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.