, I can continue to be your cardiologistHowever, please make sure that you request a new referral.

My staff and I are busy getting the office ready to open on January 2.  Open house on Thursday January 25, 5:30-7:30 pm.  More on that soon!!!

Tuesday, December 05, 2017

To My Patients:

As you've heard, I'm leaving the position that I've held at Lakeside Community Healthcare for the past nine years, and I am starting my own cardiology practice.
I'll be opening up my office in Tarzana on January 2.  It's a terrific location in the Safari Walk block of Ventura Boulevard, one half of a mile west of Tarzana Hospital.  Another fantastic bonus of my location -- free parking!

I love my patients, and don't want to lose any of you.  Some of us have known each other for nearly a decade.

You'll have the chance to come see my office on January 25, from 5:30-7:30 pm, when I'll have an open house for patients.

If you want to continue to have me as your cardiologist, please call my office in January at 818-938-9505.  I am in the process of credentialing, so I do not know at the current time which insurers I will be able to accept, but I should know more soon.

And, if you're my current patient, and you want to see me in the office this month, call my Lakeside Burbank office at 818-848-0023.

Wednesday, November 08, 2017

New Practice Update!

It's been a lot of hard work, and there's just under two months until my new practice is open for business, January 2, 2018.

I have secured a fantastic location -- the Wall Street Building in Tarzana,  Kravings restaurant is on the first floor, and there's a large Whole Foods Market across the street.
18663 Ventura Blvd, Tarzana

Now, I'm focused on the many details of my new medical practice.  There's more to this than I had imagined -- credentialing with insurers, setting up wifi, computers, and phones, choosing an electronic medical record, hiring employees, buying equipment and furniture -- these are just a few of the tasks that I've had to take on.

But for me, the hardest part has been having to tell my patients that I'm leaving.  I know some will follow me, and I'm so grateful for that, but others cannot, whether it be distance from home, or insurance.  I've been with some of my patients for nearly nine years, and those office visits feel like meetings with old friends.

Stay tuned here for more details about my new practice!!

Thursday, October 05, 2017

Big News!!!

I am starting my own cardiology practice!

I've enjoyed my time working for Lakeside, and have appreciated my cardiology colleagues that I have had the honor to work alongside.  

In my new practice, I look forward to providing a whole-person approach to cardiology.  As someone who believes in the power of us as the drivers of our own health, my vision is a practice that encourages not just conventional medicine, but also lifestyle -- plant-powered food choices and movement to keep our hearts healthy.

Not only will I be able to provide top-notch cardiac care, but there will be plenty of additional enrichment opportunities.  From nutrition seminars and individual consultations, to cooking classes and weight loss, this will be a full-service practice to help patients achieve optimal heart health.

Stay tuned..... once available, I will post my address here.  Tentative office location is on the Safari Walk strip of Ventura Boulevard in Tarzana.

Sunday, October 01, 2017

International Plant-Based Nutrition Healthcare Conference

This year was my first visit to the International Plant-Based Nutrition Healthcare Conference in Anaheim, a massive 900+ gathering of doctors, nurses, health coaches, nutritionists and all sorts of healthcare providers assembled to learn about plant-based nutrition.

I arrived a day early to attend a seminar on how to market your plant-based medical practice, which will be very important (more on that topic soon!!).  The next two and a half days were full of lectures from various doctors, nutritionists, and even a cooking demonstration!

This is what a full lecture hall looked like on the last day of the conference:

This was from Brenda Davis RD's talk.  She gave an overview on the benefits of plant-based diets.  Since I hear all day from patients telling me how they feel they need more protein, and personal trainers who push protein on their clients, I found this slide and the discussion around it very important:
Bottom line -- higher protein intakes, greater than 20% of calories per day, particularly when from animal sources, associated with increased mortality.  That said, I would be cautious even with vegan protein supplementation.

I clicked this slide from Dr. Garth Davis's talk.  He and Dr. Kim Williams, the past president of the American College of Cardiology, gave exceptional talks.  Dr. Davis put this slide up to summarize the ways meat increases mortality:
More reason to give up meat if you want to be healthy.

I think I nabbed this slide from Dr. Davis's talk as well.  There's lots of people who are "pescevegan".  They're vegan except that they do eat fish.  (Ironically, I gave up fish at age 11 due to having fish for pets, but spent the next five years eating chickens and hamburgers and thinking nothing of it).

TMAO (trimethylamine-N-oxide) is found in the gut, and higher amounts are associated with increased plaque in the arteries.  Fish consumption leads to the highest levels of TMAO.  So, if one is concerned about health, here's another reason not to eat fish.

And of course, one of the coolest things about attending a course on plant-based nutrition -- the food!!!!  Everything served was vegan, plant-based, and relatively healthy, either with no oil or minimal oil, minimal salt and sugar.  I ate quite well.

Sunday, September 24, 2017

Busy times....

I haven't posted in a little bit.  It's been a busy several weeks, as I study for my interventional cardiology board recertification exam on October 3.

I am attending the International Plant-Based Nutrition Healthcare Conference in Anaheim.  Will share more on that later this week.

And, in sad news, I lost my dear greyhound Curves this week very suddenly.  She would have been 12 in November.  I had her in my life since September 2010.  She loved to lie around, lying in the sun, playing with toys, and even fetching a ball.  It's been hard, I can just be glad she didn't suffer long.
Curves.  11/11/2005-9/22/2017

Sunday, July 30, 2017

Talking About Obesity

Talking to patients about weight isn't easy.

There's no question that obesity is a growing problem, with about a third of the population obese, and another third overweight.

But, just about no other condition lends itself more to ridicule and discrimination in our society.  And yet no one wants to be obese; unfortunately, those eating and lifestyle habits that many consider "normal" lead to excess weight.  Fat shaming is ever-present, and there's even research suggesting that people skip going to the doctor so that they can lose weight before their appointments.

So, how do I as a doctor discuss obesity with my patients?  It's challenging.  I want to help my patients without making them feel like they are being shamed; I want to be empathetic, but I do want to encourage changes that will lead to weight loss.

Regardless of my patient's body size, I ask the same questions of all new patients -- do you exercise?  If not, why not?  Tell me about your eating habits.  Do you eat fruits and vegetables?  Do you eat your meals at home?  Do you do the grocery shopping?  Do you know how to cook?

In someone who is obese, there are more likely to be answers to those questions that are less than ideal.  And, as we talk, we discuss ways of making changes that will improve health and ultimately lead to weight loss.

Of my follow-up patients, I keep track of trends -- if an overweight patient is losing weight, we discuss how he is doing it.  If a patient is gaining weight, I discuss with her what factors might be causing weight gain and how we can turn this around.

As a cardiologist, so many diseases that I treat -- coronary disease, atrial fibrillation, hypertension, hyperlipidemia -- are related to lifestyle and body size.  I have helped many of my patients to lose extra weight, and hope to continue to do so.

Wednesday, June 28, 2017

This Meme Needs To Go Away

I've seen this meme, and have been tagged with it, more times than I can count.

I'd be happy to see it go away.  Why?

--First off, it's arrogant.  It makes us vegans look like a--holes.

--Most cardiologists at this point are aware that meat-filled diets are associated with increased risk of heart disease.  So I can't imagine a cardiologist telling a patient to go eat more meat.

--The meme assumes that if you're a vegan that you won't ever have heart disease.  Not true at all.  Tell that to my vegan patient with rheumatic heart disease, a consequence of scarlet fever as a child.

--While a vegan diet does help load the dice in your favor, you are not immune to hypertension, diabetes, elevated cholesterol or obesity, all of which I have seen in patients who proclaim themselves vegan.

--Or what about the patient who sees the light after a heart attack and decides to go vegan?  My patients who have gone vegan after a major cardiac event have done great, I haven't needed to put a stent in any of them, nor have any of them had another heart attack.  But, they still need a cardiologist even if they're eating a diet that Esselstyn, Ornish, McDougall, Fuhrman, and the rest of the vegan gurus would laud.

Let's be civil and make this obnoxious meme disappear.  And when you see it again, please don't tag me.  Thanks.

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!!!