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Friday, April 30, 2010

I Hate Exercise

This is exactly what one patient said to me this week.  He had exercised in the past, but it became such a chore that he absolutely abhorred it.

I probably have several other patients who clandestinely feel the same way.  Some grit their teeth, do everything they can to get out the door and do their walk, the same walk every day, because they know they need to do it for their health.  Others with those feelings may choose not to exercise at all.

I can understand that.  If I did the same workout every day, day in day out, month after month, I'd get bored.  I'd probably quit.

My mother gets on the treadmill for an hour five days a week.  She walks at 3.5 miles per hour, or a little faster, with maybe a 2% incline while watching TV.  That's her workout.  She rarely walks outdoors.  Somehow she sticks with it, but I think that after nearly two years it's getting a little monotonous for her.

I think exercise needs to be interesting in some way.  Whether it be choosing from a few different treadmill workouts, perhaps one with an incline or another with intervals, or doing different exercises, like golf one day, bicycling another, dancing the next, and so forth, mix it up!

That's what I love about triathlon.  There are three different sports to master -- swimming, bicycling, and running.  No two days in the row have the same exercise.

What I told my exercise loathing patient:  Just get up a couple times a day and go for a short walk, even if just for a few minutes -- it'll make you feel better.  I didn't use the word "exercise", because if I did he would likely tune me out completely.  And he even agreed, he could use the stress relief of a brief walk in the middle of the day.

Exercise needs not be a chore -- make it interesting and fun and it will be easier to keep the habit.

Sunday, April 25, 2010

Sugar and Cholesterol Levels

We know that our cholesterol levels are impacted adversely by consuming cholesterol, saturated fats, and trans fats.

An article from JAMA (Journal of the American Medical Association) on April 21 2010 finds that the higher the intake of added sugar, the lower the HDL "good" cholesterol, and the higher the LDL cholesterol and triglycerides.

It is likely that this is due to fructose, which leads to increased production of lipids by the liver and decreasing removal of lipids from the blood stream.

So, as part of a healthy diet, here is yet another reason to stay away from foods with added sugar.

Saturday, April 24, 2010

Found My Nemesis

It's a bike climb in Brentwood called "The Three Bitches".  Three successive hills.  Relatively short, but extremely steep.

On this morning's ride, a group of us split off to climb "The Three Bitches".  I climbed the first, standing on my bike the entire time, huffing and puffing.  At the top, I looked to my right to see an even steeper hill, the second of the three "Bitches".

I'm always up for a challenge.  However, I'm racing Wildflower Long Course next weekend and am supposed to be tapering, or cutting back on my exercise so that I am well-rested for the race.  Now is not the time to do insane things.

But, I do promise:  I will be back.  (as I say that, ironically, I do believe that the Guvernator, Arnold Schwarzneggar, did drive by us during our ride.  No joke.)

Sunday, April 18, 2010

Two Weeks to Wildflower

I am racing Wildflower Long Course again this year.  It is one of the toughest half-Ironman-distance races -- 1.2 mile swim, a very hilly 56 mile bike, and a similarly challenging 13.1 mile hilly run.
For the most part, my training has been going well. Today's workout was a 3000 yard swim in the pool, my longest swim workout yet, followed by a 5 mile run at just under a 9:00/mile pace. I did have a lousy workout yesterday -- I was supposed to ride for two hours and then run for 45 minutes. I was not in the mood to ride, though my legs felt okay. I just wasn't feeling it, and with the lack of mind to override the body, so to speak, I ended up with a side stitch and quit at an hour and twenty minutes of riding.

We all have good days, and we all have bad days. Yesterday was a lousy day, and today was pretty great.

I've been riding and running lots of hills lately.  I have found some killer hills in my new neighborhood -- for those of you familiar with the San Fernando Valley, I run a route that includes a nearly two mile climb from Ventura Boulevard due south to Mulholland.  It's tough, but it's helped make me a strong hill runner.  My bike rides have taken me up several of the canyons from PCH up through the Santa Monica Mountains.

Last year's Wildflower was a pretty good race for me. But this year I want to do better. Last year I finished in 7:11; this year I want to break seven hours. I am more experienced and I think I'm more fit.  Coach Jamie of Triathlon Training Series, my coach for over two years, who has really helped me to grow as an athlete, continues to put together my workouts.  There have been changes, though.  Since January, I have a new personal trainer who pushes me very hard. Also, I also think my nutrition is better, incorporating more protein and less sugar and processed foods.

I have two more weeks to train.  This week will be challenging, and the following week will be a taper so that I am well rested for the race.

Friday, April 16, 2010

Plavix Controversies

Several patients have had questions about Plavix (clopidogrel) lately.

Before you read on, if you are on Plavix, DO NOT STOP TAKING IT!  You are likely on it for good reason, and depending on your clinical situation, stopping it may be extremely dangerous.  Talk to your doctor if you have any concerns.

I am not going to get into the scientific nitty-gritty here, just simply an overview.

Combination with a proton pump inhibitor (PPI), such as omeprazole, Protonix, Nexium:
There has been concern that taking Plavix and a PPI together reduces the effectiveness of Plavix.  Small studies on healthy volunteers demonstrated decreased platelet inhibition when Plavix was taken with a PPI.  However, a larger randomized trial, the COGENT trial, which enrolled thousands of patients showed that outcomes were no worse when Plavix and a PPI were combined, and in fact the combination of the two medications reduced risk of gastrointestinal bleeding complications.
Bottom line:  If you are on both Plavix and a PPI, it is likely safe to continue to take both medications.

Resistance to Plavix:
Recently, the FDA published a warning that people with certain genetic mutations may have resistance to Plavix, and these patients tend to have worse outcomes.  This statement certainly sent a flurry of phone calls and questions to cardiologists nationwide.  The problem with this warning is that it is true that these patients do less well, but there is no evidence at this point of exactly what we should do for patients who are resistant to Plavix -- should they receive a double dose of Plavix, or be switched to a different medication such as Effient (prasugrel)?
Bottom line:  Don't stop your Plavix.  Talk to your doctor.

Saturday, April 03, 2010

So You Want to Tri?

I am really excited to hear that a few people close to me want to do their first triathlon.  As I love this sport, I encourage them wholeheartedly!!!

This is me finishing my first triathlon nearly five years ago, the Finger Lakes Triathlon, in September 2005.

I had a blast and after that race, I got hooked by the sport.

Why I still "Tri":  To stay healthy, feel good, stay in shape, handle the stress of life, and to set a good example for my patients.

Triathlon is a great sport to get into.  If you can swim, bike, and run, you can do a triathlon!  Pick a sprint (short) distance race, and start training!  Of course, see your doctor first to make sure that you are healthy enough to train.

If you are in Los Angeles, look into joining the LA Tri Club.  They have lots of great workouts for beginners all the way to seasoned athletes.  And, find a race to set as your goal -- I love the Hansen Dam Triathlon, which is a friendly sprint-distance triathlon in August, and you can read my race report from the 2008 race.