My Coke (Zero) Habit

Growing up, and through college, med school, and internship, I drank plenty of regular pop/soda -- and I say pop because as a product of the Midwest, that's what it is -- pop, not soda.  As an intern on call, I carried a 20-ounce bottle of Coke in my pocket.

Sometime around the end of internship, as I thought about all the empty calories that I was getting from soda, I decided to give it up.  Since then, it's been a rare treat at a social event, limited to about four ounces, which is enough to fulfill my craving.

Then I started training for the Ironman.  Life became work, sleep, train, eat, work, sleep... you get the idea.  I was tired.  A cup of green tea was my pre-workout fuel, but then the Coke Zero can became a fixture on my desk at work during morning clinic.  I loved it -- the taste, the fizz, the caffeine, everything about it.  Next thing I knew, I was drinking nearly a liter a day of Coke Zero.

Now, I've read Skinny Bitch, and I know there's concern about aspartame.  And I know that putting processed crap into the body just isn't a good idea.  But I love this stuff.  I've cut back to one can, maybe two, per day.

A can a day can't be bad, right?  Not according to the most recent data on the subject. 

A recent abstract presented at the International Stroke Conference this week suggests that heavy consumption of both diet and regular soda in patients over age 65 is associated with a 61% increased risk of vascular events, including stroke and heart attack.  The risk remained even after adjusting for other risk factors.

The study is not perfect -- it was a small observational study of 2500 patients at one site and looked only at older patients.  While diet soda consumption has been linked to diabetes and the metabolic syndrome, this is the first study to link soda to vascular events.

So what about a 35 year-old vegan triathlete cardiologist with a one-can-a-day habit?

As I look across my desk at the empty soda can, I think it's time to give it up.  I may continue to drink diet soda at social gatherings, but as a daily habit, it's just not necessary.

UPDATE:  April 1, 2012 -- As of January 1, 2012, I have not had a sip of diet soda.  I'm done with it and I feel better for it.  Read about it here.

Sodium

Sodium.  Salt.  It's the bane of my existence as a cardiologist.

In medical school, we learn that 85% of diagnosis is history.  This is very true, especially when it comes to uncontrolled hypertension or congestive heart failure.

Why does sodium matter?  Sodium consumption leads to retention of fluid.  This can raise the blood pressure, and in someone with a weak or stiff heart, can lead to congestive heart failure.

When I encounter a patient with an extremely elevated blood pressure or new onset heart failure, the first thing I ask about is diet.

Me:  Do you watch your salt intake?
Patient:  Yes, I never add salt to my food.

And there is the first fallacy:  Just because you are not salting your food does not mean you are consuming a low-sodium diet.  There is often plenty of sodium in the food you are eating.

Me:  What did you eat yesterday?

The answers to this question are always interesting.  Here are some of the recent high-sodium items consumed by patients of mine:
Soup "but it was homemade soup, not from a can"
Pad Thai "with just a quarter of a cup of fish sauce"
Hot dogs
In 'N Out Burger
Pizza
Various foods on a cruise ship
Las Vegas buffet

If you are eating at a restaurant, you can assume you're getting a ton of sodium.  Any soups, or entrees labled au jus, in broth, marinated, in soy sauce, these will all be highest in sodium.  Or, if it comes from a box or a can at the grocery store, be cautious and read the label.  And finally, any homemade broth from an animal is loaded with sodium -- the drippings of the animal are very concentrated in sodium.

Read here for more on diet and hypertension and heart failure.
Image from legacy.co.mohave.az.us

Resolutions

My resolution is to do more yoga and to stretch.


Me and my nieces doing yoga on the Wii Fit

In the past, I've been of the mindset that you train hard to get better.  Which to some extent is true.  But, it's important to take care of your body too.  Yoga helps to strengthen and stretch.  Massage is good too.  I think that a combination of massage and yoga has helped improve and nearly resolve a hip flexor strain that I had been dealing with over the past few months.

Journey to Health

We all start somewhere.

This is where I started at age 18, an overweight college freshman who ate way too much pizza and ice cream, drank too much soda, and barely exercised.

If you scroll down to any post on this blog, you'll see pictures of me now.  It's a big difference, not only in how I look, but also how I feel.
 
I share this because I talk about lifestyle change all the time with my patients.  Diet and exercise are such important parts of heart health.  Patients have said in various manners, and others have silently thought, how can a slender cardiologist who eats healthy and exercises regularly relate to me?
 
I can relate because, as you can see above, I've been where you are.  I made my own journey from overweight unhealthy college student to fit and healthy cardiologist.
 
Just before starting medical school, I began exercising.  And over the course of medical school, my eating habits improved.  I ditched regular soda during my first year of residency.  During my second year of residency, I ran my first marathon -- slowly -- in just under six hours. 
 
Then, I started incorporating more vegetables into my diet.  During the second year of my cardiology fellowship, I went vegan.  And, over the past five years, through triathlon training and working with excellent coaches and personal trainers, I've become a better athlete, far exceeding my running times from when I was ten years younger.
 
In the meantime, I've struggled with my eating habits, particularly at night, when I have had tendencies to overeat.  A couple of years ago, I worked with a nutritionist to help get some of my eating habits in check.
 
I'm certainly not perfect in how I eat, but I've come a long way.  And I understand from my own experience that lifestyle change comes in baby steps.  It doesn't happen overnight.  But with time and with effort, we can all adopt healthier lifestyles.

Vegan Doesn't Necessarily Mean Healthy!!!

I was reminded of this recently.  A patient with high triglycerides told me of her intent to become a vegan.  She ate two meals and usually one smoothie every day from a local vegan restaurant.  While she was completely vegan at this point, her repeat blood work looked no better -- her triglycerides were still very high.

Why is this???

Not everything that is vegan is healthy.  Salt and oil are vegan.  So are avocadoes.  And coconut milk.  And white bread.  So, even on a diet that is vegan, we can still be unhealthy.

And, it's important to remember that when you eat at a restaurant, you don't know what has been added to your food for flavor.  Vegan or not, the chef usually does not care about your long-term health; he or she just wants you to love the food so you come back and buy more.

While I love a good restaurant meal, most of my meals are prepared at home.  I usually pack a salad loaded with veggies and tofu slices or lentils and a piece of fruit for dessert.

Remember:  A healthful vegan diet consists of plant-based foods that are unprocessed (or minimally processed), with lots of fruits and vegetables, with minimal (if any) oil, and low in salt.

My Team

To provide excellent care, it takes more than one person.  These are some of the people whom I am fortunate to work with every day.

From left:  Ashley our office manager, me, Lizzy our receptionist, and Keely my medical assistant.

They're a great team who care about our patients.  Lizzy is the friendly face that greets you when you enter the office and when you are leaving.  Keely is the person who brings you to the exam room and takes your vital signs.  And, Ashley works behind the scenes to schedule tests and keep the office running smoothly.

Going to a cardiologist can be and intimidating experience, and my wonderful staff helps to make our office a welcoming environment.  Without them, I could not do everything that I do every day, and I am so grateful to have them.

Off-Season Training

It's been a long off-season, or at least that's what I consider it, as I've been without a coach or a specific training plan since Ironman Lake Placid in July.

I still exercise most days, with three days of weights, three runs, and the occasional bike ride.

I was about to blog about "excuses" and the reason why we might stop exercising, with the premise of suggesting that we all get off our collective tuchus, stop coming up with reasons why we shouldn't break a sweat, and just get it done.  But then Tuesday morning came -- I woke up, ate breakfast, drank my pre-workout green tea, watched the news to hear that it was 38 degrees outside, and then went upstairs and crawled back into bed for another hour and a half.  I guess we all have our moments of inertia, and that was mine.

My running has consisted of three runs per week.  Tuesday is a tempo run, Thursday is a hill run either on my own or by doing hill repeats with my triathlon girl friends, and Saturday is a long run.  Yesterday's run was twelve miles.

Today I ran the Walk of Ages 5K.  At the start, a man in front of me tripped, and I in turn tripped over him scraping up my left knee.  But, we both got up and ran the race.  In spite of the rough beginning, I finished third place woman overall (first and second place were teenagers!) and first place woman ages 30-39.  My friend Miriam took first place in her age group 25-29.

Miriam and I and our gold medals!!!

Right now, I'm enjoying myself.  While I am training for a half marathon in January, I am maintaining my fitness and not pushing myself too hard.

Vegan Thanksgiving

My family celebrated Thanksgiving a week early.  So, if you're looking for a few ideas of what to serve at your celebration, here's what we had:

Broccoli recipe from vegancoach.com -- broccoli sauteed with shallots, walnut pieces, and a tiny amount of olive oil and soy sauce.

 Stuffing made by my sister-in-law's mother -- yummy with cranberries!

Field Roast celebration roast.  We also had a Tofurky, but that had been polished off before I took a picture of it.

Sweet potatoes!  My sister-in-law Mary Ruth made these.  They are far healthier than you would think from their amazing taste!  She mixed sweet potatoes, applesauce, and a little bit of Earth Balance spread, and cooked it in a crock pot.

Homemade cranberry sauce recipe courtesy of Chef AJ -- cranberries, oranges, and date paste whirred in my Vitamix blender.  Don't mind my brother's maturity in the picture below.

Mashed potatoes and Tofurky gravy.  I mix the potatoes with unsweetened soy milk, just a little bit of Earth Balance, a pinch of salt, and lots of pepper.

Happy Thanksgiving!!!

Get Healthy Challenge!

The staff at my office has talked about how they want to get healthier, and if you read down a couple of posts, you can hear a bit of my own frustration of maintaining my weight when not training for a major event.

As a result, I started the West Hills Multispecialty Office Get Healthy Challenge!  It is a five week challenge to eat better, adopt positive healthy habits, and lose weight.  The challenge started yesterday with a weigh-in.  I've offered up a $100 prize to the person who loses the most weight.  I've also given everyone a copy of the book Skinny Bitch for inspiration, since no one quite says it like Rory and Kim.

Each day, I am providing a health tip.  Today's tip:  Pack a lunch so you're not tempted by unhealthy choices around you.  Yesterday:  Soda has 100 calories per eight ounces -- cut it out!  I think I'm also going to have a "Skinny Bitch Potluck Lunch in a couple of weeks.

Nine people in my office are participating, and so far there's a lot of buzz..  I'm really excited!!!!

Cookin' With Chef AJ!

Chef AJ is a plant-based chef who prepares unprocessed foods with no sugar, oil, or salt. I've taken some of her classes and have loved her food, but have never prepared any recipes, until now.

This is my Vitamix, and in it I am making her "Dream of Tomato" soup.  It includes tomatoes, red peppers, lemon, and some spices.  I love the "Hot Soup" function because it blends everything and at the end of a few minutes, you have.... guess what?  Hot soup!

To make it my own, I added flax seeds and a cup of soy milk.

And, here's her Cranberry Relish.  At Thanksgiving, I make cranberry sauce every year.  It has orange juice, which is very sugary, and then even MORE sugar added.  AJ's version is simple:  Cranberries, oranges, and dates.  And psyllium husk, which I didn't have, so I didn't use, but it doesn't need it.

I love this stuff.  I'm going to make this for my family for Thanksgiving, but for them I'll probably add a few extra dates to make it sweeter.

Learn more about Chef AJ's classes:  http://www.chefajshealthykitchen.com/

Success and Relapse

We're doing great.  We've lost weight.  Look awesome.  Ran our first 5k.  Completed a marathon.  Or an Ironman.

And then, perhaps complacency sets in...

We aren't quite as careful... the exercise drops off, the good eating habits slip.  And there's a bit of denial... I still look good, my clothes still fit, I've only gained two pounds.  Four pounds.  Then ten pounds.

But the reality is, often we relapse from the good habits we've adopted.

That's a position I find myself in.  After Ironman, my exercise has decreased dramatically, as it should -- 20 hours of exercise per week is way too much.  I'm still working out six or seven days a week, but the intensity of those workouts has decreased, or they're shorter.  I walk/run with the dogs and call that cardiovascular exercise, when that is nothing compared to what I used to do.

And I'll have to admit, my eating habits haven't adapted entirely to that change.  And here I am, seven pounds heavier than when I finished Ironman Lake Placid.

It's time to get back on the wagon..

I'm writing down everything that I eat.  I'm being more mindful of my portions.  And, I'm making sure that I get an hour of cardiovascular exercise every day.

I will do better.  We all can.  Tomorrow is a new day, and going forward, I will get back to where I was.

Dog Companionship Can Make You Healthier

I've had my pooches for six weeks now.  It's been an adjustment for all three of us.  I've learned that it takes dogs time to build up stamina for long walks when they've lived in a kennel environment all of their lives. And they've learned that my dining room floor is not a toilet.

Curves and Gold, my rescued greyhounds, have been so wonderful to have.  As I've mentioned before, they make me a happier person.  They always greet me with wagging tails.

There's great benefits to owning dogs.  Dog companionship has been demonstrated to lower blood pressure and cholesterol.  Dog owners have less depression.  They get over acute illnesses much quicker.  And dog owners live longer.

Of course, if you're looking to get your own dogs, rescue.  NEVER buy from a breeder.  So many dogs need loving homes.

If I eat healthy, can I avoid statins?

Recently, I gave a talk to a group of participants who are following an unprocessed, plant-based diet for thirty days.  I spoke about what heart disease is, the risk factors for heart disease, and how to prevent it.

Interestingly, the most popular topic was statin medications.  Several of the participants wanted to know why statins, which are cholesterol-lowering medications, could be needed if an ideal healthy plant-based diet is followed. 

Yes, diet is very potent at lowering cholesterol.  In fact, a plant-based diet can be as potent as the highest dose of statin medication in lowering cholesterol levels.  However, in spite of a "perfect" diet, they may still be recommended.

Diet is powerful, but there are certain circumstances where statins are indicated:


- When diet and exercise are not enough to lower the LDL cholesterol to goal, which may be the case even in people who are following a pristine diet

- Coronary artery disease, history of heart attack, diabetes, peripheral arterial disease, and stroke -- even if the LDL cholesterol is low, statins have pleiotrophic effects, which means that they do more than just lower the LDL level. They reduce progression of arterial disease, improve the lining of the arteries, and reduce occurrence of heart attacks and strokes.

There are randomized controlled studies of hundreds of thousands of patients that definitely support the use of statins to prevent arterial disease in patients who have risk factors but do not yet have arterial disease and also in patients who already have disease.

I wholeheartedly support a plant-based diet and exercise to get cholesterol to goal, especially since I am a vegan and avid exerciser. But some people simply cannot get to that goal, and others have risk factors that indicate a strong benefit from a statin medication.

Newsletter Feature Article About Me

It's great to be recognized by my employer for my triathlon endeavors:

New Creations in My Kitchen

Two creatons made with my new Vitamix blender:

Truffles!!!

Now, I can't quite give away all of the ingredients just yet because they will be entered into a competition this evening and I think these truffles just might be able to win.  The concept is easy, though:  Mix a nut with dried fruit and dates to sweeten them.  Or add cacao to make something chocolatey.  Put them in the freezer.  Then serve.  Yum.

Green Smoothie 

Mix one cup of almond milk, one banana, seven strawberries, and two handfuls of kale.  Since I had just worked out, I added one scoop of chocolate Sun Warrior protein.  On the Vitamix, choose the "smoothie" operation and the machine does all the work.  Or you can make this with your own blender.  Amazingly nutritions and tastes very good, even though it's green :)

Bill Clinton Adopts a Plant-Based Diet

Former President Bill Clinton, once known for his trips to McDonald's while in the Oval Office, has gone nearly vegan.

He underwent coronary artery bypass grafting surgery in 2004.  He then had an angioplasty of one of his vein grafts in February 2010.  Here, he talks about why he changed his diet:



I wish him the best -- it sounds like so far he feels great and has lost some of the excess weight that he was carrying. I also hope that the publicity of someone as prominent as him switching to a plant-based diet inspires others to be healthy.

End of a Season

Best to end the season on a high note.....  my 2010 races:

Los Alamitos Race on the Base -- 4th in age group, my first reverse triathlon (run - bike - swim)

Wildflower Long Course -- 7:39:25, not a good race, 28 minutes slower than last year, much due to lack of sleep in the days leading up to the race

Redondo Beach Sprint -- 2nd place Athena -- on the day after riding 125 miles

Ironman Lake Placid -- 14:45, hitting my goal of finishing my first Ironman in under 15 hours, and screwing up my right knee in the process

Malibu Classic -- 2nd place Athena, on a screwed up knee and basically no running for seven weeks

Long Beach Tri -- today -- ending the season -- FIRST PLACE ATHENA!!!!  Had I raced as an age group athlete, I would have taken fourth place.  But, I'll use my size advantage while I have it :)

Was I Supposed to Train for this Race?

It's been a crazy five years.  Five years ago, I spent an entire summer training for a sprint distance triathlon.  On Sunday, I raced the Malibu Classic triathlon seven weeks after completing an Ironman, and on no particular training schedule.

I didn't think about it until a friend talked about his "taper" for the race.  And it came to me -- Was I really supposed to train for this?

Life since Ironman has been more mellow.  I've been focused more on weight training, lifting five days a week, which I've never done before.  I've been swimming twice a week with the Fortius coached swims, cycling when I feel like it, and running hardly at all due to a slow-to-recover tendinitis in my right knee.

Actually, let me be more honest about the knee issue:  I'm stubborn.  I was told not to run for two weeks after the Ironman.  I ran in one week.  Bad idea.  Then I ran five miles on concrete a week later.  That was a worse idea that led to me limping for the next three days.  Gradually it's gotten a bit better but I've tried a few times to increase the running and it has not worked.

In total, I've run less than fifteen miles in the seven weeks since Ironman.  So why not go out and run four miles at the Malibu Classic?  Sure!

The knee was bad all week before Malibu.  But I had already paid big $$$ for the entry and the race is more like a social hour than an actual competition.  Or at least that's how I treat it.

I raced in the Athena category, as a woman over 150 lbs.  Don't get me started on this one, but I'm a tall girl at 5'10", and my current 156 pounds makes me a normal-sized person, not an "Athena".  But the long legs... huge bike disadvantage.  Huge.  Really.

The water was ice cold -- 58 degrees.  While warming up, or shall I say freezing in the water, I contemplated skipping the whole thing.  I hate cold water.  And with my knee not behaving, I had no idea if I could even complete a four mile run without excruciating pain.

You really want me to swim in this ice cold water???

My swim was strong.  I knew I was doing well since I was surrounded by swim caps from the previous wave of athletes.  Running on the sand out of the water led to excruciating knee pain.

There was only person at the Athena bike rack, and the rest of the bikes were still there, so I figured I was in second place.  Number one took off, and I was about a minute behind.  Putting on a knee brace took another twenty seconds in transition.

I decided that my bike strategy would be to haul ass -- my run is usually my strength, and with my knee in the condition it is in, I had no idea how slowed I would be by the pain, or if I could even *finish* a four mile run.  Dropping out was a definite possibility, so I might as well just kill it on the bike.  A couple miles into the bike ride, I saw another rival with the "ATH" on her calf.  She passed me, leaving me at #3.  I then passed her on a climb.  And she passed me again.  We chatted -- I told her that I thought she and I were #2 and #3 and that I'd see her on the podium.

She and I leapfrogged positions on the bike.  Shortly after the turnaround, I passed #1 who was struggling on the climb out of Leo Carillo beach.  But, the other girl was ahead of me, so at this point I thought I might be #2.  At the time I didn't know it, but there was another Athena out there ahead of all of us.

My bike-to-run transition is a little longer because I don't ride a bike in socks, but I have to put on socks to run.  I was surprised to find another Athena at the rack putting her shoes on to run.  And, the girl who led initially passed me in transition, and I passed her about 30 seconds into the run. 

Surprisingly the knee wasn't all that bad.  It hurt, but it was a consistent, moderate ache that didn't seem to get worse.  I came upon another "ATH" on the run who I didn't even realize was out there.  I passed her.  I passed a lot of runners, and as it turned out, my pace was about 9:10 per mile, where a year ago it was 8:30.

My finishing time was about 2:05.

I found my new friend from the bike ride.  I figured we had podiumed, and my guess was that I was third place.  I was wrong...

... I was second place!!!!!!!!!!  Out of 23 athletes in my category!!!

Second place on the podium, rockin' my stylish knee brace.

It feels great to be on the podium, and a great birthday present to me :)

New Housemates!

Introducing my new friends:

Curves

Gold

Curves and Gold are rescued greyhounds.  Bred for racing, they spent a year and a half as canine blood donors, and then another six months in a kennel waiting to be adopted.

They're beautiful and sweet dogs.  They are long time friends, and yet have completely different personalities.  Gold, a 6 1/2 year-old male, had a two year racing career in West Virginia, with several first and second place finishes.  Curves, a 4 1/2 year-old little girl, never raced -- at 51 pounds, she's tiny for a greyhound, and she'd rather play with toys, particularly those that squeak, than focus on racing.

Dogs are great to get us out the door.  They love to walk and run and play.  As for running, greyhounds are sprinters.  Kind of the opposite of me, the Ironman :)  At most they'll jog 3-4 miles, and the rest of the time they are couch potatoes.  Curves and Gold will jog about a third of a mile with me, and after that, they're done.  I'd love to build them up to a couple of miles, but for now, I just love throwing tennis balls to Curves in the backyard while Gold chases after his little doggie friend Curves.

And there's just something so wonderful about coming home to two friends eager to see you.  I feel like there's something about me that's just happier having them around.

I'm in the Sports Section!

From this week's edition of my hometown paper, the Detroit Jewish News.

Not bad for someone who was in "special gym" in elementary school for being unable to stand on her right foot, or the girl who gained twenty-five pounds during freshman year of college from being sedentary and eating too much junk.  I am proud to say that I've come a long way.

Try Vegan -- For Cheap!!!!

There's a great deal from Gobble Green.  For those of you in the Los Angeles area, they'll deliver a week's worth of food -- that's seven days worth of food, three meals a day -- for $99!  An amazing deal.  And the food looks delicious.

The deal is only good for two more days.  Get your Gobble Green food delivery today!!

Low-Carb Versus Low-Fat

Every so often, one of the journals will publish a study trying to compare a low-carbohydrate diet such as Atkins to a low-fat diet.

Last week's Annals of Internal Medicine had a comparison of patients following either diet for two years.  Weight loss at two years was about the same, but on a few parameters, such as change in HDL, the low-carb diet was superior.

There are a few problems with the study.  First off, low-fat was defined as 30% or fewer calories from fat.  30%?  Really?!  I would hardly call that low-fat.  Also, there's nothing stating what people actually ate.  When people in previous studies have been told to consume 30% fat, their fat intake actually hovers around 36%.  That's definitely not low-fat. 

If you look at Dean Ornish's studies on low-fat diets in patients with coronary disease, the fat content prescribed is 10%, and those patients had overall regression of their coronary disease and improvement in their lipids, even in the absence of statin medication.  Perhaps 10% fat is challenging for most to obtain, but I think 30% is way too high to be called low-fat.

Look closely at the patient populations of the low-fat versus low-carb studies such as this one.  They're overweight but remarkably healthy.  They don't have diabetes and aren't on statin medications for cholesterol.  Their blood pressure is under pristine control.  And of course they don't have coronary artery disease.  These are characteristics vastly different from the general American public, and a huge departure from the typical patient whom I see in my office.

Here's my problem with the concept of the Atkins low carbohydrate diet:  We weren't designed to eat that way.  Think back to our predecessors who dwelled in caves.  They didn't eat huge quantities of meat.  And admittedly, they weren't vegans either.  They ate the little meat that they could hunt down, catch, and kill.  There was no McDonald's drive thru or a supermarket meat counter to buy a prepared slab of meat.

I strongly believe that a plant-based diet is the best option for health.  Plant-based diets reduce risk of coronary disease, lower blood pressure and cholesterol, help to manage and reduce the risk of diabetes, lower body mass, and reduce the risk of many cancers.

Worldfest

I just found this, and thought I had published it.  Perhaps not.  Better late than never -- it was written back in May.

Worldfest, a celebration of all things vegan, took place today in Encino.

There were lots of food vendors and yummy things to try. I enjoyed Olade, a low-calorie drink (20 calories per 8-oz bottle), and in particular their Tropical flavor. I promptly went to Whole Foods afterward and picked up several bottles. Rawsheed had great raw pizza samples, and this was an amazing introduction to his very creative line of raw cuisine.

For dinner, I needed something unique. So I hit up Strictly Vegan, a Jamaican catering company out of Rancho Cucamonga:

This was a spicy treat!  Gardein vegetarian chicken with peas and carrots, squash, rice and plantains.

And of course there were the speakers.  Rip Esselstyn was speaking as I came in.  He's the firefighter behind the book The Engine Two Diet, and the son of famed cardiothoracic surgeon Caldwell Esselstyn.  His talk basically can be summarized as:  It's not about curing heart disease -- it's about eating the right things and taking care of your body so you don't need a cure.  Amen to that -- the message that I try to get across to my patients on a daily basis.

And finally, after Ironman Lake Placid when I have more time, I want to adopt a dog.  I spent a lot of time talking to the folks at CalGAP, California Greyhound Adoption Promotion, who promote adoption of ex-racing greyhounds.  I asked them important questions like, with a doggy door can I leave a Greyhound when I'm at work?  Will the dog go jogging, and how far?

About that knee... and what CAN I do??

The knee felt great.  On Sunday, I ran a half mile warmup before lifting some weights.  So, on Monday, it made sense to run five miles.  On concrete.

Wrong answer.

I then proceeded to limp for the next two days.  But I listened to the advice I give my patients:  If you can't walk, then get in the pool.  So I got in the pool and I stretched and I swam.

The knee still aches, but it's better.  I know I need to not run for at least two weeks.  And this bums me out, and I could sit and stew on it and be mad.

Or I can look at it in a more positive way:  Here are all these days when I would have run, and now I have the opportunity to do something else.

Yesterday, I climbed up and down Sepulveda Boulevard for an hour on my bike.  That was fun.  Tomorrow morning I'm swimming in the open water.  On Sunday, a friend and I are doing a dance class.

It's all in how you look at things.  Were it not for an injured foot six years ago, I would have never dusted off my old mountain bike and I certainly never would have jumped into the pool to brush up on my freestyle stroke, and I never would have done my first triathlon, let alone the Ironman that I completed less than three weeks ago.

I can't run.  But there's so much else that I CAN do.

Sun Warrior

I tried a new protein powder -- Sun Warrior Raw Vegan Protein, in vanilla.  It has 70 calories per serving with 16 grams of protein.  The number one ingredient, interestingly, is raw sprouted whole grain brown rice, and according to the label it is one of the most easily digested proteins.

And yet, it tastes terrific!  I've mixed with soy yogurt, and this evening I made a smoothie with one scoop of vanilla Sun Warrior, one cup of strawberries, half a cup of blueberries, and a cup of ice.

At 200 calories, this smoothie is very filling.

Ironman -- The Day in Pictures

Out of the water after two miles, pulling my wetsuit off.

Beginning the bike ride

Beautiful scenery on the ride....

Leading the pack!  Okay not really, but the picture sure makes it look like I am.

Running the marathon.  Having fun. :)

The finisher shot!!!!!!!!!!!

Limping on an excruciatingly painful knee, and somehow couldn't get the grin off my face.  I'm an Ironman!!!!!

After the Ironman...

It's been ten days since Ironman Lake Placid.

To answer the question I've heard the most:  How's the knee?  -- It is still sore.

I took off the two days following the race from exercising.  I was traveling, but my knee still hurt, and it's hard to exercise while limping.

I was back in the pool last Wednesday and swam 1000 meters in about 28 minutes.  I was slow.  I was tired.  But it felt good to get back in the pool.

I've worked out every day since.  I have taken it easy though.  I've swam a few times, went to a spin class, got on an elliptical, and even took a choreographed dance class.  It's been really interesting being without a coach and a schedule.

On Sunday, I tried to run.  I had been pain-free in my knee for two days and thought I could do it.  Nope.  About three quarters of a mile in, it hurt.  It hurt worse at a mile so I turned around.  A mile and a half into the run, I had to walk.

While nothing would make me happier right now than going for a run, I know that I can't.  I've learned from past experiences that ignoring minor injuries turns them into more major injuries that will keep me out of running for even longer.

I've changed the focus of my training.  Rather than focusing on endurance, I'm focusing on bodybuilding.  I'll be weight training five days a week.  I've never done this before, but I look forward to the challenge.

Food as Medicine

One of my new favorite shows is "Losing It with Jillian Michaels," and one of the points that she makes is that your food can be the poison that kills you, or it can be your medicine that makes you healthy.

I love to eat.  Over time, my diet has evolved from grilled cheese, fries and coke, to far healthier choices.  Needless to say, salad was not always part of my repertoire.

Above is one of my favorite salads.  It's healthy too.  On a bed of organic lettuce, I add some of my favorite veggies, like carrots and peppers, slices of fruit like mangoes and apples, tomatoes, avocado, and 150-200 calories worth of protein like lentils, marinated tofu, Field Roast, or Chick'n-free Chicken from Follow Your Heart. 

I don't add salad dressing.  Rather, I let the salad marinate in the tomatoes and fruit, and no calorie-laden dressing is needed.

I get my organic lettuce and bulk veggies and fruit at Costco.  Or I buy from local farmer's markets.  Trader Joe's has marinated tofu or lentils in their refrigerator section, and Follow Your Heart in Canoga Park (if you live in LA) has lots of "fake meat" options, including my favorite, Chick'n-free Chicken.  Field Roast, a soy-free "grain meat" sold at Whole Foods, has a meaty texture and tastes great sliced in sandwiches, cubed in salads, or cooked with veggies and mashed potatoes.

Ironman Lake Placid -- The Race Report

This may be my longest blog post ever, but it was an amazing day that I will never forget, and there are so many things that I want to share.

My goals for the day: Finish in under 15 hours, preferably without a glow-stick – racers who are out well after dark are forced to run with a glow stick so that they are visible.

Pre-Race

We arrived at 5 am to be body-marked with our race numbers written on our arms and legs with permanent markers, inflate the tires of our bikes, drop off our “special needs” bags, and pee about three or four times (luckily the port-o-potty lines moved fast). I then handed off my morning clothes to my parents, who were so fabulous to drive all the way to Michigan to watch me race.


Swim – 2.4 miles

The swim was a two loop course in Mirror Lake. I entered the water and the nerves kicked in. Though there was an underwater cable which could be used to sight the direction of the swim easily, that area was incredibly crowded so I elected to position myself in an area a bit less crowded to the side. My swim distance would be a bit longer, but it would be less stressful and hopefully with fewer kicks, elbows, and scratches. I treaded water as we waited for the start gun at 7 am.

There were over 2,600 of us starting the swim, and triathletes can be aggressive. Within thirty seconds, someone kicked me in the chin. I tried to find clear space, which was challenging amongst this cluster of people. My ankles got scratched numerous times by other swimmers’ watches. By about five minutes in, I finally had some clear space in front of me, though throughout the swim people constantly were knocking into me.

I completed my first lap in just over forty minutes. This was definitely on track to my goal of finishing in less than an hour and thirty minutes. For some reason, the cluster of men in front of me were taking their time getting out of the water. I dashed around them and back into the water for my second loop, rejoicing in my excellent first loop time. This time I managed to find my way onto the cable, at least for about five minutes. But, even though we had spread out a bit, the cable was still crowded and I again drifted to the outside.

Total swim time: 1:23:09. Well under my goal of 1:30.



First Transition

Again, people were way too slow getting out of the water. I dashed around various stragglers, pulled my wetsuit down to my waist, and found a wetsuit stripper. It’s a cool process – the athlete lies down and two people pull the wetsuit off of you. It’s much faster than taking it off yourself. I threw the wetsuit over my shoulder and ran, and again, most people were not running or were barely shuffling, so it was a process of darting around people again to get to the transition area, which was a block away and across the street.

Transition at an Ironman is entirely a different process from at any other triathlon. I grabbed my bag of bike transition items and dashed into the women’s changing tent. Forget modesty – clothes are coming off quickly and there are volunteers in the tent to help us with whatever we may need. I tore off the swimsuit, which took a bit of effort, and put on my shorts and tri-top. As I put on my bike shoes, took a few bites of my Purefit bar, put on my hemlet, stashed my sunglasses for the time being (it was very dark in the tent), and stuffed my swim gear into my bag, I asked a volunteer to put sunscreen on me. I handed the bag off to a volunteer and ran out of the tent holding my banana, trying to figure out where to stash it because I wasn’t ready to eat it quite yet. As it was too big for my pockets, I stuffed it under my sports bra strap, which held it in place.

Transition #1 time: 12 minutes (could have been a little faster, but with a long bike ride ahead I prefer to be prepared and comfortable)


Bike (112 miles)

I ran out of the transition area with my bike and saw LA Tri Club friends Gerardo, Ray, and Karen. I waved, pumped my fist in the air, and nearly fell off my bike in all of the excitement.

Start of the bike course.  Banana stashed at top of shirt.  Fist in air and almost falling off my bike.

The bike course at Ironman Lake Placid is known as one of the toughest. It consists of two loops of the course. While the first thirty miles includes a nice long downhill and some rollers, the last twenty-six includes a long steady climb followed by some flats and then yet another set of climbs. Living in Los Angeles, we have the Santa Monica Mountains nearby. Early in the season I did a lot of long steady climbing, and my training has consistently included hilly portions of PCH (Pacific Coast Highway), so I was ready for this course.

The biggest mistake that one can make on the Ironman Lake Placid course is to ride it too hard, especially in the first loop. 112 miles is a long way to travel, and killing one’s legs on the bike leaves little reserve to run a marathon.  Therefore, I made a consistent effort to not push all-out on the bike.

A lot of the bikes had fancy wheels, and many riders had the sophisticated aero helmets.  I was amused that with my Cervelo P2C, standard wheels, and normal helmet, I was able to ride faster than some of those with the fancy equipment. That said, the bike is still my weakness, and with that in mind, I knew that I would be passed frequently.  One very important rule: Two kinds of people will pass by on the bike – those who are faster, and those who will be walking the marathon course.

The first few miles had some gentle climbs.  Then there was a nice, several mile long descent into the town of Keene.  My speeds were up to 45 miles per hour, which was a little scary with the rain coming down, but I held onto the handlebars as opposed to my aero bars.  Then there was a fairly flat ride north, an out-and-back on a slight hill.  Then the race really began as we turned out of the town of Jay and headed uphill into Wilmington.  While not a very steep hill, it was a long and challenging hill.  Once into Wilmington, the course flattens for a while, and as we head back to Lake Placid, there are several climbs followed by flats.

The loop back through Lake Placid is exciting – spectators are screaming and cheering. I stopped to get my “special needs” bag, with a Tofurky sandwich in it, and I eagerly explained to the volunteer who gave me my bag exactly what Tofurky is.  I saw my parents and I saw my friends again. Then I did the bike loop all over again, just a bit slower, but still feeling strong.

I have to give huge props to the volunteers at the aid stations. They were kind, encouraging, and upbeat. I would get off the bike to use the port-o-potty, and a volunteer would hold my bike and ask if I needed anything, like another bottle of water or sports drink. When I came out, I would have that bottle and be ready to go. I thanked the volunteers every chance that I could; they made my day.

Bike time: 7 hours, 38 minutes. The second loop was only a bit slower than the first. Surpassed my goal time of 8 hours.


Transition #2

I passed my bike off to a volunteer with the bike shoes still clipped in, and ran barefoot to grab my transition bag. This time, I did not need to change clothes, though I did have a spare shirt in case I felt the need. I chose not to go into the dark and smelly changing tent and instead sat down on the grass to put on my shoes, socks, and visor and stuff my pockets with my snacks. I had a peanut butter and jelly sandwich which definitely hit the spot, took a few bites, then ran into the changing tent for more sunscreen and to drop off my bike equipment, and out for the run.


Run – 26.2 miles

Starting the run -- PBJ sandwich in left hand, high-fiving someone with the right

Up to this point, I felt great. My energy level was high. I ran the first half mile stuffing my face with PBJ. Yum. I knew to keep my pace conservative at the beginning in order to conserve energy for the end, but with the downhills it was hard to hold back. I wanted to run eleven-minute miles, and considering that in my best marathons my pace has been about 9:40 per mile, I thought this would be no big deal. Little did I realize just how much a long swim and bike would take out of me.

The first six miles went well, and I averaged 10:55 per mile. Then I slowed down. My knees were aching, and my pace gradually became 12-13 miles per hour. I felt like I was running faster, but I definitely was not.

The aid stations were fully loaded – sports drink, water, pretzels, bananas, orange slices, Powerbars (not vegan, so I had my own Clif bars in my pockets), energy gels, cola, and chicken broth (another non-vegan item, but no big deal since I didn’t feel like I needed more salt). At each aid station, I would drink a few ounces of sports drink and a few ounces of water. I walked those few steps as I drank, because with this long of a day, it wasn’t worth the few seconds I could save as I choke on my drink while trying to run with it. I ate well while on the bike so I had enough energy and didn’t need to worry too much about eating while running. And, I definitely was hydrated enough since I was peeing quite frequently, perhaps a bit too frequently, but that is better than the alternative -- dehydration.

The run was an out-and-back twice. Again, running back into Lake Placid, the crowds were amazing and encouraging. There’s a hill heading back toward the Olympic Oval, and while most other people were walking, I was running up that hill with the biggest grin I could muster, which helped me find more crowd encouragement. I run hills – I love them!

I saw my parents as I started the second loop and handed them a few extra items from my pockets and gave them a high-five. “Go have dinner – I’ll see you at 9:30!” I yelled.

My right knee gradually ached more and more on that second loop. I ran into Mark, an athlete of my former coach Mary Eggers, who I had met just a few evenings earlier. I talked to him through miles 14-15, which took my mind off the pain. He walked, and I kept running. The second loop felt longer than the first as my knee ached.

Around mile 19, the pain was getting severe and occasionally sharp. But, I kept running. My run pace hovered around a miserable 13 minutes per mile. At mile 22, I realized that continuing to run in excruciating pain was not a sustainable strategy, so I started to power-walk. I’m sure I looked ridiculous, swinging my arms and taking big steps. My pace was not that much slower than my jog/shuffle, and my knee was not nearly as painful.

There were a lot of ambulances – over the last half of the run I saw over a half dozen of them. I reminded myself that I was lucky that I was still on two feet and not on my way to a hospital.

As we got into town, around mile 23, Mark from Rochester caught up with me – he said, “Run this with me” or something like that. I said, “I don’t know if I can, but I know I should.” I started to run again. The knee hurt, and I winced with every step. Luckly, we were heading back to town with all the crowds, and their energy carried me. Again, I put on my biggest grin, a smile hiding me gritting my teeth with pain. I saw the hill back into town and I kept on running it. I saw my roommate Liz, who qualified for Kona that day, who in spite of already having finished and having spent time puking in the medical tent still mustered the energy to wait to cheer me on. “You’re the only one running up this hill!” she yelled. And on I went. At mile 25, I started to walk again. Mark caught up with me, and I looked at him and said, “I need to run now,” and off I ran.

The crowd was great – “You’re almost there!” That last mile was the longest of my life. As I headed into the Olympic Oval to finish, I saw Gerardo, Ray, and Karen, and they took this picture. Looking at it, you have absolutely no idea how much pain I was in, but from that point, endorphins carried me forward.

On my way into the Olympic Oval -- Can you tell that my knee is killing me?

The crowd was amazing and loud as I ran into the Olympic oval. One runner passed me, and I let him go ahead of me so that he would have his few seconds to himself as he finished. As I approached, I heard the voice of the infamous Mike Reilly, who announces all of the Ironman races, “Heather Shenkman, of Sherman Oaks, California…. YOU ARE AN IRONMAN!”

I remembered to smile and keep my arms high in the air so that I’d look good for my finisher picture.  The finisher picture looks awesome, and I'm carrying it around in my white coat pocket to share with everyone.  Once I have a digital version, I'll post it.

A volunteer held onto me as I nearly passed out at the finish line. I posed for my finisher picture, received my finisher’s hat and shirt, and limped over to meet my parents. I had just completed 140.6 miles and now I could barely walk. Mom and Dad carried my stuff (and luckily they did not need to carry me!) and helped me get my bike to the area to be transported back to Los Angeles, and then drove me back to my hotel. If they were not there, the end of that race would have been grueling – I have no idea how I would have hobbled with my belongings and my bike and how I would have gotten back to my hotel.

Overall time: 14:45:25. Better than my goal of 15 hours. And without a glow-stick. My splits were pretty consistent, and even with my knee issues my run time didn’t drop off at all.

The day after the race....

It was an amazing day. But I will never do another Ironman. Why? I’ve done one and I am now and Ironman. I have nothing more to prove. I value my free time, and I look forward to spending that time with my family, my two nieces, and my friends, and fulfilling one other dream:  getting a dog.
 
Two days later, and my right knee still aches and I am still limping.  With ice and ibuprofen, it should feel better soon, and I will slowly get back to a scaled-down workout routine.

I Am An Ironman!!!!

I did it!!!

It was an amazing and challenging day.  My finishing time was 14:45, which was within my goal of finishing in under fifteen hours.  I feel great, though my right knee is a bit sore.

The full race report in all its glory is coming soon.

Tomorrow is the Big Day!!!

Tomorrow is the Ironman.

I did a short swim in Mirror Lake this morning, dropped off my bike, and then a short run.  Now I'm relaxing.  Drinking water.  Trying not to be nervous.

My goal is fifteen hours.  If I have a good day I might be able to pull this off in under fourteen hours. 

You can track my progress at IronmanLive.com.  My bib number is 2553.

I've put in the training and I'm ready.  Here goes nothing.

Live from Lake Placid!

Sunday is the big day.

We arrived on Wednesday night, after two flights cross-country and a 2 1/2 hour drive from Albany.

Race Check-In at the Lake Placid High School gym

On Thursday, we checked in for the race.  The details are mind-boggling.  We were ID'ed at least twice, weighed in (so that if we end up in a medical tent that the personnel will know our healthy weight), and received our race numbers and bags.

The product expo

LA Tri Club friends

We bought schwag with the race logo on it, including t-shirts, workout clothing, water bottles, and the obligatory M-dot sticker that will go on the back of my car to commemorate this event.

Then we went swimming in Mirror Lake.  It's a beautiful lake, very clear, and on Sunday will be very crowded.

Bike course -- sketchy roads, beautiful scenery

On Friday morning, we went for a 45 minute bike ride followed by a 20 minute run, all at relatively easy paces.  The bike ride was over one of the more challenging parts of the course, which I had no trouble on, and gave me a little bit more much-needed confidence.

Tonight (Friday) is the welcome dinner, followed by the mandatory pre-race "talk".

More to come....

It all started in Upstate New York...

Five years ago, I was a cardiology fellow-in-training and a repeatedly injured recreational runner.  To stay in shape, I dusted off my clumsy mountain bike that I bought in 1992 at Toys R Us before heading to college.  I also did spin classes and I swam.

My spin class instructor, Mary Eggers, was a triathlon coach.  One day, once I could finally start to run again, I asked her if she thought I could do a triathlon.

I spent the entire summer of 2005 training under Coach Mary's guidance for a sprint triathlon.  Then in September 2005, I completed my first triathlon, the Finger Lakes Triathlon.  I had a blast that day.  And, from there on out, I was hooked.

In the past five years, I moved to Boston and then to Los Angeles.  My world has changed more than I could have ever imagined -- new jobs, new people, new homes.  But, triathlon training has stayed constant.  It has been my link to meeting some amazing friends.  It has been my stress relief.  And it has been my source of strength when I have had tough days, to go pound the pavement for a run or jump in the water for a few laps to sort out my thoughts or to escape.

This week, I will be returning to upstate New York, to Lake Placid, for my first Ironman distance triathlon.  That's a 2.4 mile swim, 112 mile bike, and 26.2 mile run.  140.6 miles in one day.  I'll get to see Coach Mary who hooked me on this sport.  And, I'll have the chance to complete my biggest physicial challenge yet:  The Ironman.

Taco Dip

I love entertaining, and now that I have my own home I have an opportunity to do it.  It's an opportunity to share delicious vegan food.  Here's one of my favorite recipes:  Taco Dip.

There are four layers, from bottom to top:
Refried beans

Guacamole

Tofutti brand sour cream

Daiya "cheddar" cheese

This dip goes fast, and guests are left wondering if this comfort party food really is vegan.

The Ironman Blues

After all of this training, who would do an Ironman again? 

I did my long workout today, on call.  64 miles on the bike, along the same nine mile loop, so that I'm close enough to my hospital in case I need to tend to a sick patient.  I was exhausted the minute I got on the bike.  Four and a half hours later, I was wiped out, my eyes dry from riding, perhaps a bit woozy from the heat.  Then I put on a pair of running shoes and ran six miles.

Don't get me wrong -- I want to be an Ironman more than anything else.  I love exercise and the way it makes me feel.  But, this is more than I ever care to put my body through again.

One more long workout tomorrow.  Then I taper.

Sixteen more days to Ironman Lake Placid.

The Secrets of Thin People

There is no such thing as naturally thin.

If you are looking to lose weight, watch thinner people -- they have different habits.  Watch at a party what they are eating.  How often do you see them hitting up the buffet table?

A few other secrets of thinner people:

They eat breakfast.

They eat several times a day.

They exercise regularly.

You'll often find them taking the stairs instead of the elevator.

There's no need to obsess over diet and weight, but if you watch closely, you'll see that thinner people have different habits that keep them at a healthy weight.