Balancing Act

Being a cardiologist and a triathlete don't always go together so well.

My job is unpredictable, because my first priority is always an ill patient. When I'm on call, which is about every three days, I have to answer my pager when it rings. That means that my pager is in a plastic ziplock bag at the edge of a pool when I'm swimming laps. Or it's sitting on my shoulder while I'm in a spinning class because the music is so loud that I wouldn't hear it otherwise. Or, it's on my fuel belt, along with my cell phone, when I'm out for a long run.

On occasion, I actually have to rush to the hospital to take care of an acutely ill patient, and that can mean dropping a workout completely at the spur of a moment. If a patient is having an acute heart attack I need to be at the hospital within thirty minutes. I've adapted my workouts during times when that is an issue. I have a run that I call the "MI Shuffle" -- MI for myocardial infarction, or heart attack. I start the run at my apartment, and I run the 2 miles to my hospital and back. From any point on that run, I can either sprint to the hospital or back home to get my car to drive to the hospital. If I have a bike ride to do, then I ride laps around the local park, because from any point in the park I can ride to the hospital in a timely manner.

And then there's the issue of time. My average work week is about 60 hours, which for a physician isn't that horribly busy. I know busier doctors. And I do about 10 hours of training each week right now. I wake up every weekday between 4:15 and 5:15 am to get to the gym, the pool, or onto the streets for a run. Mornings are the most reliable part of the day with the fewest disruptions and hence the best time to work out.

Weekends aren't always open either. For triathletes, the long workouts are done on the weekends, and those are the core of training for those of us gearing up for a half ironman. But, I'm rounding at the hospital every third weekend, which can mean up to 16 hours of running around the hospital seeing up to thirty patients in a day. So, if I'm on call on the weekend, I'll move my weekend workouts to the middle of the week so that in case I get very busy I don't miss out on too much.

As I advance from base training and put in even more hours of training, it's going to be very interesting.

Base Training

I'm a few weeks into the base phase of Half Ironman training. I've also chosen my first triathlon of the season -- Wildflower Olympic distance on May 4. It's a challenging, hilly course. Further, it's known as the "Woodstock of Triathlons" since most people camp near the course the weekend of the event. Now, I've never been one to camp as I have a great appreciation for mattresses and indoor plumbing, but for a good event, I'll suck it up for one weekend and sleep in a tent.

I've started swimming again, and I think I'm going to join up with a master swim group soon.

And finally, because the bike is my achilles heel, I'm going to set up a private session with my coach to help out with my bike form. I know I'm very inefficient on my bike, and with fixing those problems, hopefully I'll move faster than my usual 14-15 mph on long rides.

Tomorrow I run hills. On Saturday I bike hills. My life is going to be full of hills for the next several weeks.

What have I gotten myself into?

I am now in the base training phase for the Vineman 70.3 half ironman in July. So far it's not so bad. As long as I'm not on call, I can reliably get in my workouts. It's a goal I'm excited about.

But, I'm not as excited about the Ironman that I signed up for in November. Why? The marathon was tough enough. Do I really want to run that far after swimming 2.4 miles and cycling 112 miles. Do I really want to cycle 112 miles? Right now, a 24 mile bike ride is a long ride to me.

And, do I want to be out in the sun exercising for what will likely be more than sixteen hours straight?

What about the training? Can I train for it AND do my job, AND have a life?

I signed up with a friend. If I decide not to do it, will I let her down?

I think I am going to focus on my next big race, Vineman 70.3. After that race, I'll see how I feel, if I really want to do the Ironman. Because, if my heart isn't into it, I won't do it.

Not Quite Common Sense

A conversation after I perform a coronary angiogram:

Me: You have a blockage in your artery.
Patient: So you put in a stent?
Me: No.
Patient: You didn't open the blockage?
Me: No. You will do better with medicine.
Patient: The blockage is still there?
Me: Yes. But it was a complicated blockage, and putting a stent in it just wouldn't be the right thing to do. Medication is a better way to treat this.
Patient: Medicine? For a blockage?

It seems intuitive -- Find blockage, open blockage, patient all better. It doesn't quite work that way. In fact, there's a trial published last year called the COURAGE trial that found that many patients with stable coronary disease do better with medicines than with angioplasty. There are definitely situations where angioplasty is the right thing to do, but there are others where medicines or surgery are better options.

Further, any time we place wires, balloons, and stents in a coronary artery, there is a risk. We could tear the artery. We could puncture a hole in the artery, causing blood to accumulate in the pericardium, the sac around the heart. And the dye that we use can cause injury to the kidneys. These are just some of the many possible life-threatening complications.

I'm sure there may be a few unscrupulous cardiologists out there who would be willing to put a stent in just about anything. The patient knows the blockage is open and does well, perhaps just as well as if no stent had been deployed, and yet an unnecessary risk has been taken.

Maybe it's a hard sell to say that there's a blockage and it's better not to open it. But, often it's the best thing to do.

Photo from www.endovasc.com

Pictures from The Marathon

Before the race, on Ventura Blvd.

Somewhere in the middle of the marathon, chugging along.

The last mile, downtown. In pain.

Crossing the finish line!!!

The cheezy finisher's photo.

More on The Marathon

Not everything goes as planned. I couldn't find my pace group, so I prepared to run alone, aiming for 11 minute miles with one minute walks through the water stations at each mile marker. I had my trusty Garmin GPS to pace me and measure my heart rate. I'm a scientist -- I like numbers.

I wanted to make sure I didn't start too fast, and I was partially successful at that. The first mile was all uphill and the next four were all downhill. It was tempting to run full gear down the hill, but I remembered the advice from Coach Mary: In the first few miles, two types of people will pass you: People who are faster than you, and people who will be walking at mile 22. Seven years ago, at my last marathon, I was the girl walking at mile 22, and I didn't want that to happen.

The first 10K split had me at 1:08:19, a 10:59 per mile pace. And I kept going, felt good, a little aching in my knees but otherwise fine. Half marathon (13.1) split was 2:26:44, 11:11 per mile pace, a little slower, but I felt good. I felt fabulous through mile 18 or 19, not too much aching, able to run more than the people around me who were too often slowing to a walk. My 30K split was 3:27:41, a 11:08 per mile average.

Hit the wall? Is there a wall? I don't see it.

And there it was at Mile 22. The bottoms of my feet ached, but mostly, I just felt tired out. There was a hill, and I took an extra minute and a half walk break to get up the hill rather than run it. And I started running again, slowly, like a 12 minute mile pace. I changed my rhythm to five minutes running, one minute walking. Those five minutes were the longest five minutes ever.

At mile 24, there was a photographer, and I was the only runner in his view. I put on my best smile to hide how miserable I felt. I wonder how that came out.

And then at mile 25, I found some steam. The end was in sight. In fifteen minutes, or sooner, I'd be done, so now was the time to give it everything. We headed through downtown, past mile 26, turned right on Flower Street, and through the finish.

My time: 4 hours, 57 minutes, 35 seconds. An average of 11:21 per mile.

I wanted to run faster, to finish in 4:45. But I'm still proud of myself. This was 18 minutes faster than my marathon seven years ago, and a more consistent running effort. To put it into perspective, my place was:

5,767 out of 17,011 finishers

1,390 out of 6,520 women

217 out of 778 women in my age group.

All in all, not too bad.

Photo courtesy of www.answers.com

4:57

Not as fast as I wanted, but my fastest marathon yet, and a fairly consistent pace. Hit the wall at mile 22.

Tlred, sore. More tomorrrow.