NEW LOCATION!

MY NEW OFFICE --
18663 Ventura Blvd, Suite 202, Tarzana CA 91356
818-938-9505

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!!!

Sunday, April 09, 2017

Life After Ironman

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

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

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

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

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

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

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

Sunday, February 12, 2017

Living alone -- not an excuse!!!

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

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

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

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

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

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

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

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

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

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

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

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



Sunday, January 08, 2017

Doctor Visit Pearls

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

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

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

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

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

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

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

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

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

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

Thursday, December 01, 2016

Back in Action!

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

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

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

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

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

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

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

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


Sunday, November 20, 2016

Marijuana

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

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

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

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

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

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

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

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

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

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

Sunday, October 09, 2016

Retired Triathlete at One Year

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

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

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

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

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

August 2015

And now:

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

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

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

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




Monday, September 19, 2016

Plant-Based Diets are Catching On!

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

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

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

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

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

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

Saturday, August 13, 2016

Listen to my conversation with Kirk Hamilton PA-C



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

Listen to the podcast here.

Friday, July 15, 2016

Weight Loss -- What Doesn't Work

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

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

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

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

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

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

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

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

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

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

Saturday, June 18, 2016

Bringing Vegan Food to LA Unified School District

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

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


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

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

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

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

Saturday, May 07, 2016

Forks Over Knives Article

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

Sunday, April 24, 2016

Passover Seder 2016

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

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

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

Big crowd for seder!

Matzah Balls for soup





Chocolate chip cookies and chocolate brownies

Chocolate Matzo Loaf