Happy New Year!

My Resolutions:
1) Complete my first half ironman distance triathlon -- Vineman 70.3 in July.
2) Run the LA Marathon in 4:30-4:45.
3) Help my 53 year-old father complete his first triathlon.
4) Learn Spanish. Es mui importante en California.
5) Keep up with the cardiology literature.

I think that's enough.
Happy New Year everyone!

Passed!

I just found out that I passed my interventional cardiology board exam!!!

It was a lot of studying, and such a relief.

Training Update

I'm training for the Los Angeles Marathon, my first marathon in six and a half years. Even though I'm a few years older, I'm going to finish faster by training smarter. My goal is to run the marathon in 4:30-4:45. If I can maintain the 10:30 per mile pace from the City of Angels Half Marathon, then I can do it.

Part of my training is running with others, which is something I've never really done before. I've joined the Los Feliz Flyers, a group that does weekly track workouts. The group has all sorts. There are some rather hardcore members, and then there are the "TOG's" -- The Other Group. The TOGs are a little slower than the hardcore group, and we run a total of three miles for a workout. Last week, we did 800 m at 5k pace, then 1200 m at 10k pace, 800, 1200, and 800. It's a good group, not competitive, and I find myself somewhere in the middle of the TOGs pack.

Next, I'm joining a group for my longer runs, the LA Leggers. They have several pace groups and meet early on Saturday mornings. This morning I tried them out for the first time, joining the twenty or so members of the 10:30/mile pace group -- I wasn't sure whether to run with the 11 minute/mile group or the 10:30's, but I think I chose well.

Where Does Cholesterol Come From?

Of course it's not real shrimp. But it's tasty and nutritious -- VegeUSA's Vegan Shrimp with Sweet Chili Sauce. This whole plate of "shrimp" is 140 calories, 4 grams of fat, and zero cholesterol.

Did you know that "real" shrimp has twice the cholesterol as the same quantity of beef?

Lately, I've tried an experiment -- I've asked my patients with elevated cholesterol, "Do you know what foods have cholesterol in them?" The answers are interesting. Many patients just don't know. Sweets, oily foods, fat, they say.

The answer is simple: Animals make cholesterol. So anything that was an animal, or came from an animal, has cholesterol in it. Beef, chicken, pork, fish, seafood, dairy, and eggs are full of cholesterol.

A vegan diet, which is a without animal products, is cholesterol-free. And cutting back on animal product consumption, or better yet, following a vegan diet, will lower cholesterol.

Giving Back

Volunteering has always been something that is important to me. I feel very lucky to be where I am in life, to have had great family and mentors to guide me toward my career in cardiology. Because of this, I decided to put my talents to use, and I am the cardiologist of the Los Angeles Free Clinic. I volunteer one evening a month to see uninsured patients who need a cardiologist.

Tonight was my first shift. It was an interesting and rewarding experience. It's very different to think about practicing medicine in a situation where we can't order the tests we take for granted. Echocardiograms, stress tests, and cardiac catheterizations take months to obtain. So I have to rely on my clinical judgement and physical examination skills.

Easy Meal

A quck, easy, and healthy dinner from Trader Joe's:Sweet Potato Bisque soup, straight from the carton to the microwave. On the plate, lentils (ready to eat right from the bag) on leftover whole wheat couscous. And, a salad with baby beets and black berries, with ginger sesame dressing.

Thoughts from a Weekend On Call

It's been a busy weekend. I didn't get a chance to work out, which makes me feel like a complete sloth.

I do love my job. I save lives. Honestly. And it's a great feeling when I do get the chance to help someone.

Other times, I'm asked to see patients who are critically ill, who have already something very bad happen to them. Often it's like being asked to see Humpty Dumpty after he's fallen off the wall, and being asked to do what all the king's horses and all the king's men can't do.
This weekend has had elements of both, and I am emotionally exhausted.
Image from www.alphabet-soup.net

Rave Run

This might have been the coolest run ever.

Griffith Park has a holiday light display every year. You can idle through in your car after waiting in a long line.... I chose to run!

Ella Corre -- City of Angels Half Marathon Race Report

"Ella corre" is "She runs" in Spanish. I'm learning Spanish. It's a good skill for a physician in Southern California to have. So to practice, I may throw a little Espanol into my posts.

It was cccccooooolllllld this morning! As we waited for the start, it was about 41 degrees. If this were any other city I've lived in (Detroit, Rochester NY, Boston), it would be expected to be this cold in December. Not in Los Angeles. We huddled in Griffith Park by the heat lamps, then shivered in the porta-potty lines before the race started.

The first five miles were in Griffith Park, which is where I've done my training runs. My goal was to run 10:30 mile splits, and at the halfway mark to pick up the pace if I felt good.. My first four were about 10:00-10:15. Part of me was excited, and the other part of me was worried that I'd lose steam.

I lost a little bit of steam, and my splits slowed down, but not too much. The scenery was nice -- Griffith Park, Silver Lake, Echo Park reservoir, and then into downtown LA.

My main issue was gastrointestinal. My stomach felt heavy, like I would throw up, or worse. And while a well-timed Gu packet gave me more energy, five or ten minutes later my stomach was getting angry at me. This is an issue I need to figure out well before Vineman 70.3 in July 2008.

Even now my stomach is screwed up. I planned to have a Tofurky sandwich on whole wheat with lettuce, tomato, and guacamole. Instead I had a banana, sweet potato soup, and two slices of whole wheat toast with Earth Balance and strawberry jam, and my stomach didn't really like that either.

So, anyway, my lackluster time: 2:17:47. I ran two half marathons last year on 2:11 and 2:12. I've slowed down this year, probably because I've cut back to running 4 times a week, maxed out at 24 miles in a week, and I'm a year older. On the flip side, I have added a spinning class each week to cross train, and unlike last season, I haven't been significantly injured. Maybe for me slower is smarter.

Biggest Loser and Why Can't Everyone be So Successful

The reason I really like this show is that it demonstrates that people can become healthier by losing weight, exercising, and eating healthfully.

On the most recent episode, the remaining seven contestants met with the show's doctor. One contestant's cholesterol dropped by 100 points. Another who was pre-diabetic no longer was glucose intolerant. And, one contestant who had hypertension no longer needed to take blood pressure medication after his large weight loss.

These feats were all accomplished by a change in lifestyle -- not with medications.

Why can't I get my patients to do the same? Many of my patients are overweight, eating terribly, with risk factors for heart disease -- diabetes, high blood pressure, abnormal cholesterol. They're often fortunate that they have not had a heart attack or stroke YET.

I try to give them the knowledge to eat well and exercise on their own. Most are receptive to my advice and willing to make changes. But invariably, they come back a few months later.... HEAVIER!!!

Sometimes, I liken it to my high school cheerleading coach, who when she would get annoyed at us not listening to her, would turn around, face the wall, and continue to talk, until we all noticed and started giggling. I feel the same way -- I might as well be talking to a wall.

But, I think a lot of it is our society. Sedentary is acceptable. Restaurants serve non-healthful foods -- they really don't care how healthy their food is for the most part, as long as it tastes good. And when you're hungry on the run, what do vending machines have? Junk.

The Biggest Loser contestants are sequestered on "The Biggest Loser Campus". They aren't exposed to negative influences of society. They have personal trainers. They have healthy food.

I have had one successful patient who I cared for during cardiology fellowship. He was hospitalized with a heart attack. He was a smoker, overweight, with a history of high blood pressure and high cholesterol. I gave him my usual talk -- quit smoking, eat better, consume more fruits and vegetables and less meat (most doctors won't say this, but it's true, meat is not good for you), exercise and lose weight. He quit smoking, lost 50 pounds, and as a result, dropped his cholesterol and blood pressure. In the two years that I cared for him after his heart attack, he did really well, without any angina (heart-related chest pain), and lower blood pressure and cholesterol levels.

Lifestyle change is possible. It takes a motivated person. When successful, these people can live longer, healthier lives.

I Want to Swim!!!

Those are words you'll rarely hear me say.

In my two full triathlon summer seasons, here's how it works: I burn out toward September, and get sick of biking and swimming. Then I start running more and train for a half marathon. And then I do whatever on earth I feel like to stay in shape, treadmill, kickboxing, spinning classes, until March, when it's time to get back in the pool and dust off the road bike for another season.

But I have more ambitious goals now...... I'm training for a Half Ironman!!!!!



Yes, that's 1.2 miles of swimming, 56 miles of biking, and a 13.1 mile run.

This past season, I had no coach. But to do a half ironman, I definitely need one. So, I'm going back to my coach from Rochester, Mary Eggers of Train-This. She is a triathlete superstar and will be my online coach.

I've found a local masters swim group. And I want to swim! After the City of Angels half marathon on Sunday, I'm ready to start training for my first half ironman!!

Vegan Thanksgiving 2007

Tofurky

Stuffing, gravy, cranberry sauce, sweet potatoes

My plate!!!! Gone in no time. Clockwise from upper left: Corn muffin, tofurky with gravy, stuffing, cranberry sauce, sweet potatoes, green bean casserole, squash, and a generous helping of mashed potatoes and gravy in the middle.

Staying on Track During the Holidays

Sometimes we fall off the wagon and a few pounds creep on. We ease up from our good habits, cut out a day or two of exercise, slip up on the diet with a few extra cocktails or chips and dip at a few social gatherings. Over the course of a few weeks, they may lead to a few extra pounds.

Now, we don't just gain weight for no reason. Our weight reflects a balance of what we take in, food and beverages, and what energy we expend by exercising or through our daily activities. A gain in weight means we're either moving less or eating more, or both.

The first thing to do is to take a step back and analyze what it is we're doing wrong. Next we have to decide how to correct that.

For watching what we eat, one of the most effective strategies I've found is a food diary. Write down everything you eat, the quantities of each food, and the number of calories. Share the list with your doctor. Or, use it to be accountable to yourself. That way, if you're tempted to have another four cookies, you know you'll have to write it down, and will be less likely to splurge.

And, even if everything you eat is vegan, that doesn't automatically mean it's healthy. I'm a big fan of Turtle Mountain Purely Decadent vegan chocolate almond fudge brownie ice cream, but even vegan treats need to be consumed in moderation.

Exercise time is one of the first things to disappear at this time of year too. But, make a commitment to stay in shape. Write in exercise "appointments" on your calendar, just like any other appointment that you would make. Or, if your exercise routine is getting stale, try something new.

I find the show The Biggest Loser to be really inspiring. If you've "fallen off the wagon", I find it helpful to see people who are even farther off from their goals reach them through hard work.

Have a great Thanksgiving!

Back on the Bike

After my Long Beach Triathlon disaster, my bike has been sitting in my living room unused. I've been doing a lot of running to get ready for the City of Angels Half Marathon on December 2. My cycling has been limited to a weekly spinning class at Bally Fitness to keep my quads strong and avoid muscle imbalance issues that led me to major iliotibial band problems last year.


But, as I plan on finishing a half-ironman this coming year (1.2 mile swim, 56 mile bike, 13.1 mile run), I need to be riding on the roads. The LA Tri Club had a (mostly) women's beginner ride, 32 miles up the Pacific Coast Highway from Malibu. More experienced riders called the route "mostly flat". For me, not so much.

The first sixteen miles were okay. On the last sixteen, my legs felt like jello toward the end. Which tells me, I need to ride more.

Next: getting back to swimming. I haven't swam since my last triathlon either.

Veggie Stew

Sautee vegetables in oil for five minutes. I used potatoes, cabbage, carrots, cauliflower, and celery. You could easily use any other vegetables. Peas, corn, or sweet potatoes work well here. Then add broth. Simmer for 25 minutes. Then add soy sauce and flour. Cook another 10 minutes. Season to taste and serve over rice or pasta.

Creamy Corn Chowder

I have never made a soup that I thought was fabulous... until now. This is from the Blossoming Lotus 7 Minute Chef, an online book put together by the chefs of the Blossoming Lotus restaurant, who are the ones who catered my brother and Mary Ruth's wedding in Hawaii.

The soup is not hard to make. I started by sauteeing an onion with garlic, salt, and pepper. Then I added some potato, and then water, corn, carrot, and a little soy milk. After simmering, I added roasted cashews, blended half of the soup, mixed it back together, and added some more corn. This made for a very delicious and filling soup.

It's done!

The interventional cardiology board exam is done!!!!! Did I pass? I think so, but I won't know for a few months.

And now it's back to living normally. It felt good to go back to work today, to get out of my apartment where I've been studying for hours on end.

I accumulated a to-do list while studying. It includes baking cookies, getting an oil change, framing my diplomas from the past few years, and buying an ipod. And, losing the two pounds I gained while studying -- sadly, even with running 23 miles, a spinning class, and two days of weight training in a week, while sitting on my rear end the rest of the time a couple pounds crept on.

So back to life. And the picture? Yes that's me. I've decided I need a picture of my face on the blog, instead of the back of my head running past a bunch of port-o-potties.

Interventional Cardiology Board Exam Tomorrow

I've been studying for months. Hopefully, it will all pay off.

Those of us who became board certified after 1990 have to re-certify every ten years. It's a nuisance to study and take exams, but I suppose there's some merit to it -- medicine changes so much in just a few years. In my specialty, interventional cardiology, in ten years alone there have been revolutionary changes to how we perform angioplasty, the medicines we use, and the stents that were just beginning to come into use ten years ago.

One of my mentors, who certified years ago, likes to gloat to me about how he never has to take an internal medicine or cardiology board exam ever again. I jokingly remind him that that's because he's old.

So here goes nothing tomorrow. If I pass, then no more exams until 2012, when I have to re-certify in internal medicine.

More Eat Your Veggies Meals

Peanuty noodles, greens medley, and baby carrots.


Tofu scramble, yucca fries, and strawberries.

Eat Your Veggies Delivery Service. They've even fed Alicia Silverstone. And these two weeks before my interventional cardiology boards, they're making my life much easier.

Take your meds, please

One last important word on how to be a good patient: If you can't afford the medications precribed for you, please tell your doctor before you are discharged from the hospital. Especially if one of those medications is Plavix. And ESPECIALLY if you just had a coronary stent placed.

What are you dressing up as for Halloween?

I'm told that my office staff dress up for Halloween. It's festive, it's fun.

I'm not dressing up. Here's why -- I don't look like a cardiologist. As a young woman, I look nothing like your stereotypical, gray-haired cardiolgist. I'm mistaken as the nurse, the physical therapist, the nutritionist, the social worker -- you name it. And not just by patients, but by health care workers as well.

Some patients have even told me that because my last name ends in "-man" that they assume I'm -- a man!

In a world of stereotypes and preconceived notions, I need all the credibility I can get. Hence no costume.

Photo from paranormalworld.net

Curried chickenless wrap, Jicama slaw, and Banana

Here's day #1 from Eat Your Veggies vegan food delivery service.

What is jicama anyway? I don't know, but jicama slaw is tasty. With a side of cold lentils and watermelon for dessert, this was dinner. And it was delicious!

Now back to studying.....

Blog Slowdown

That's my niece. Aunt Heather buys her cool shirts.

The blog has been slow, and until after my interventional cardiology board exam on November 8, there won't be too many posts here.

For now, life is work, studying, and working out. I simply can't get by without my morning run or workout, so even if that means missing an hour or two of sleep, I'm better off for it.

In fact, to avoid grocery shopping and cooking, I'm trying out Christy Morgan's vegan meal delivery service, Eat Your Veggies. I'll post a few pictures and let you know how it is, but the meals she's dropped off look scrumptious.

How to be a Better Patient

Here are a few suggestions for how to get the best health care from your doctor that you possibly can:

1) Know your medical history and what medications you take.

Some patients have no knowledge of what medications they are taking, what their medical history is, or what medical procedures they've had.

Yes your information may be "in the chart", but sometimes that chart isn't readily available. You may have another doctor prescribing medications, and you may not be taking the medicines listed in the chart. For example, if your blood pressure is high it's important for me to know that the rheumatologist started you on prednisone two weeks ago, or that your primary care doctor stopped your lisinopril because of that pesky cough.

Also, it is very helpful to carry a current list of all of your medications and doses.

2) Describe your symptoms in simple terms.

We learn in medical school that 90% of medical diagnosis is taken from the history that we are given by the patient. The best descriptions are the simplest: "I have crushing chest pain that started two hours ago and radiated to my left arm." "I have angina" is not a description of your pain. As a doctor, I need to know your exact symptoms.

You do not need to describe to me the workup you've had since walking into the clinic or hospital. "My blood pressure is high and they did an EKG and drew blood from me" is not the information I want. I know this already. Tell me what symptoms brought you here.

3) Take your medicines as prescribed. This is especially true with hypertension (high blood pressure).

Blood pressure medications are not to be taken on an as-needed basis. You need them every day. Some patients tell me that they can "feel" when their blood pressure is high -- this is not true. That's why hypertension is called The Silent Killer.

If you have any doubts as to whether you should take a medication, ask me. I'd be glad to explain the benefits of the medications that I've prescribed you.

4) If you do not speak English well, please allow me to use a translator to converse with you. That way, we will understand each other better, I will know what your concerns are, and you will understand what your plan of care is.

Image from http://www.arealahec.dst.nc.us/medical.jpg

Vegetarian Wedding

My brother, Kevin, and his fiancee Mary Ruth tied the knot last weekend in Hawaii. The wedding ceremony, as you can see, took place on the beach.

Blossoming Lotus, a vegan restaurant, catered the event. The food was nothing short of amazing!!!

Noodles and edamame, spring rolls, and Migthy Aphrodite's Greek Salad (with "Feta" cheeze).

Senorita Bombia's Enchilada Casserole, with mole sauce and sour cream.

And, last but definitely not least, the cake. Ahhh... a vegan cake. I can't remember the last time I ate cake at a wedding. This was delicous and pretty!

I had hoped to submit this to VegNews magazine for their vegan wedding issue, but sadly it's too late this year. But here it is, an awesome vegetarian wedding.

How the Mighty Have Fallen

I used to cook a lot. In fact, my initial intent of having this blog was to show how easy it is to cook healthy vegan meals. But lately, I've done so little cooking. Almost none, in fact. Much of the reason is, ironically, time -- balancing a new job as a cardiology attending, working out, studying for my interventional boards, and occasionally spending time with family and friends. On top of that, it's so easy to call up Green Leaves for a seitan wrap and a miso soup to go.

Tonight, for the first time in a while, I cooked. I sauteed broccoli and onion in my wok with General Tso's sauce and paired it with some pre-cooked wild rice from Trader Joe's.

Once the boards are over, I'm going to cook more. I miss it.

Here is a nice positive article about vegetarianism, entitled "Protein a key concern for vegetarians"

It's very positive about vegetarianism. It talks about a restaurant in Atlanta called Cafe Sunflower -- I've been there and it's delicious.

But, I disagree that protein is a "key concern" for vegetarians. Anyone who consumes a balanced vegetarian diet will get plenty of protein. We only need 10% of our calories from protein. Most Americans are well in excess of that.

And why don't we talk about the "key concerns" of the standard American diet -- obesity, diabetes, heart attacks, stroke, osteoarthritis, hypertension, high cholesterol........ ???

Adventures in Raw

Leaf is a raw vegan restaurant with two locations in LA. My omnivorous friend Jodi absolutely raves about this place, so when I met up with her for dinner tonight, we headed to Leaf in Culver City.

We had the mock salmon nori rolls as an appetizer, which was really delicious! For a main course, we split a Bombay Burrito Wrap and a Rawzagna (that is, lasagna but made raw!). Both were pretty good. And, for dessert, we had apple pie. I was pretty skeptical about raw dessert -- last time I had a raw dessert item, a raw chocolate brownie, it did awful things to my gastrointestinal system. But, the apple pie was amazing, and there were none of the previously experienced after-effects.

I'll admit, I haven't had a lot of experience with raw cuisine. I've heard talks on the subject and how food is not heated above a certain temperature to preserve the enzymes in the food, and how the enzymes are beneficial to our bodies. I don't buy into this theory and there's really no science to back it up. But, what I can say, is that raw is healthy in that the food isn't processed, has no animal products or cholesterol, is full of fruits, vegetables, and fiber.

Is Bigger Better? Maybe not.

Here's a great piece on why height matters in sports.

Now it makes more sense to me why, at 5'10", I do well in the swim portion of the triathlon, but not as well on the bike or run.

One of Many Reasons I Love LA

This restaurant is on the way between the two hospitals I work at. I tried it out for the first time tonight for a Seitan wrap as dinner on the go. The wrap was delicious and the folks behind the counter were really nice people. They're going to be seeing a lot more of me.

I can't get over how easy it is to be vegan in LA!

Going Green

When I moved here, I was excited to be living in a greener community, one where people care about the environment. After all, I recycle everything I possibly can. It almost pains me to throw a piece of paper in the trash.

So, I was absolutely stunned to find out that my apartment didn't recycle anything! And neither did my office! Over the past few months I've collected my recyclables from home and hauled them up to my brother's place whenever I had the excuse to visit and play with my niece. In hopes that my apartment might consider recycling, I contacted the city to see if they might be able to talk our management into recycling.

Today I received a pleasant surprise -- a flyer on my door saying that my apartment now recycles bottles, cans and plastics! They don't recycle paper, but this is a nice start.

And, since joining the cardiology practice where I'm at, we now recycle pop cans. I've even gotten them to go vegan for lunch on my birthday, which is definitely a green thing to do. I'd love to see them recycle paper.

So, speak up -- you can make change happen.

Image source: www.bserecycling.com

Flat

That's the one word to describe my experience at the Long Beach Triathlon today.

I thought the race would be interesting for different reasons. I raced the day after Yom Kippur, the Jewish day of atonement, on which I fasted all day before the race, and I wondered if that would impact my race times. I entered in the Athena category, for women who weigh more than 145 pounds, when I normally race in my age group. The water was polluted and disgusting after a day of rain yesterday, which I thought was interesting, as all the other beaches in southern California are closed for this reason.

The swim went well. The water was gross, but I tried not to think about that. I got out of the water, onto the bike. "Your back tire is almost flat," I heard. And I could feel it, but I thought, maybe I can just finish this short 10-mile course with the tire being *almost* flat. No such luck. About two miles in, it was completely flat.

I was on the side of the road, panicked. I had two tubes. I had a lever to pull the tire off. But, I did not have a pump or a CO2 cartridge. I was absolutely panicked. My race is over, I'm going to quit. Then I saw a man fly off his bike and hit the pavement. I dropped my bike and ran over -- "Are you ok? I'm a doctor." Fortunately he didn't need my doctoring skills, or what little I could do out on a triathlon course, and he got back on his bike and kept going.

One woman helped me pull my tire off my bike, remove the tube, and put a new tube in. But still, I had nothing to inflate it. I yelled out to people riding by -- "Anyone got a pump?" A couple people threw me their pumps, but they didn't fit the presta valve on my tire. Another woman with two flat tires joined me on the side of the road. Then my hero, an 84 year-old man, pulled over. He had a few CO2 cartridges and was able to provide air to both me and the other woman with flat tires. "I'm 84 years old, just being here and finishing is all I want." Wow.

Next I fiddled with the bike and was able to put my back tire back on the bike. I sliced my finger and had chain grease all over my hands, but now about what felt like a lifetime later, though it was probably only 30 minutes, I had a functioning bike.

I thought about quitting. How embarassing a finish will this be? I'll be dead last. But I thought more about it. I'm no superstar. I just come here to do my best. And, I can cheer people on. I'm now officially at the back of the pack, with the people who need the most encouragement.

So, back on the bike, I rode past the Queen Mary ship, and finished my first loop of the bike course. There weren't many people out on the bike course, and I could have gotten away with pulling back into the transition area after doing only five miles on my bike. No one would have known, except me.

But I took the second loop. There were no bikes with me. I had an air pump in my back pocket to return to a racer who loaned it to me. I'm going to be last, I thought. Dead last. In this race, though, there is a prize for the last place finisher. That would be cool, I thought, last place prize. As I continued, I passed a couple dozen people on their bikes. When I rode by a photographer, I pulled the air pump out of my back pocket, waved it in the air and yelled "Whoooo hooo!" Yah! I'm the girl with the flat! And I'm gonna finish this stupid race!!!

Finally I got to the transition area. People were picking up their belongings and heading home. That would have been me. How frustrating. And I had three miles left to run. So I headed out for my run. Yelled for my back-of-the-pack brothers and sisters. Looking great! Way to go! Almost there! I was full of energy. Someone I ran past even asked, "Where do you get all that energy?" "I get it from sitting on the side of the road for 30 minutes with a flat!" Maybe I shouldn't have said that. Oh well.

Running into the finish chute, I was alone. The announcer had enough time to call out my name as I ran past. Cool.

And to top it all off, someone took my wetsuit home with them.

I would have loved to finish in style, no flat tire, giving it my best effort. What I've learned from this, first and foremost, is how to change a tire during a race, and to make sure I have all the equipment with me -- tubes AND CO2. Worse things have happened.

Hospital Cafeterias

When our patients are hospitalized, we work so hard to teach them how to eat -- low fat, low cholesterol, high fiber, and so forth.

But what does the cafeteria serve? Junk. The entrees are covered in calorie-heavy sauces. There are burgers, and fries, and onion rings. Maybe there's a vegetarian entree, and my hospital prides itself on always having at least one vegetarian option, but that item typically is smothered in cheese.

Yes there is a salad bar and garden burgers are available. But I believe we are sending our patients a mixed message by offering less healthful options.

It's a shame that hospital cafeterias sell out our patients.
Picture from www.roadfood.com.

Beaten Up in the Cath Lab

Reportedly, a physician at a San Diego hospital beat up on a patient during a cardiac catheterization procedure. While I don't condone this behavior in any way, I can understand as an interventional cardiologist how something like this could happen.

The cath lab is a stressful environment. The procedures that we do are very intricate and do carry significant risk. We're dealing with coronary arteries that are only a few millimeters wide. Often our patients are quite sick.

Further, we demand a lot of our patients. We ask them to lie flat and completely still on a narrow, hard table. This is uncomfortable, especially for older patients and people with back problems. While we give sedation medication, our patients are not completely knocked out and they do have to deal with the discomfort.

Often patients for various reasons find it hard to cooperate, and thus they move. Our equipment is literally laid out on top of the patient. So if they move their leg or arch their back to adjust themselves, they not only risk tossing important items on the floor, but they risk harm to themselves as they disrupt our delicate work.

While this physician who allegedly beat his patient is innocent until proven guilty, such violence toward a patient doesn't need to happen, and it shouldn't. The patient could be given more sedation. Or, soft restraints could be used. The patient could even be completely sedated and intubated to facilitate the procedure being done.

So, you combine the difficulty of a patient to lie still with the stress of a physician doing a complicated procedure. But beating up a patient is just not the right way to deal.

And the Birthday Celebration Continues

To celebrate my birthday, I had the opportunity to choose where we were ordering from for our Friday lunch -- we order out for lunch every Friday. I chose California Vegan. The office staff seemed to enjoy it, if you count second helpings, clean plates, and unsolicited "I've never eaten vegan but this is really good!"

And, going above and beyond the call of duty, they brought me a vegan chocolate cake! Mmmm yummy!

Happy Birthday to Me

Today I turned 32. My brother baked me a pineapple upside-down cake for the occasion.

How cute :)

Watch Me Finish the Triathlon!

This is too cool. Click on this, then enter my race number, 847. Then click my name and "select athlete".

You'll see me running about ten seconds into the clip.

My First Olympic Distance Tri -- Done!!!

Woo hoo!

Late Arrival
I couldn't find the shuttle buses in the morning. So I got to the transition area around 6:40 am. The announcer was talking about all athletes clearing the transition area. As he's saying this, I look around and see the very long lines for body marking (where race numbers and ages are written on our skin with permanent marker). As I was wearing my LA Tri Club gear, a woman comes up to me with her own permanent marker -- "LA Tri Club, can I mark you?" What a time saver! Membership has its privileges.

The Swim
The forecast calling for one-foot waves -- dead wrong. On top of this, we had a northward current. Watching the waves before me, I knew exactly where I had to sight while swimming in so as not to get taken off course. I started in the back of the pack for the swim, so as not to deal with thrashing limbs in my way. I relaxed, thinking about it as one of my leisurely training swims at Manhattan Beach. Venice Beach, however, has nasty water -- yuck. I kept a consistent pace, based on the people around me. When I finished and got out of the water, I didn't feel too tired.

Transition 1 -- Swim to Bike
While changing out of my wetsuit and into my bike shoes, I hear the announcer: "The last of the under 35 women are finishing in the water and the first of the over-35 women are getting out of the water now." Thanks for the inspiration. Not.

Bike
As usual, I am slow as molasses on the bike and everyone and their 65 year-old grandmother passes me. The ride was a nice course -- Venice Boulevard to Fairfax to Wilshire to Highland to Hollywood and Sunset and then into Downtown LA to the convention center.

Transition 2 -- Bike to Run
I was nervous that my bag that I dropped off yesterday with my running shoes wouldn't be there. Maybe it's my lack of luck with checked airline luggage. But I was pleasantly surprised. My bag, with my shoes and hat, was there. I still felt full of energy. And off to run.

Run
As I ran out of the transition area, I suddenly felt quite drained. Am I really going to now run 6.2 miles? Am I friggin crazy? And my stomach felt somewhat unsettled. Maybe I needed more fluid, or more Gu. But I just didn't feel like having it sitting there in my stomach. At the water stations, which were frequent, I grabbed a water cup from each, and would take maybe one sip before feeling the urge to get rid of the cup.

My pace was going to be an easy jog. I had no plans for speed. There were two loops. The first one took us way up the hill to the Disney Concert Hall. That hill was absolutely miserable. Many people walked it. I jogged it quite slowly. The second loop had us run halfway up that hill, which after 4 miles of running was also miserable.

But, being a club member does have its privileges. I don't know many people in the LA Tri Club, but "Go LA!" is always a good thing to hear on a challenging run. I yelled it to everyone in LATC gear, some yelled back, others ignored me, and some others just gave a thumbs up.

I finished in 3:33, three minutes off my projected time of 3:30. That's my stopwatch time; I have no idea what the official time is.

Relaxation
I spent my afternoon lounging on the beach. Ahh that felt good.

Next Race
Long Beach Triathlon on September 23?!?!?!?

Breakfast and my T2 Bag

Recently, I've changed what I eat for breakfast. Over the past year I've been working out most mornings before work, and I have found that just a bowl of cereal leaves me absolutely ravenous by 10 am. So, when I wake up I have a small bowl of cereal. Then, after my workout, I eat breakfast: oatmeal, soy yogurt, fruit, and orange juice. That keeps me full until lunch time.

The big triathlon is tomorrow!!! *fingers crossed* And this is the stuff that's going to go into my second transition bag, which I am dropping off at the race expo today. In a triathlon, there are two transitions: between the swim and bike, and between the bike and run. Because the LA Triathlon is a point-to-point course, and the bike begins at Venice Beach and ends in downtown LA, the second transition is in a different location as the first. So, today I have to pack my bag with everything I need for the second transition: shoes, socks, a hat, and Gu gel. And maybe a towel.

The "DB" hat was a gift from my program director back in Boston. It's a bizarre inside joke. But it's a good hat, fits well, keeps me cool during a run, so I use it a lot. And no one in LA knows what "DB" stands for :)

Hydration, klutziness, and other pre-race thoughts

I need sodium while racing. Worst case scenario, I'm on the course for four hours. Gu gel just isn't going to cut it, I'm told. And I hate Gatorade. I tried the PowerBar Fruit Punch drink, which I found to be decent. I'd rather have the taste of plain water for my hydration, but I know I need the sodium.

The sprained ankle is healing, I guess. It's been 3 and a half weeks, and it's still quite swollen. I can do everything on it -- run, bike swim, weights, etc. At the end of a work day, it does hurt, especially if I'm wearing heels. So I've been a bit lazy and wearing scrubs quite a bit to work.

And speaking of being a klutz, I faceplanted yesterday while running. I tripped on the sidewalk and landed on my right side, scraping up my right knee, hip, and both palms. I got up, shook it off, and ran another 45 minutes. I don't know how often normal people trip and fall while running, but it seems to happen to me about twice a year.

Oh and one other thing... I think my weight is fine at 159 lbs. I don't want to lose any more weight. I don't need to.

All this rambling... can you tell I'm a little nervous?

Sweat Rate

It was suggested that I calculate just how much I sweat in an hour. I decided to do this today, in 104 degree heat, as I rode my bike through Griffith Park up to the Valley.

I weighed myself before. Then, during my hour-long ride, I sucked down two 24-oz bottles of water and a Gu pack. I felt constantly thirsty. Normally the bike provides some air conditioning because you're moving at a decent pace. Not today. I felt hot and awful.

My worry with hydration during a long event, such as the upcoming olympic distance tri, is not only of drinking too little, but possibly of drinking too much. Slower endurance athletes like me are at risk of hyponatremia, a too low sodium concentration in the blood from drinking more fluid than what their body is losing.

Even after drinking so much, I weighed myself -- I had lost a half a pound! In that hour of cycling, I had lost fifty-six ounces of fluid. Almost two liters!

Maybe the moral of the story is to not ride in ridiculous heat like this. But at least now I know that in extreme heat, I sweat a LOT.

The Looming Olympic Distance Tri

After my ankle sprain, I thought seriously about whether or not to keep my spot in the LA Triathlon. My ankle was ridiculously swollen and black and blue. Running on it was painful, so I didn't run for the first week. Even kicking while in the pool hurt.

I changed my goal for the race to endurance, rather than speed. I've done plenty of sprint tris, now for my first olympic distance tri, I just want to finish. I may be DFL (dead f........ last), but I'll finish.

My training hasn't been crazy. I do weights for an hour three days a week with my trainer and then six cardio sessions, about 45 minutes to an hour and a half each. I haven't doubled up on workouts much either, in other words, usually just one workout a day. And I think I'm enjoying my training more that way.

One more week. I'm a little nervous.

Shunsh Kashish

That's Armenian for "Take a deep breath."

English is not the first language of the vast majority of my patients. In fact, more than half of my patients barely speak English. If only I spoke Armenian, the first language of 80% of my patients. Or Spanish. Or Tagalog.

I've developed a small vocabulary of Armenian. Just the medical basics. In chveses -- how are you? Lavay -- good. Tsav unis -- do you have pain? Barke -- lie down. Nustie -- sit up. Batz -- open. Pagai -- close. And a few others.

Pee pee and poop are universal words too.

I really do wish I spoke a second language. I took Latin in high school. Everyone told me how helpful it would be in medicine. What a waste. Don't believe the hype, kids. Learn Spanish.

Another Manipulated Story

I'm listening to the radio this morning, and I hear, "A mother in Phoenix is charged with starving her children. They were on a vegan diet."

Then the news man decides to editorialize, "You know, vegan diets just aren't good for kids."

Ok, who made the news man a nutritional expert? Further, there obviously was something missing from the story. There's a very detailed piece from a Phoenix newspaper here. I'll give you the highlights.

Yes, the family was vegan, but....

- The parents were terrified of childhood obesity.
- They shunned doctors. Their children had never seen a doctor, nor did they have any immunizations.
- The children had epilepsy, and even with that disease the parents would not take the kids to a doctor. Instead, they relied on a homeopathic woman who prescribed herbs.
- One child died of untreated grand mal seizures.
- The family limited the amount of time the kids could eat.

Vegan diets are getting more press and more acceptance. It is still frustrating to see stories like this manipulated to make veganism look irresponsible.

Riblet and Stir Fry

I'm all about preparing what's easy for dinner, as opposed to looking for new and cool recipes. Maybe if I cooked for other people besides myself I'd feel more adventurous. This is something a little interesting, I suppose. There's a Gardenburger Riblet, which is full of protein, and baby broccoli and shitaake mushrooms stir fried in a little canola oil and Soy Vay.

Sprained!

I'm on the disabled list again...

On Sunday, I was playing dodgeball. After hurling the ball at the opposing team, I ran backwards, landed on the outside of my left ankle, and fell to the ground onto my right wrist.

I sat down and iced for a few minutes. Then, bored, I joined back in. It didn't hurt too bad.

Now my wrist and ankle are sore. I'm limping and it hurts even to write.

And I'm supposed to meet with my trainer tomorrow morning.

This better heal fast. I have an olympic distance tri in 4 weeks!

Camp Pendleton Sprint Triathlon

It was a different kind of triathlon -- the first one that I've done that was entirely on a military base. It was also the longest bike in a triathlon that I've ever done -- 30 kilometers or 18.6 miles.

I'm awful on the bike. If I was good enough that I could contend for a medal, then this was the wrong race. But this was my usual performance: do well on the swim, get passed by lots of people on the bike, and pass a few people on the run.

I don't have the official results until Wednesday. But I know that based on the distance of the bike and the huge number of people passing me, this was not a shining race for me.

My next goal is to become better on the bike. I'm going to have my bike fitted, just to make sure that any mechanical issues that are slowing me down are taken care of. In other words, that involves taking my bike to a shop and having it fine-tuned to fit me. I think I need to raise the seat a bit, but I'm not sure. My trainer says he's going to be working with me on a spinning bike too.

Next Triathlon: Camp Pendleton Sprint

My next triathlon is on Saturday.

With all that has passed in my life recently, my training has at times been less of a priority.

My last triathlon was over a month ago. Before that triathlon, I put in all the hours, got in all the workouts, yet didn't do as well as I wanted to. This time around, I've done a few things differently.

I have been working out with a personal trainer three times a week. We do strength training, endurance, stability, and plyometrics. They're tough workouts.

Another experiment: I've lost a few pounds. At my last tri, I was 165 lbs (I'm 5'10"), and now I'm 159 lbs; in other words, my body mass index has dropped from 23.6 to 22.8. Both are well within the range of healthy for my height. But, theoretically, less fat moves faster. My goal is a 17% body fat percentage; at last measurement I had 27% body fat.

I can't wait to see how it all plays out on Saturday at Camp Pendleton.

Going in Peace

I don't share deeply personal stories on this blog. But I want to share this one because of the impact that it has had on me, being the family member of an ill patient rather than the physician.


My grandmother was the healthiest 92 year-old woman I knew. An avid shopper, she walked on the treadmill for 30 minutes every day and went out to dinner with her friends on Saturday night. She lived independently in her own apartment. She looked in on her 88 year-old little sister who lived down the hallway. Until last Thursday.

She was leaving the dining hall when she fell. She hit her head. She was confused. She was emergently taken to the nearby hospital. The CT scan showed "a little bleeding", I was told. Keep in mind that I'm in Los Angeles and my grandmother is in Michigan. She's waking up, my mom says.

The next morning, I'm told she has bleeding in her brainstem, but "they're still not sure" what is going on. But my grandmother was awake and alert, though she had a lot of bruising from the fall. My brother, who also lives in LA, and I booked a flight to leave that night.

The next morning, my brother and I were at my grandmother's side. I could barely recognize her, with the right side of her face drooping and bruised. She opened her left eye when I spoke to her and held her hand; she said my name. Then she said my brother's name.

Shortly after that, she recognized none of us. It became apparent that she was fading. Several doctors came in, none offering much explanation of what had occurred. But their optimism was disturbing. A brainstem bleed in an elderly woman who was clearly getting worse was very very bad. One doctor talked of the possibility of doing an invasive procedure called a transesophageal echocardiogram. The neurologist, when I asked him point blank what my grandmother's prognosis was (I had a pretty good idea, but wanted to hear his thoughts) said, "We'll see in a couple days."

I didn't feel like the doctors were realistic with us. I didn't appreciate the euphemisms and false hope. I wanted them to be more honest about what her prognosis was and not overly optimistic in fear of shocking us.

Then she had periods of apnea -- in other words, she would not breathe for up to forty seconds at a time. The ICU nurse, who took wonderful care of my grandmother, came in and asked what we wanted to do, did we want to consider having my grandmother put on a breathing machine. No, my mother said, my grandmother would not want that, and at that time, with none of her physicians there, we decided to pursue comfort care only -- no more invasive tests, no blood draws, accepting that this is a terminal process.

There were some terrific nurses who cared for my grandmother. But other caregivers were less than great. I overheard that my grandmother's primary physician considered more than two milligrams to be "way too much" morphine. She was grimacing in pain and needed more medicine. A nurse elsewhere refused to increase a morphine drip, insisting wrongly that the hospice physician would not permit more medication.

It's hard sometimes to be a caring family member and a doctor at the same time. The hospice nurse said to me when I was discussing my grandmother's medical status, "Be her granddaughter." But I couldn't just stand by idly and watch -- there were times when my knowledge as a physician led me to speak up. I requested morphine before my grandmother was moved from one bed to another, to cover the pain that the move would involve. When she started to have rattling with her breathing, I requested a scopolamine patch. When her mouth was dry and crusted, I asked the nursing staff to please swab her mouth. Would those things have been done for her comfort if I wasn't standing by? I'm not so sure.

Was I, a cardiologist, intimidating? Did my brother, the attorney, compound that? Perhaps.

My grandmother died in peace early on Tuesday morning. She was comfortable. Of course I am sad, but I know that she didn't linger in pain. She passed away surrounded by those who loved her.

From this experience, I feel more like I can empathize with family members of ill patients. I want to continue to be honest -- at times, I've feared that I'm too honest or too blunt, but that's what my family wanted, not false hope. And I hope I can better think about the details that matter in keeping patients comfortable.

New Toys

I walk into Sports Authority to buy goggles. Fifteen minutes later, I walk out with all this:


A heart rate monitor (upon the recommendation of my new personal trainer), a kickboard, and a pull buoy (keeps your legs afloat while you stroke with your arms, the opposite of a kickboard). Oh yes, and the goggles. They're great. I can get out of the pool and not have big circles around my eyes for the next few hours. Nice soft gaskets.

Tri training is coming along. In anticipation of the olympic distance triathlon in September, I've ramped up my training a bit. I have a personal trainer who I meet with three days a week at 5:30 am. In addition to this, I'm trying to run 3 times, bike 2 times, and swim 2 times each week. Oh yeah, and did I mention I have a job?

Last week, though, I think I really pushed it. It was my first full week of the new personal trainer, who is pretty tough. Then on Saturday, I rode my bike for 27 miles up some seriously killer hills (the most I've been doing is 45-minute to 1 hour spin classes) and on Sunday morning I swam a mile at Manhattan Beach, which is the longest open water swim that I've done yet. When Sunday afternoon came around and I was going to do an easy, 60-minute run, I ran out of steam a little more than halfway through and had to bail. Today I feel better, though.

Mexican Lasagna

I stole this idea from Mary Ruth, my brother's fiancee. Layer tortillas with various toppings -- refried beans, corn, mushrooms, salsa, peppers -- anything! Then bake in the oven. Serve with salsa. My brother was convinced that you can't do this without cheese to help everything stick together, but the refried beans are sufficient to make it work.

Tri'ing in LA

This town is awesome for triathletes!!!

I joined the LA Tri Club. At 1,450 members, they are one of the nation's largest triathlon clubs. They have multiple workouts every day for all levels of triathletes. It's also a great way to meet people. The day after I landed in LA, before I had even moved into my apartment, I swam in the ocean with the group. This morning I biked with the "beginner" cycling group. We traveled 27 miles, up two huge hills, one of which was five miles long. My legs are hurting big time!

People here are more active than anywhere else I've lived. At the beach, it's not just loafing people eating hot dogs. Groups of cyclists gather for rides along the ocean. Runners are everywhere. And under a tree, you might see someone doing push-ups or sit-ups. It's inspiring.

My next race is August 9, an evening Playa Del Run -- 1 kilometer swim and 5k run. After that is the Camp Pendleton sprint triathlon on August 11. Then, I'm doing my FIRST OLYMPIC DISTANCE TRI -- the Los Angeles Triathlon, on September 9.

Today in Cardiology

My blog got a mention in this month's issue of Today in Cardiology!

And here's tonight's dinner: A Garden- burger Breaded Chik'n patty on whole wheat bread, with lettuce and organic Vegenaise (that's an eggless mayonaise -- no cholesterol!)

Cardiologists, any words of wisdom for a just-graduated cardiologist?

Aversion Therapy

I am terrified of open water swims. Especially those with lots of waves. Like the ocean. And, let's just say there's a lot of ocean here in Southern California.

Now, somehow swimming is my best of the three triathlon events (swim, bike, and run). But still I can't keep from panicking. This caused me some serious trouble in the Hyannis Sprint when my panic triggered an asthma attack.

What better way to get used to swimming in the ocean than by throwing myself into the midst of a race? One with big waves and lots of flailing limbs? There's a race series called the Playa Del Run which takes place on several Thursdays. You can swim the one kilometer and then run five kilometers, or you can just swim or just run. As I've never swam a kilometer in open water, let alone a raging ocean, I did only the swim portion.

I lined up with about 120 people to run into the ocean. Off we went with the gun. The waves were BIG!!! I saw people dive right in, under big waves -- which is what you're supposed to do. I still turn myself sideways and hope it doesn't knock me over. After some breaststroke, I start to ease into freestyle. But every time someone knocks me, I get annoyed, look up, and go back into breaststroke.

But, I didn't panic! I just let the crazy people go ahead, and once it was more clear, I eased back into freestyle. Once we were around the first buoy, people spread out, and there were few limbs to crash into. From what I'm told, it was a really choppy day, but I felt okay.

I came out of the water a little tired, though pleased with finishing that distance of a swim, and watched as people ran ahead of me to the transition area for the 5K run.

That day, I couldn't imagine doing a 5K after the swim. I do feel proud of myself that I could not only swim that distance in the open water, but that I was able to do it calmly. My time was okay too.

Next time, I'll swim AND run!!!

Unsettled

Technically, I'm homeless.

I moved out of my Boston apartment over a week ago. My belongings are in a Bekins truck driven by a guy named Buck from Buffalo.

It's been a relaxing week, seeing my parents in Michigan. Now I'm loafing around in California. I should be studying for my radiation and fluoroscopy license exam. But I'm not.

More posts and stuff when I am moved in.... and I can download pics from my camera.

Boot Camp

Just to mix things up a bit, and because I don't have another triathlon in the foreseeable future, I'm taking a few boot camp classes this week. This morning I ran 2.2 miles in 19:45 (9 minutes per mile, not too bad for me on a humid early morning), did 57 push-ups in 2 minutes, and 55 sit-ups in 2 minutes. I'd love to run faster, but I'm content with the others.

The class is 13 weeks long -- I would love to stay for the entire length of the class, since it seems like it's going to be pretty challenging. But, I will be moving to LA. I'm going to try to find something like that there. That would be fun.

Second Tri of the Season

This one was MUCH better than my first this season.

The swim was 0.5 miles on a nice calm inland lake called Lake Chargoggagogmanchaugagoggchaubunagungamaugg, which will herein be referred to as Lake Cha. The start was very crowded -- legs kicking everywhere. I tried to keep moving, but I really like my personal space so all these people kicking me and swimming into me was really ticking me off. My breathing was really off too, and I was starting to get that panicky feeling again. So, briefly, I did the breaststroke, let the crazy people ahead, and once it was less crowded and I had my space, I swam again. I felt better, got into my groove, and finished off the swim. Lake Cha was nice and peaceful, without big waves, which was nice.

When I swim, I've tried to breathe every three strokes like I do when I practice in the pool. But it never works out that way. So, instead, at the suggestion of our tri club run coach, I decided to go with what I felt natural doing -- breathing every two strokes. It worked out well.

The distance from the water to the transition area, where our bikes and other equipment are stored, was long. So, it was a very long-seeming barefoot run in a wetsuit to get my bike.

The bike started off well. People who break the rules annoy me. One person was riding in the middle of the road, very slowly. I suggested to him to get over to the right. Then some woman passed me on the right (which is a huge safety no-no -- when you pass, you pass riders on the left), and was about to try to zig-zag through three riders. So I rode up next to her and said, "If you pass, you need to do it on the left." I don't think she was thrilled to hear from me. And she passed me again. Two miles later, there she was cursing at the side of the road with her bike upside down trying to fix a tire. Karma's gonna bite you, right?

The course got TOUGH!!!! Around mile four, we approached a huge hill. I put my bike in low gear, stood up, and powered through it. Some people walked. Then at the top of the hill, phew, that was tough, and around the corner was ANOTHER HILL, which was similarly steep. And then ANOTHER!!! Whew were my legs tired! Following these hills came a long downhill, steep at times, and my speed got up to 35 mph, which on a bike is damn fast. I hit the brakes at one point, which was good as the pavement went very rapidly from smooth to treacherous and bumpy and flying off the bike at that speed could have been really really bad.

The rest of the bike ride was considerably less hilly. I took it easier, so that my legs wouldn't be worn out on the 3-mile run. My pace on the 12-mile bike was 15.5 miles per hour, nothing to write home about, but faster than I could have done last season on this type of course.

The run flew by. I didn't feel like I was flying, but it went fast. I was breathing hard, but comfortably, unlike the triathlon two weeks ago. I remember catching up to a woman, who looked like she was struggling, and of course I said, "Good job, keep it up." She said, "My legs are so heavy... they hurt!" I looked down at the back of her leg, where our ages are written -- hers is 53. "Look, my mother is younger than you, and I could never see her doing one of these in a million years, so you are awesome! Keep going!" I think that got a chuckle out of her.

So I finished strong. I don't know when my next race will be, but it will likely be four weeks from now, once my bike and belongings arrive safely in LA and I have a better idea what my schedule will be.

PETA's Letter to Michael Moore

Michael Moore's new movie Sicko, which exlores the many flaws of the American health care system is coming out soon. In honor of this, Ingrid Newkirk, president of PETA, took the opportunity to write a letter to Michael Moore. Included in the letter is the following:

...there’s an elephant in the room, and it is you. With all due respect, no one can help but notice that a weighty health issue is affecting you personally. We’d like to help you fix that. Going vegetarian is an easy and life-saving step that people of all economic backgrounds can take in order to become less reliant on the government’s shoddy healthcare system, and it’s something that you and all Americans can benefit from personally.

The letter goes on to make some great points about the health benefits of a vegetarian diet. But, calling Michael Moore an "elephant" and insulting his weight are completely inappropriate. People are sensitive about their weights. Further, this type of language is more likely to infuriate him rather than to convince him to give vegetarianism a chance.

A vegetarian diet is no guarantee that one will be thinner either. While some people have lost weight by going veg, I know plenty of overweight and obese vegetarians as well. And, while I wouldn't consider myself fat, I do have to work to keep the pounds from creeping on.

Would I call any of my patients an "elephant"? No way!

A better tactic would be to congratulate Michael Moore on his movie, and to suggest that vegetarianism is a way to prevent many of the illness that we see today, rather than insulting his weight.

Finding Time to Work Out

Here's how I get the training in. This year I've had one of the most unpredictable schedules. I've been on call literally every other day for the entire year. So, my schedule has had to be flexible for those days when I stay late at work to finish a case, or if I get called in off hours.

I've gotten accustomed to running with my pager, putting my pager on the side of my spinning bike and checking it every few minutes because I know I can't hear it with the booming music, and bringing my pager poolside in case it goes off while I swim.

But, I've managed to fit in triathlon training. In fact, ever since my third year of medical school, ten years ago, I've exercised at least three days a week. Right now in the midst of triathlon season, I average six days a week.

For example, here's what I did this week (and what I plan on doing for the rest of the week):
Monday -- 6:30 am -- Master Swim, 1 hour, 2000 meters
-- 6:00 pm -- Outdoor bike ride with women's group, 21 miles, 1.5 hours
Tuesday -- 6:30 pm -- Speed training run, about 4 miles total, three speed loops of about 0.4 miles each
Wednesday -- 6:30 am -- Master Swim, 1 hour, 2250 meters
Thursday -- 7:15 am -- Tempo run, 50 minutes, about 4.5 miles with 2.5 miles of fairly hard pace running on the Esplanade
-- 6:15 pm -- Spinning class, 45 minutes
Friday -- 6:00 am -- Weights with my personal trainer, 1 hour, followed by a short run if the mood strikes me
Saturday -- DAY OFF (it always feels weird not to work out)
Sunday -- TRIATHLON!!!!!!!!

ADDENDUM -- Even after writing this, I had to change it up. I spent a few hours at the hospital in the middle of the night on Thursday, so Friday became my DAY OFF and my personal trainer was kind enough to train me on Saturday.

Runner Safety

On Saturday night around 11:15 pm, a young woman was sexually assaulted while she was jogging along the Boston Esplanade.

What on earth is she doing running alone that late???

I run on the Esplanade at least three days a week. But I sure don't run there in the dark.

I've been harrassed while running. About nine years ago, I was running through a densely wooded park near my parents' home in the daylight, but completely alone. A man walked up to me. "Excuse me, can you tell me which way is Commerce Road?" I pointed him in the correct direction.

He then ran toward me. I turned around. He said, "You have great #$%@. Do you mind if I squeeze them?"

I was so scared, I turned around and sprinted out of there, out of the woods and a half mile home to my parents. Winded, in tears, I called the police.

From that time on, I've been more cautious. A hard way to learn a lesson, and I was lucky that I wasn't hurt.

Gift Dilemma

I'm looking to purchase a gift for someone, on behalf of not just me, but from a group of us. Someone close to the recipient came to me and said, "Get him one of these. He's been begging me to get him one."

The item that has been suggested to me is made of leather. I do not purchase or wear leather -- it is a cruel industry that is not just a byproduct of meat and its production destroys the environment. I shopped all over the internet and in Boston for a non-leather version, and was not successful.



The route of least resistance would be to just buy the leather item, which I found in a store in Downtown Boston. And, for a moment, I thought about just buying it and saving myself time and aggravation. In good conscience, though, I just can't do it. I have another gift idea that I think will work well, and I'm going to go with that.

To learn more about where leather comes from, click here.

The End of Training

This week, I'll be finishing up my interventinoal cardiology fellowship.

It's an exciting time. I'll be moving to Los Angeles and joining a group there. And finally, I'll be earning a salary that matches with the amount of years of education and training that I have.

Now, after seven years of training after graduating medical school, I'll be an interventional cardiology attending physician. I must admit, it's a little daunting to be on my own. No longer will I have my attending scrubbed at the table with me to ask, "What do you think of that lesion? Should we use this balloon?" and so forth. It'll just be me and a radiation tech. But, I think I'm ready for the challenge.

Leaving Boston will be bittersweet. I'll be leaving friends, mentors, and coworkers. Boston has been a really fun place to be. For those of you who know me in real life, you know that the decision to come to Boston was a challenging one, but if I had to do it over I wouldn't change it in a heartbeat.

So, on to a new city and a new stage of life.

Salad

I had this as part of my dinner last night -- organic lettuce, beets, cannelini beans, and artichoke hearts. It was easy to throw together and very filling.

The Results are In....

I was 39th out of 65 in my age group.... putting me at 60% from the top. Did I predict that or what (Look at the post below)?

Strangely, in spite of all my panicking, the swim was my strongest of the three, the bike was in the middle, and yes indeed, I tanked on the run. My pace was about a 9:56 mile, when I typically run 9:00 miles in a 5k or triathlon.

So, I plan to focus more on running. More speed workouts and more tempo workouts.

Choppy Water and Asthmatic Wheezing

It didn't feel like a good day for me.

The ocean swim was really choppy and the field of swimmers was crowded. Normally, I get into my groove about a third of the way through and I get comfortable swimming the course. Not this time. I was short of breath the whole time. Wheezing, no less.

It's a little known secret, and something that I like to deny to myself, but I have exercise-induced asthma. I like to think I've outgrown it. In fact, I haven't touched an albuterol inhaler in four years; I haven't needed it. Every so often during a race, particularly if pushing myself at the end, I'll feel it.

Back to the swim -- the waves of the ocean landed salt water in my mouth far too many times. I couldn't keep my head in the water long enough to swim freestyle for much of the swim. And I was panicking. Panicking and wheezing. It'll get better. Let's get past this buoy. Or I'll pass this group of people. And I'd try to pass the slow people in front of me, but then I'd get winded and panic more.

I was so relieved when the swim was over! Still wheezing, I walked fast to my bike and hopped on. Even on the bike, my breathing wasn't great. But I felt strong. I got to do something I'd never done before -- pass people on the bike course. Granted, some of those ridiculously souped-up bikes passed me, but in the past, the bike has been the slowest part for me. Thanks to 2-3 spinning classes per week throughout the winter and spring, I've gotten faster. I biked the course at 18.3 miles per hour -- last summer, I was lucky to pull 15 mph!!!

Then there was the run. And the wheezing came back in full force. I was breathing loudly... really loudly. I passed no one on the run. Everyone passed me. And several people who passed me tried to encourage me, like I was some kind of invalid -- come on, you've got it, keep going, and so forth. I felt so slow running -- maybe it's that I'm coming off an injury, or maybe because I finished the bike in a faster time, I ended up with faster runners. I'll be surprised if I was anything faster than a 10 minute mile.

So, lessons from this tri:
-- Keep doing spinning classes
-- Swim in open water so I don't freak out when it's race time
-- Do more brick workouts -- running after biking, as in an actual race.
-- Do more running speedwork.
-- Stash an albuterol inhaler with my stuff, just in case.

The results aren't out yet, but my guess is you'll find my name about 60% down the list of women in my age group.