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.