Another Trip to the Farmers Market

All of the above items were found at the farmers market in Sherman Oaks on my trip this evening. Clockwise from left: fresh pita bread, dark green lettuce, barbeque tofu, tempeh, and fermented shitaake mushrooms.

Vineman 70.3 Race Report

On Sunday, I raced Vineman 70.3 in Sonoma County, California. For those of you not in the know, that's a 1.2 mile swim, 56 mile bike, and 13.1 mile run.

I knew it could be a hot day, so I was prepared. I had done a few key runs and bike rides in the heat, intentionally, so that I would be acclimated to 90+ degree temperatures. And, I had been drinking Gatorade, about two liters, daily for the two days preceding the race.

I had a really good race. Though, with all my hydration, I had five port-o-potty stops. I suppose that being well hydrated beats the alternative in this weather.

With the weather projected to be hot, I was glad to be one of the earlier waves to start. The gun went off for our swim at 7:18 am. The Russian River is a shallow river and it is possible to stand up in waist-deep water at many parts. Though I got clobbered by aggressive swimmers a few times as usual, it went okay, and as expected, my swim was about the same as my pace last year.

I quickly pulled off my wet suit and grabbed my bike out of transition. There's a short, very steep hill, as we leave transition. Rather than grind up the hill on my bike and kill my legs at the beginning of a long ride, I ran up the hill with my bike, actually passing people riding up the hill, and then mounted the bike.

Being an early wave, I was getting passed not only by women in my age group, but also by the waves of men (and women) who started after me. It is a little demoralizing getting passed by so many people. Nonetheless, I kept a steady pace of 16.5 miles per hour on the rolling hills of the course.

Speaking of hydration, though, I was very well hydrated. So hydrated, in fact, that I stopped three times while on the 56 mile bike ride to use the restroom, or should I say port-o-potty. But it worked out well because I never seemed to encounter a wait, and while I was in the bathroom I managed to talk a volunteer each time into filling up my front water bottle with Gatorade. So by the time I did my business, I was tanked up with Gatorade and ready to go.

On the positive, toward the end of the ride I started passing some people. Maybe some of them started too fast. But, by the end of my bike ride, it was approaching noon and the temperature was well over 90 degrees.

My bike to run transition was pretty good -- 3 minutes and 16 seconds.

As I started the run, I definitely noticed the heat. By now it was approaching 95 degrees. I was still feeling okay. I remembered that the run was hilly, and with this heat I knew that I was going to have to be especially conservative.

While I was apprehensive about the run, I know my strengths: I can run hills, having practiced running them in my Hollywood Hills neighborhood for months, and I know I can run in hot weather. A lot of people were succumbing to the heat and a lot were walking. I was able to run the entire course, with the exception of two port-o-potty stops, and walking for a few seconds at each aid station. There, I'd slug down one cup of Gatorade, toss one cup of water over my head, grab a piece of fruit and keep on going.

The last three miles were especially tough, and I had a little bit of stomach upset, but nothing that slowed me to a halt. My previous ten minute per mile pace slowed to closer to 11 or 12 minutes per mile, but I was still running, which was better than many people around me. I think a lot during those last miles about why I push myself to do these things -- because I love the challenge, and quite simply, because I can.

My half marathon split was 2:19. Far from my best half marathon, but considering that I had just swam 1.2 miles and biked 56, and it was 95 degrees outside, I was very pleased.

My finishing time: six hours and 35 minutes. That's thirteen minutes faster than last year.

Wednesday Morning Ocean Swim

This is from my Wednesday morning workout at Ocean Park in Santa Monica, before coming to work.

Juicy Ladies

I've been driving by the Juicy Ladies storefront for months, eagerly awaiting a smoothie place with maybe a couple of healthy offerings.

I was pleasantly surprised when I finally came in -- they have a delicious salad bar, part of which is shown above, delicious sounding sandwiches, and absolutely amazing smoothies! And on top of that.... IT'S ALL VEGAN!!!!!!

I piled up a plate with their kale salad, sesame tofu sticks, beet salad, and couscous, and when I was done had a peachy keen shake, which was creamy and delicious, sweetened not with fruit juice but with agave and almond milk. An omnivorous friend joined me today, and he too had salads and the vanilla almond shake, which also was amazing.

I think I have a new favorite lunch stop!

Can You Trust Vegan Restaurants?

It's always a leap of faith dining at restaurants to trust that the food being served is vegan. In a vegan restaurant, I tend to trust that the servers and owners share my values and are serving me a vegan item.

This blog posting has made me think twice about being so trusting.

Seventeen vegan restaurant items were tested for egg, casein (a dairy derivative), and shellfish. Ten of the seventeen, including some of my favorite places like Real Food Daily, Vinh Loi Tofu, M Cafe de Chaya, and Vegan Glory, did well.

However, seven of the seventeen restaurants, most of them vegan Thai restaurants, had food that tested positive for non-vegan ingredients. For example, some of the vegan "cheeses" actually contained dairy ingredients, and many of the mock meats were found to have egg and shellfish in them.

My concern over this lack of honesty is not mostly for dietary purity. There are many people with shellfish and milk allergies, and they could easily consume a product that could harm them.

My take home message: When in doubt, order an item with tofu or seitan (see two posts below), instead of the "fake meat".

Hungry Duck 5K

I visited my family in Michigan this weekend. On a trip, might as well do a race, right?

I ran the Hungry Duck 5K in Brighton, Michigan. It was a nice, residential area course, with some hills, including a not-so-nicely positioned hill in the last half of a mile. Nonetheless, I had a great day -- I finished in 24:55, which is my best 5K time ever, which won me third place in my age group and this hat. The duck necklace next to it was a finisher's "medal". There was even a "duck" standing at the finish line high-fiving us as we crossed. Loved it!

I was even quoted in the local paper.

Otherwise, a relaxing weekend by the lake. Caught up on some of my cardiology journals. Refreshed and ready to go back to work tomorrow.

Could it be... Seitan?

Forgive the lame joke. If you watched Saturday Night Live in the early 90's you'll get the reference.This is Seitan, which is wheat gluten. Basically, it's the protein part of wheat. The texture is meaty and it's loaded with protein and very low in fat. I stir fried strips of seitan with broccoli in a little bit of oil, soy sauce, and sesame seeds.

Breath of Life Triathlon Race Report

I've come a long way from the days when I rode an oversized road bike, my transition bag was a Home Depot orange bucket, and I was happy with 11 minute/mile run splits.

I now have a beautiful Cervelo P2C triathlon bike that fits me, a real transition bag, and the ability to run six miles with sub-9-minute splits. I'm still no superstar, but I've come a long way.

Today's Breath of Life Triathlon is a race that I participated in last year, with a time of 3 hours and 9 minutes. My goal was to beat three hours.

This is an olympic distance race: 0.9 mile swim, 24.9 mile bike, 6.2 mile run.

The swim: Cold water, lots of seaweed. Did my usual hyperventilating in the first two minutes, got clocked in the head by another swimmer, found my groove and finished the swim portion in 29 minutes. That's four minutes faster than last year's split, and I have not been working that hard on my swimming. As it so happens, it was a low tide so the swim was shorter.

I ran up to the beach. In front of me were a cluster of men from the previous wave who were walking up to the beach. I dashed between them, running through sand, and in the midst of my dashing and rushing dropped my goggles and swim cap. Whoops!

Transition has gotten faster. Find bike, catch breath, pull off wetsuit, drop helmet and suglasses on ground, put Luna Bar in mouth, pick up sunglasses and put on face, put on helmet, put on bike shoes, double check to make sure I have everything with me, grab bike and run out of transition area.

The bike was nice and flat. With my new (since last season) Cervelo P2C bike, I move faster. I haven't been riding too much since I've been focusing on running. But, I think my average speed was about 17.5 mph, a good mile per hour faster than last year. I still get passed on the bike a lot, but that's ok because I'll pass several of those folks on the run. Not the most beautiful bike course, but mostly flat and fast. Other than losing my water botttle straw from the bottle at the front of the bike (dropping things seems to be a theme today), I felt good about the bike.

After riding into the transition area, I quickly racked the bike, threw on socks then shoes, grabbed 2 Gu gels, my Garmin GPS (to tell me my pace... yeah I'm a geek), visor, and ran out to the run course. The first mile was in 8:15, the second and third in about 8:45, the fourth and fifth more like 9:00-9:15, and the last mile in about 8:15 to finish strong. My calves cramped up and my stomach cramped, but I could keep up my pace. I loved the out-back-out-back run course with the chance to see and cheer on other friends and club members who were racing.

Finish time: 2 hours, 55 minutes, 4 seconds. Almost fifteen minutes faster than last year. Far from first place, but definitely not last place. For me, a good race.

Heart Rate Monitors

You don't need one. But, I've found that wearing one helps me to see just how hard I'm working when I'm training.

This is my heart rate monitor that I wear on my wrist:
from DicksSportingGoods.com

And this is the strap that is worn around the chest:
from www.smoothfitness.com

For an aerobic workout, to build fitness, you want to aim for 60 to 80% of your predicted maximal heart rate (PMHR). Your PMHR is approximately 220-age.

So, for a 50 year-old person, PMHR is 170 beats per minute. The target range for a workout should be 102-136 beats per minute. You can allow your heart rate to go higher, which would put you into the anaerobic phase, using more glycogen for fuel than fat.

Exercise

Exercise is such an important part of health of the mind and body. I mention exercise in just about every office visit. In fact, when I worked in Glendale with a predominantly Armenian patient population, most of whom didn't speak much English (or exercise), I learned the Armenian word for exercise, marzank, to help me get across how important exercise is.

Most guidelines suggest that we should get thirty minutes of exercise most days of the week. However, newer findings suggest that an hour a day is even better. In studies of people who have lost weight and kept it off, most of them exercise for at least an hour most days.

Exercise does not mean that you have to go to a gym. Do something that gets your heart rate up like going for a brisk walk, bicycling, or hiking. Find others, like a spouse or friends, to exercise with to make you more likely to do it.

"I'm too busy" isn't an option. Your body doesn't care that you're an important CEO who doesn't "have time". If I have to wake up at 4:30 am to get in my workout, that's what I do. Even President Obama works out every day, and he's the leader of the free world! If time is an issue, go for a brisk walk for 15 minutes after lunch, then another 15 minutes when you get home.

"But I'm active at my job, I walk all day" -- That's better than having a desk job, but walking at work is not exercise. Cardiovascular exercise involves doing something where you get your heart rate up over an extended period of time.

Now, lace up your shoes, and go for a walk!

Welcoming New Patients!

This ad recently appeared in the LA Times and Daily News.

Grain Meat

Soy is all too common a source of protein for vegetarians. So, when I saw this at the Locali store, I had to try it out:
In these Field Roast Smoked Tomato deli slices, the main ingredient is wheat gluten, not soy. Three slices have 110 calories, 13 grams of protein, and only 3 grams of fat, none of which is trans or saturated fat.
After my long Sunday morning run, I made an open-face sandwich with three slices of Field Roast deli slices, avocado, lettuce, and tomato slices. 280 calories and very filling!

Shojin -- Organic Macrobiotic Japanese Cuisine

I love trying new restaurants. While there are plenty of vegetarian restaurants in the Los Angeles area, other than Madeleine Bistro, there aren't many that offer fine dining.

Shojin was a new adventure for a friend and I this evening in Little Tokyo. The restaurant offers vegan, macrobiotic, organic Japanese cuisine. We ordered the special menu, a five course menu of pre-selected items. It came with ponzu seitan (pictured below), a tempura avocado hand roll with soy paper, sea vegetable salad, spaghetti with vegetables, and a fruit tart for dessert.

The food was absolutely delicious and healthy.

Click here to visit Shojin.

Hemp Milk

For a change of pace from my usual cereal and soy milk, I just tried hemp milk. One cup of unsweetened hemp milk has 70 calories, 4 grams of protein, and plenty of vitamins and nutrients. It's also a balanced source of omega-3 and omega-6 fatty acids. I purchased this from Whole Foods.

San Diego Rock' 'N' Roll Marathon

Today's San Diego Rock 'N' Roll Marathon was my fifth marathon, and now I can finally say that I've run a marathon like it's supposed to be run. In every marathon that I've done up to this point, I've started too fast and found myself miserable from mile 20 onward. Not today.

One key to my success today was that I rested this week. I learned from my Wildflower race a few weeks ago just how important it is to not overexert in the days before the race.

My friend Ray, an ultramarathoner, who was doing the marathon as a "training run", agreed to pace me to a 4:20 finish. That was my goal for the day. We started at a 10 minute mile pace. I stayed consistent at that pace for several miles. I felt great.

Around mile 19, I still felt good. I gradually picked up the pace. For miles 22-24, I was hitting a 9:30-9:40 pace. I was passing just about everyone; it felt great!!! At mile 25, Ray turns to me and says, "Here's where you're going to give it everything you've got." I picked up the pace to 8:30/mile, and for the last two tenths of a mile, I hauled it in to the finish line.
My finishing time: 4:18:32. A minute and a half faster than my goal. And, I did it in negative splits, meaning that the second half of the race was faster than the first. Overall, a great day!

Change

I spend a lot of time talking to my patients about lifestyle change. I truly believe that a patient is not treated by pills alone. If a person commits to a healthful lifestyle, he or she will live longer. And I believe that people can change.

But change does not come easy. It comes a few small steps at a time.

I don't expect a patient with out of control blood pressure and lipids, who does not exercise, and who eats no fruits or vegetables, to come back to me a month later having become a vegan who exercises five days a week and with normal blood pressure and cholesterol. If he or she returns to me a month later with an improved blood pressure, perhaps a pound or two lighter, and is now eating a salad every now and then and walking two days a week, I consider that success, and we can improve even further from there.

Diet change is especially tough. Someone who consumes a lot of meat and not many fruits and vegetables cannot overnight adopt a plant-based diet. A great way to start is to give up beef and aim for two vegetarian meals a week. Then give up dairy, and try new things like soy milk and rice milk and hemp milk. And then another change towards eating healthfully, and another....

I can recall a time back in college when a grilled cheese sandwich, a large order of fries, a 24-ounce Coke, and a large ice cream sundae was a normal dinner. At that time, I thought that by putting on my Rollerblades a couple of days a week for a few minutes to get to my classes that I was exercising enough. I was overweight and had so little energy. It took years and many small steps along the way to become a healthier person.

Small steps can be the key to long-term success. Celebrate small successes, and keep moving forward.
Image from www.35unger.com

"It's in my chart"

Be an active part of your health care. Know your medical history. Carry a list of your major health problems and medications and their doses with you at all times. Consider getting a medical alert bracelet.

Just because something is "in the chart" doesn't mean that I have it in my records, especially if I'm meeting you for the first time. I do not rely on "the chart" for what doses of medications you take -- you are the keeper of the pill bottles and you are the one who puts the pills in your mouth, so you are the one who knows exactly what and how much you take. Further, all of your records may not have come to me yet if I am meeting you for the first time.

And, finally, imagine this scenario: You end up sick in an emergency room where none of your doctors practice. Your medical information is absolutely crucial to your treatment in the next few minutes and hours.

My New Favorite Workout

Exercise is a habit. If we enjoy exercising, it's easier to stick with it.

My favorite workout right now is the Ocean Speed Circuit. At 6:30 am, nearly 100 people from my triathlon club gather in Santa Monica to swim in the ocean. We swim out to a buoy, swim back to land, run a few hundred feed on land from one cone to another, and then get back in the ocean and do it all over again.


It's a great workout -- getting into the ocean, diving under waves, and running on the sand definitely gets the heart rate up. Swimming in the ocean always reminds me that I'm from the Midwest -- I am not entirely confident swimming under and over waves, and with the quick entrances and exits from the water, my ocean swimming has improved.

And really, what better way to start the day than a dip in the ocean?

Here's what it looks like from a traffic helicopter.

Wildflower Triathlon Pictures

Getting out of the water after the swim


Climbing that first big hill out of the transition area



Cruising along on the course... with a smile

Running the course... trails and hills... very challenging

Dashing to the finish line

And the big finish!

Farmers Market

I love a trip to the farmers market. The produce is locally grown, less expensive than at the grocery stores, and absolutely delicious! On top of that, supporting your local farmers market is kinder to the environment, because your produce was transported from somewhere nearby, like San Luis Obispo, California, as opposed to, say, Chile.

This sandwich is created from my farmers market trip today. Fresh whole-wheat pita bread with avocado hummus, cucumber slices, and a chopped tomato. Don't mind the few bites taken of the sandwich -- it's the best way to show you what's inside. Paired with a salad and some strawberries also purchased at the market, a very filling lunch after my long run this morning.

Big Lunch Salad

This is my typical lunch: A big salad.

The base of the salad is dark lettuce with carrots. Sometimes I'll add some beets, celery, cucumbers, or sunflower seeds. I always include some form of protein, such as kidney beans, chik peas, lentils, or tofu. Here, I've added Follow Your Heart's Chicken Free Chicken. The salad is topped with two tablespoons of Follow Your Heart's Thousand Island dressing.

I pair the salad occasionally with a slice of bread or a side of pasta and always include fresh fruit for dessert.

Follow Your Heart is a favorite stop of mine. They are a vegetarian grocery store in Canoga Park, just a mile and a half from my office. In addition, there is a fantastic cafe in the back of the store with delicious healthy vegetarian items.

Follow Your Heart is located at 21825 Sherman Way in Canoga Park.

Pictures from Wildflower

This is me climbing the hill called Nasty Grade. I'm almost at the top.


On the run, near the end. Fighting a stomach cramp and finding some adrenaline knowing that the finish line is less than a mile away.

Wildflower Race Report

It' s been a crazy year in my athletic life. I started by DNF'ing a marathon, coming back two weeks later to race a marathon where I achieved a personal record, and then being derailed from racing by an arrhythmia known as supraventricular tachycardia.

Eight days after my arrhythmia ablation, I raced Wildflower Long Course, one of the world's toughest half ironman distance races. I am pleased to say I had a great time and a great day as an athlete.

Wildflower is the only reason that I own a tent. It is known as the Woodstock of Triathlons. The only feasible way to race is to camp there the night before, and then of course celebrate the night after with my team at the campground.

My goal time for the race was 7 hours and 15 minutes. I thought that was a pretty ambitious goal and wasn't sure I could make it.

We started with the swim, which I estimated would take me 43 minutes. After accidentally following a swimmer into an embankment, I straightened myself out and had a good consistent swim. There were a lot of us out there in the water and I managed to avoid being elbowed or kicked too much. I followed a sea of different colored caps. But, toward the end, as I was getting out of the water to run to the transition area, I suddenly noticed a sea of men in pink caps that I had not seen before! I thought I was in the wrong place, until I realized that they were all the frontrunners in the shorter mountain bike triathlon race that was taking place that day.

Time for swim portion: 44 minutes. Close to my goal.

I pulled off my wetsuit, put on my bike shoes, helmet, and sunglasses, and hopped on my bike. I heard several friends and club members cheer me on as I rode out of the park. One person who knew about my arrhythmia issues yelled, "Surgery one week ago, racing today, no big deal!" Well actually it wasn't a surgery, it was a percutaneous procedure through the vein in my leg... ummm never mind. It's the thought that counts.

I had a tough time on the bike course when I tried it out a month ago. My goal was to finish in 4 hours and 15 minutes, or maybe 4 hours if I was doing really well. Since then, I put a new rear cassette on my bike that would make hills easier. What a difference!! I glided up the hill known as Nasty Grade with more ease than last time, passing several riders. As it turned out, I finished the bike ride in 3 hours and 50 minutes, taking forty minutes off my previous time!

On to the run. This is my favorite of the three sports. I had hoped I could finish in 2 hours 24 minutes, an 11 min/mile pace. This run course is TOUGH!! It is really hilly and mostly on trails. I passed a lot of the athletes who had passed me on the bike. Many people were walking. Other than a few very brief steep portions, I ran the entire course, though at many points my run was more of an uphill shuffle. I ran past Blaine from NBC's The Biggest Loser, who was competing with his cousin and fellow Biggest Loser contestand Dane, and this time around no one drove them to the finish line.

I had a sudden stomach cramp at mile 12. It hurt so badly that I started walking, until a member from my club yelled behind me to stop walking and to run. So I picked up the run again, and before I knew it, I saw the finish line, and the adrenaline kicked in and I had no more side pain. I heard "Dr. Heather Shenkman is coming across the finish line!"

Finish time: 7 hours, 11 minutes. Four minutes faster than my goal.

My run time was 2:29, a little slower than my goal, but actually faster than a lot of athletes in my age group.

I have to say, I just had a great race. For the most part, I felt great, even to the end. I had fun and achieved my goal time.

Ironically, I think some of my success was due to the rest that I had to take because of my heart procedure. I came into the race feeling well rested, which I think really helped. That's a lesson that I will take with me to my upcoming races.

Ablated!

I had my SVT ablation today (for more on that, read the post below this).

It was a long procedure -- about three and a half hours, since I had an atypical electrical pathway. I now understand why adenosine is so uncomfortable and how isoproterenol makes the heart pound. I recall lying on the cath lab table, in a fog of versed and fentanyl (sedation medications), as my heart would intermittently pound. But in the end, it was a success.

The staff in the cath lab and the nurses on the floor were great.

I definitely have a new appreciation for what my patients go through.
Image from heartrhythmguide.com

Seeing the Other Side

As of late, I find myself in the role of the patient.

About six weeks ago, I noticed some short bursts of palpitations and lightheadedness. Then during a weight training workout, I felt my pulse racing for about a minute before it would stop. I had only four hours of sleep the night before, it was 5 am at the gym, and I figured it was just due to fatigue.

A week and a half later, it occurred again while lifting. I looked down at my Polar heart rate monitor -- 180 beats per minute. That can't be right. My first instinct was to keep on exercising and hope it would stop, but trying to do squats with a racing heart doesn't work so well. I tried carotid sinus massage, pressing on the neck to try to stop the racing heart rhythm. Then I laid down, and by bearing down I was able to break the endless loop, watching my heart rate monitor flash from 180 suddenly to 73 beats per minute.

Being a cardiologist, I knew that this was likely a supraventricular tachycardia -- in other words, an abnormal circuit in the heart that can cause the heart to race. I obtained a portable heart rate monitor that I could carry with me wherever I went -- on long runs and bike rides, or in my lab coat pocket. If the palpitations recurred, I could capture the electrical impulses so that the rhythm could be diagnosed and appropriately treated.



Two and a half weeks went by without any palpitations. I hoped that meant that I was cured, but that was quite unlikely. Then, after a challenging bike climb, it occurred again. I pulled out my trusty event monitor to record the rhythm and sent in the recording.

My suspicions were correct. I have supraventricular tachycardia, also known as SVT. And the episodes are becoming more frequent, and at times are lasting longer, up to 25 minutes at a time!

There are two ways to treat this. The first option is medication. That would decrease the frequency of the attacks. However, it would cause my heart to be slower all the time and would limit my capacity to swim, bike, or run, and in all likelihood would not cure me. The second option is an invasive procedure called an ablation, which involves feeding a catheter from the large vein in the upper leg up to the heart, localizing the abnormal rhythm, and burning through that abnormal electrical circuit. The cure rate with the latter option is 90-95%.

I'm opting for the latter, more invasive procedure. I need a cure. If I had SVT while running or bicycling, it would be disruptive, and I'd have to stop. Worse yet, if I had SVT while swimming in open water, that could be downright dangerous.

Until my ablation procedure is done, I cannot race. Which absolutely kills me, because I was looking forward to my first race of the season this weekend.

I am nervous -- even though the complication risk is very low, normally I'm the one performing the procedure, and now I will be the patient on the table. I think this will give me a different appreciation for my patients' experiences.
Image from http://kirstyne.files.wordpress.com

More Passover Dishes

The recipe is called Mrs. Feinberg's Kugel. I have no idea who Mrs. Feinberg is, but her kugel is fabulous! The recipe includes 1 cup grated apple, 1 cup grated sweet potato, and 1 cup of grated carrots, and one cup of matzah meal. Then add 1 tsp salt, 1 tsp cinnamon, 1 tsp of baking soda. The recipe also calls for 1/2 cup of margarine -- I only used 1/4 cup, but probably could have gotten away with even less than that. There is also an optional addition of nutmeg and sugar, but honestly, the dish is sweet enough that it doesn't need added sugar. Bake for 45 minutes at 325 degrees.

Mushroom and potato casserole. Boil redskin potatoes, mash, and put them at the bottom of the dish. Then saute sliced mushrooms and onion, just until the mushrooms give up their juice. Pour the mushroom and onion mixture on top of the potato layer. Top with almond slivers and raisins. The dish calls for 2 tablespoons of margarine, which I omitted.

Matza Farfel Pasta

Tonight is the first night of Passover. Passover is a Jewish holiday on which we do not eat leavened bread, nor do we eat items that may resemble leavened bread. This includes soy, lentils, and peanuts, all of which are normally staples of my diet as a vegan.

I enjoy the holiday because it challenges me to prepare food that I would not normally make.
This is whole wheat matzah farfel with baby bella mushrooms, pasta sauce, and carrots. I sauteed the sliced mushrooms in 1/2 cup of pasta sauce, then added sliced carrots, and last 1/2 cup of matzah farfel. 320 calories.

Triathlon and Risk of Sudden Death

Research presented at the American College of Cardiology 2009 Scientific Sessions demonstrates that the risk of sudden death is higher during a triathlon than during a marathon. Most deaths occur during the swim portion of the race and the average age of those who died was 42 years old.

I think that the take-home message here is that athletes, particularly those who do not compete regularly in races or those who have cardiovascular risk factors, should be screened by their physicians before racing.

They're Not Mashed Potatoes....

but they're healthier and still really tasty!
I made mashed cauliflower. I boiled 12 oz of cauliflower for about 20 minutes, poured it through a drainer, and then mashed it. I added just one teaspoon of Earth Balance margarine, salt, and pepper.

Peanut Butter Cup Smoothie

1 banana, 1 cup soy milk, 1 tablespoon peanut butter, and 1/2 scoop of vanilla soy protein powder. It's 17 ounces of smoothie, 370 calories, 11 grams of fat, 20 grams of protein. For a thicker shake, try using half a cup of soy milk. For a lower calorie shake, cut everything in half.

Destination: Wildflower Long Course

My next big race is the Wildflower Long Course Triathlon on May 2, 2009. It is known as the second toughest half-Ironman distance course in North America. This will be my toughest race yet.

Last weekend, I went up to Lake San Antonio for a long weekend training camp. We swam, biked, and ran on the terrain that we will be racing on. The training was great, but it was a huge wake-up call to me that I need to improve my cycling skills.

This would be me riding the 56-mile hilly course. I'm smiling because I know I'm almost done. Whew!






















The 56-mile bike course has lots of rolling hills at the beginning, then levels off for several miles. Around mile 43, there's a hill called "Nasty Grade". It can best be compared to "Heartbreak Hill" in the Boston Marathon -- when you're done with much of the course and a bit tired out, up ahead is a long hill to conquer. Nasty Grade is several miles of climbing. It levels off and you think you're done, but then there's more climbing to do. At the top, some joker spraypainted on the road, "What hill?". I laughed so hard when I saw that, after sweating through that long climb.

Swimming is.... swimming. I don't really love to swim. I am tall and have broad shoulders, so I'm not too terrible. My attitude, or perhaps attitude problem, toward swimming in triathlons is that it's so low yield -- even with tons of practice, a swimmer will only shave a minute or two off her race time. However, with running and cycling, many minutes can be saved. I attend an hourlong coached swim session once a week, but soon I'll be doing an open water swim also.

Running.... I love to run. I could run all day. Like Forest Gump. Except I like my music and can't live without my Garmin 305 GPS to tell me how far and how fast I am running.

The next few weeks will be some tough training.

The Art of the Tofu Scramble

Craving scrambled eggs? Try this healthy alternative:

Saute chopped onions in a frying pan with a little bit of water or Bragg's liquid amino acids (but go easy if you're watching your salt consumption!). No need for oil or margarine. Then add garlic.

Then add mashed or cubed extra-firm tofu. Mix in the vegetables of your choice -- I like spinach, peas, carrots, or sweet potatoes.

Add some spices for flavor -- I like coriander. oregano, black pepper, turmeric, and chili powder.

Saute for another 5-6 minutes and enjoy!

Heart Healthy Guide

For a long time, I've wanted a good, concise sheet to give to patients on lifestyle and heart disease. I haven't found any publication that is concise and hits upon all of the main points of diet, exercise, weight loss, and smoking cessation.

I put this together on my own. Read it and feel free to share your thoughts.

Exercise and Mood

I know that exercise improves my overall well-being.

Running helps me problem solve. It also boosts my mood when I'm feeling less than chipper.

Swimming, though it's not my favorite, destresses me. Perhaps it's the calming effect of the water, but when I get in the pool, I feel like the weight of my life is lifted from me.

Biking gives me a sense of accomplishment. With what other sport can you tell people, "I did 50 miles today"?

Yet another reason why exercise and triathlon are such a big part of my life.

Injury

If I've learned anything in my 30's as an athlete, it is to take injuries seriously. If you push through an injury now, it'll only make the recovery and time off from running longer.

A couple of weeks ago at my track workout, I tripped on a shoelace and fell flat on my face. I brushed myself off, tried not to look completely embarrassed, and kept running. My hands were a bit raw from scraping the track, but otherwise I felt great.

When I got home, my left adductor thigh muscles were sore. I iced them, and the soreness went away.

Four days later, I ran my marathon. Around mile six, I started feeling that soreness again. It was a mild nagging pain that went away by mile 10, and caused me no trouble thereafter.

Then, with each successive run, it's nagging me even more. I ran 8 miles on Sunday with it sore most of the run, then took three days off and on Wednesday it was back again with a vengeance.

Now I am taking a week off. I'll be doing lots of biking and swimming, and maybe a couple of power hill walks (though I'll be tempted to run... but I won't). I'll also be icing twice a day and taking my ibuprofen.

Image from marathonracerunning.com

Comeback Marathon

It probably wasn't the most sane idea to sign up to run another marathon two weeks after dropping out of a marathon. But, I wanted to see how my training would stack up and I hoped my nerves wouldn't get the best of me.

I ran the IMS Arizona Marathon this weekend. This time I finished, though I still landed at the port-o-potties three times and had stomach cramps that caused me to walk intermittently, especially at the end.

It was a somewhat tough, point-to-point, mostly uphill course with a net elevation gain of just under 400 feet. And it was the smallest race that I've ever run, with only 99 marathon finishers.

I am so grateful for my friend who ran with me. He hadn't run in over a month, yet braved the race with me. For the 15 miles that we ran together, he kept me entertained and motivated, though I wasn't the greatest most friendly running partner that day.

My time was 4:34:09. That's third place in my age group (out of five -- yes that's intentionally in small print). That's a personal record by over 23 minutes. Minus the gastrointestinal issues, I could have easily taken ten minutes off that time.

Now I just need to figure out what to eat and what not to eat. Pre-race dinner was pasta with marinara and some faux burger crumbles. Perhaps it was the soy? Or maybe I'll just pop some Immodium before my longer runs??

Losing Weight

Obesity contributes greatly to heart disease. When people don't exercise and carry too much weight, they put themselves at risk of diabetes, high blood pressure, and elevated cholesterol.

I tell a lot of people to lose weight in order to reduce their risk. Here are some weight loss tips that I've seen work:

- Use a nutritionist. That's someone who can tell you exactly how many calories your body needs and what foods you should and should not be eating with any particular medical problem.

- Write down everything you eat and the approximate number of calories. Share that diet diary with someone, such as a nutritionist, your doctor, or a personal trainer. It keeps you accountable. If you have to write down that handful of M&M's that you're thinking of eating, are you really going to eat them?

- Weigh yourself daily. That way you see trends of weight gain before your weight gets out of control.

- Follow a vegan diet, or at the very least, cut back on the quantity of animal products that you consume. Vegan diets have been shown to aid in weight loss, help control blood sugar in diabetics, and lower cholesterol.

- Do some form of exercise most days of the week. Long-term registries of people who have lost weight and kept it off for several years show that the vast majority of successful "losers" excercise almost every day.

- Remember that weight loss and weight maintenance is about lifestyle change. These are not changes that you are to make for a couple of weeks and then revert to previous poor habits.

Getting Ready for a Comeback

It's been a tough week emotionally. I keep thinking back to my marathon mishap from last Sunday, and I think it all comes down to my chronic stomach issues.

I do fine on any workout under two hours. However, anything longer than that, and I've had stomach issues. First I chalked it up to the protein in the Clif Bars that I would consume during a race. Then, one particularly bad day occurred the day after chewing four pieces of sugarless gum (sorbitol increases intestinal motility). I think I just have a sensitive stomach and need to stick to basic pasta and marinara the night before a long workout.

I felt sick all day on Sunday and much of Monday. But, I forced myself to drink water and juice to rehydrate. And, I wasn't sore, at all! I think that's because while I dropped out around mile 21, I had been essentially walking from mile 15. On Tuesday, I did a relatively easy workout at the gym, and on Wednesday I was back to my usual workout with my personal trainer in the morning and a track workout in the evening.

Since I can't have a DNF hanging over my head, I've decided to race the Arizona Marathon on Sunday, February 15. My coach had me ramp up this week, run 9 miles today, and then next week I'll taper my exercise in preparation for the marathon.

Having to drop out of the marathon last weekend was a tough blow, but I'm learning from the experience and moving on.

DNF

DNF stands for "Did Not Finish". Today is my first DNF, at the Surf City Marathon. Marathoners like Paula Radcliffe and Deena Kastor, and triathletes Chris "Macca"McCormack and Norman Stadtler have DNF'ed at big races. So I suppose that middle-of-the-pack athlete me can have a bad day too.

I've done marathons and half-ironman distance races. I trained harder for this marathon than for any other marathon that I've done. I did a 22-miler with solid 10-minute splits. I ran an 18-miler in negative splits just three weeks ago. And, two weeks ago, I finished a half marathon in 2:03. I was hoping to not only do well, but to have a personal record by several minutes. So what happened today? I'm not sure.

Dinner last night was at a Mexican restaurant, with pinto beans, rice, and some veggies and fried bananas. It wasn't anything too unusual, other than that I probably ate more than I usually do. But my stomach was fine in the morning. My pre-race fuel was my usual raisin bran with soy milk, yogurt, and a piece of fruit. I felt strong at the start. My strategy was 9:45/mile splits. I was hitting those consistently, maybe a little faster on a couple miles with a downhill. I was fueling with Gu, and with the Sharkies on the course which I specifically tried out on my own last weekend because I knew they'd be at the race and wanted to make sure I'd digest them okay. And I felt great -- that is, until about mile 13, when I slowed down a bit. I had a little bit of stomach cramping. Maybe I was dehydrated, I thought, so at the mile 14 water station, I walked through, drinking a cup of electrolyte drink plus two cups of water. I felt better for a little bit.

Then came worse stomach cramping and the urgent need to stop at a port-o-potty. And again, I felt a little better after that. I passed another water stop, but took nothing because I just felt I couldn't keep it down. At the next water stop I grabbed a Larabar, which I knew from past experience that I could digest while working out. But again the Larabar sat in my stomach like a rock. I had to walk a lot because running would induce cramping. Then I became lightheaded. I walked through several water stops without taking any drink or food because I couldn't keep them down. I passed the first aid tent at mile 18, thinking about stopping, but still, I wanted to see if I could feel better. I knew my goal time of 4:15 was in the toilet, but maybe 4:30? 4:40?

No such luck. I just felt worse and worse. A lot of people that I knew passed me, asked if I was okay. I appreciated their enthusiasm, but I was so embarrassed. Here I am, having trained so hard for this race, and I'm walking the last half of a marathon.

By mile 19, I resigned myself to the fact that I would not be finishing. Running just wasn't a possibility at this point, because I was even more lightheaded. I hadn't had any fluid since mile 14, which was well over an hour ago and I had no way of keeping any fluid or nutrition down. I had yet another emergent port-o-potty stop at mile 20. I couldn't feel my radial pulse, which is an indication of hypotension or low blood pressure. And finally I saw the first aid tent at mile 21.

I stumbled over and as tears streamed down my face, I stammered out.... "lightheaded.... cramps...." Next thing I knew I was lying down in the first aid tent, in tears, covered in blankets. I'm not one to cry at the drop of a hat, but I felt sick, but worse yet I was ashamed of myself having worked so hard for months for this marathon to land on a cot in a first aid tent. There, I was able to sip a bit of water, about an ounce, but not more than that. After resting for what felt like an eternity, shivering under countless blankets, I could sit up and not feel like I was going to fall over. I rode back to the start in the "sag wagon". I could have stopped at the first aid tent to get some IV fluids, but I didn't want to be in the happy race environment any more, so again stopping at a port-o-potty twice on the way, I stumbled to my car and drove home.

On the way home, I was able to keep a fruit smoothie down, though that wasn't pleasant. I weighed myself at home and found that I'm six pounds less than when I started this morning -- clearly dehydrated. And even now, hours later, I'm not feeling that great, though I'm sitting here sipping orange juice and oatmeal.

I'm mad, but it happens. Now, I need to move on. I want to prove I can run a marathon in 4:15-4:20. Based on my previous times I can do it. I'm going to find a marathon in the next couple of months and I will do it.

The Perfect Banana Mango Smoothie

I had an awesome banana mango smoothie at a restaurant recently, and asked for the secret to how it was made. They said that the secret was frozen bananas, a little orange juice, and a little soy milk.

Here's what I came up with: 1/2 cup frozen banana, softened in the microwave, 1/2 cup frozen mango, 2 oz soy milk and 2 oz orange juice. Throw it all in the blender, and yum! 160 calories.

Rock N Roll Half Marathon

I've been working hard with my running and nutrition, and it's definitely paying off.

I traveled to Arizona this weekend for PF Chang's Rock N Roll Half Marathon. My goal was to finish in under two hours. After all, I ran the City of Angels Half Marathon in 2:06:42, and a few weeks ago, I did an 11-mile run at a 9:30 per mile pace.

Then again, things don't always go perfectly as planned on race day.

I was wearing a race bib on my back with "2:00" on it. I planned to run with the 2-hour pace group. Unfortunately, we couldn't find the start, and when we finally found it, there were just thousands upon thousands of people there. I got into the start corral, but could get nowhere near the 2-hour pace group. However, I could see their wooden stick with "2:00" on it and planned to keep it in sight and catch up in a couple of miles.

Finally, our corral is allowed through the start line. It's a mass of people, and fortunately, I was in a corral with people who run about my pace, so I didn't have to dodge around walkers or get knocked over by misplaced Kenyans aiming for a world record.

The first mile went well. I knew I had to keep a 9:10 per mile pace to finish in under 2 hours. The second went well. Right on pace. The bands were entertaining, and every so often there was a crowd cheering us on. Then during the third mile, I felt something under my feet, particularly my left foot. It was annoying, kind of burning, like a part of my sock that was bunched up. I ran through the pain. But it got worse. I gritted my teeth and kept on running.

Finally, at mile seven, I thought to myself, I need to do something about this sock! I stopped at the side of the road, pulled off my shoe, and to my dismay, my sock was perfectly stretched out over my foot. I stretched out my toes and discovered the issue: My plantar fasciitis was acting up at an inopportune moment. Was it the relatively new shoes? I had worn them for three runs, though they were all relatively short. Or could it be my forgetting to take my usual ibuprofen in the chaos of race morning?

I quickly laced up my shoe, stood up, muttered under my breath, "Go girl go!" and took off. The pain got worse as I went, and by mile eight I could feel absolute agony in the bottom of both feet. I found that by flexing my toes with each step that the pain would subside slightly.

Unfortunately, the discomfort of my feet slowed my pace to 9:30-9:40 per mile. By now I lost sight of the pink "2:00" sign. I pushed on, occasionally gritting my teeth. If this happened on marathon day (which is in two weeks), I'd have to drop out. But this is only a half marathon. And I have to push on.

Adding to the annoyance of the pain in my feet, I had the "2:00" bib on my back. Random people would ask me if I was the pace group leader (obviously not!) and if I was on pace. Finally, one girl at mile 11 inquired, and I knew that 2 hours was a lost cause. As she ran by me, I reached to my back, pulled off the safety pins, and at the next water stop wadded up the pink "2:00" bib and threw it in the trash.

This is one of those races that just wasn't fun for me because of the pain. I had to keep reminding myself, only three more miles, only two miles, only 2 kilometers, only a quarter of a mile, and so forth. As some put it, it's one of those races where we "dig deep", to find the emotional energy to just get through. I remind myself of the things I've accomplished -- and know that if I could get through those things, I can sure trudge through one more painful mile of a race.

My finishing time was 2:03:24. I didn't meet my goal, but it's a personal record for me for a half marathon. And I'm still proud of that performance, knowing that under better conditions, I can go even faster.

Crock Pot Magic

I have a new toy: a Crock Pot.

They're amazing! Basically, you add a bunch of ingredients, turn it on, go to work, and magically hours later you have a healthy, tasty meal!

I made chili by mixing tomato sauce, black beans, chick peas, and vegan burger crumbles, and setting the Crock Pot at low for eight hours. Another day, I added some frozen vegetables to a bottle of pasta sauce and cooked for four hours. The veggies added great flavor to the sauce.

This is my most recent creation. Two cans of chick peas, one pound of baby carrots, onion, veggie broth, salt, pepper, thyme, rosemary, and oregano, mixed up in the crock pot, cooked on low for seven hours. Then the mixture was poured into the food processor and voila! A healthy side dish with veggies (carrot) and protein (chick peas).

Bike Ride Calamity

Today I have decided that I need a RoadID for my bike shoes. Here is why.

My tri club had a New Years Day fun ride today. About twenty or so riders met up, including a woman who had just moved to the area and was new to the club. I introduced myself, welcomed her to the club, and we chatted for a few minutes before we headed out onto the ride.

She was about 50 feet ahead of me. About a half a mile into the ride, I saw her fly over her handlebars, flip in the air, and hit her head on the ground.

I dropped my bike and ran toward her. She was unconscious, and gasping for air. I prevented anyone from moving her, checked to make sure she had a pulse, and then very gently lifted her jaw to open her airway. There was another physician riding separately who also stopped to help. Another rider called 911.

While she lay unconscious, other people in our group searched her bike for some identification, as we had all just met her for the first time today and all we knew was her first name. Unfortunately, we could not find any ID.

It seemed like a long span of 2 or 3 minutes before she opened her eyes, and even then, all she could tell us was her name. Shortly after, she could tell us her parents' phone number, and we contacted them. The paramedics arrived and took her to the County Hospital.

She was pretty banged up, with some scrapes and bruising to her face, left shoulder and elbow. Fortunately, she was wearing a helmet -- I believe it is our club's policy that to come on a club ride that you need a helmet, but I see so many people riding without one -- and she sustained only a minor concussion. She does not remember the accident.

The lessons I've learned today are:
Carry ID when you ride.
Always wear a helmet when riding.

Image from torontoist.com

Time really flies!

I have no idea where the month of December went. But I certainly didn't spend much of it blogging!

The holidays are of course a busy time. For me, they are also a big time of transition since I will be joining a new cardiology practice in January. It's a good decision for what I want in my career, but I will miss my patients and the staff at my hospital and my office. I have posted my new office phone number in the right hand column.

I am still running and doing my best to eat healthfully at this time of the year when yummy high-calorie treats abound. This month, I ran my fastest half marathon ever in 2:06:41 and my fastest 5K ever in 25:51. To get to my goal of running faster and qualifying for the 2010 Boston Marathon, I'm running about 35-40 miles per week. That means some very early mornings sometimes -- as early as 4:30 am. To motivate myself, I think forward -- all this hard work will be well worth it when I achieve my goal of running Boston.

Have a great holiday season, and more sometime soon....

Chicken Free Chicken Stir Fry

This is tonight's stir fry: Follow Your Heart's Chicken-Free Chicken with Annie Chun's Chinese Stir Fry sauce and a bunch of frozen veggies -- carrots, okra, spinach, broccoli, and cauliflower.

I recently discovered Chicken-Free Chicken. It has great flavor and texture, has 80 calories, 2 grams of fat, and 11 grams of protein for a two-ounce serving. It is made by Follow Your Heart and is sold at their store in Canoga Park, but can also be purchased at Whole Foods Market.

Buy These Shoes!

Choosing leather-free shoes is an ethical choice for both the environment and for animals.

Do-Ni footwear is not only beautiful and vegan, but they donate all of their profits to non-profit organizations.

I just bought a pair of their shoes online and can't wait to try them out.

Smoothies

In my quest to eat better, I've discovered smoothies.

Since moving to LA, I've loved Jamba Juice smoothies. My favorite is the Mega Mango. I always felt somehow guilty, that they taste so good, and even if there is fruit in them, it can't be good for me! Surprisingly, the 16-ounce all-fruit and juice smoothies at Jamba Juice are 220 calories. And, if you add a scoop of vegan soy protein powder, it brings the grand total to 250 calories! Not bad?

I've started making my own smoothies at home. My recipe is 4 oz soy milk, 3 oz siklen tofu, 1 cup of berries or mangoes or any other fruit, and 1 tablespoon of crushed flax seeds which are full of omega-3's. I use frozen fruit for the smoothies, and put it in the microwave for about 45 seconds. Then I pour all the ingredients into my blender and set to "Puree". The total calorie count on this creation is 200 calories, and provides me lots of energy for an early morning run.

In my three weeks of eating better, I've lost 6 pounds. This puts me at a healthy body mass index of 22.4. My running has also gotten faster. I would have never thought I could run 6 miles in under an hour, let alon the 56:14 time that I posted on the treadmill on Thursday.

One Week of Eating Healthier

This is tonight's dinner: Two vegan chicken cutlets, brown rice, spinach sauteed with cannelini beans (and no oil... who needs oil when you have good spices?), and some sweet potato.

Working with a nutritionist has been an eye-opening experience. I've been on this meal plan for one week. I have eaten more veggies, more protein, less carbs, learned to not eat and eat and eat when sitting at home at night, and to just walk away from a tub of Laffy Taffy, one of my favorite candies in this whole world.

I've learned that I need to eat frequent meals, but not TOO frequent. My habit is to eat, and then nosh something an hour later, then something a half hour later... I need to limit my eating to about six times a day.

After one week, I have lost two pounds.

More meals to come....

Diet Overhaul

I'm in the best shape of my life and the slimmest I've been as an adult. I'd consider myself a healthy weight.

But, my diet hasn't been great. I've just about given up cooking, so I've relied a lot on processed foods to microwave, along with the occasional big bowl of cereal for dinner with a pound of frozen mango.

To achieve my big goal of qualifying for the Boston Marathon, I not only need to fuel myself better, but need to slim down a bit to run faster. I don't need to lose a lot of weight, perhaps ten pounds. I would still be within a normal weight range for my height, just as I am now.

I have consulted with a nutritionist. She is the wife of a physician that I work with, is a PA and also has several fitness certifications, so she knows what she's talking about. Also, from talking to her previously, I knew that she would not be critical of a vegan diet.

I met with her, bringing along my food diary. She cringed at my "4 oz of coke", "6 french fries", "gyoza dumplings", "bag of mangoes", the high amount of carbs that I consume, and the lack of vegetables. She came up with a food plan that is higher in protein and lower in carbs.

Two days into the new eating plan, and things are going well. Here is tonight's dinner: 1 cup of whole-wheat pasta, 1/4 cup marinara sauce, and a tofu scramble with 4 oz tofu, 1 cup of carrots, and 1 cup of spinach, sauteed in olive oil, garlic, salt, pepper, and turmeric.


What surprises me is that I'm not ridiculously hungry! During the day, I feel more full than I used to before this eating plan.

So far, I feel great, and I hope this eating plan helps get me to my goals.

Racing for Something More Important

Most races have some sort of cause that it benefits, and often I don't think much about that when I race.

Today's Eco-Fest 5K Run had a more important meaning.

Lawrence Fong is the LA Tri Club's membership director. Not only that, but he's a great friend and athlete, and one of the first friendly faces I encountered as a newcomer to Los Angeles and to the LA Tri Club.

On Wednesday evening, he had a brain bleed, and was found on the ground. He was immediately taken to the hospital, where he underwent emergent surgery to his brain to relieve the pressure. Since then, he is starting to recover and respond to commands, but he has a long recovery ahead of him.

One of Lawrence's passions is racing. He was planning to work as staff for the Eco-Fest 5K. All proceeds raised from this race go to Lawrence and his family.

It was a terrific race. Many club members, including Wayne Fong, Lawrence's 76 year-old father, raced. It was a cross-country course, up and down and zigzagging across a hill, and was pretty challenging.

I had a great race too -- I placed second in my age group and won a cowbell, some socks, sunscreen, a water bottle, and Clif Shot Blox.

For more information about Lawrence Fong and how you can help, click here.