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.