I take care of patients with complicated medical illnesses. Unfortunately, that means that occasionally my patients pass away.
One of my patients died a few mornings ago.
I met him in February. He was an engineer and inventor, one of the brightest people I've ever met. He had right heart failure, and was one of the few patients who knew why I look so closely at a patient's neck.
"How's my angle of Louis?" he would often ask as I looked at his neck veins to assess his right heart pressure.
He was one of my more talkative patients. He would talk about science, research, often things that were a bit over my head. He was dutifully compliant with his medications and kept meticulous records, though he occasionally indulged in foods higher in salt, which led to occasional decompensation of his heart failure.
He read my blog, because he'd ask me about my races and comment on my posts. In particular, I remember him being very curious about my experience with supraventricular tachycardia and my ablation earlier this year. I think he even posted an anonymous comment about my "ablative cardioversion".
I was also fortunate to have the connection of my medical school advisor being one of his closest friends. He invited me to his home for lunch, which gave me the opportunity to reunite with my former advisor. Seeing his home gave me more insight into who he was as a person and as an inventor.
But, it was ultimately other health issues that took their toll. A compression fracture caused terrible back pain. Cognitively, I could see him declining as he became less intellectual and less talkative at his more recent visits. Most recently, swallowing became difficult for him and he was hospitalized due to aspiration into his lungs.
He was discharged home and passed away two days later.
He's a unique man who definitely left an impression.
Tuesday, December 15, 2009
Sunday, December 13, 2009
Athlete Cookies
My friend Gail competed as part of a relay team for the San Diego Triathlon, to benefit the Challenged Athletes Foundation. She offered to make cookies for anyone who sponsored her $100. I took her up on the offer, and challenged her to make vegan cookies. Here they are, and they are very funny!!
From left to right, these are in honor of my best 5K race, my best marathon, and my most recent marathon which I ran in costume.
Clockwise from the top, these commemorate Santa Barbara Long Course triathlon with its chilly ocean swim, California International Marathon, and the New Moon Century ride.
These cookies are for Wildflower Long Course triathlon and Vineman 70.3, the two half-ironman distance races that I completed this year.
Thursday, December 10, 2009
Running as Supergirl
I thought seriously about whether to post my marathon pictures on the blog. As a cardiologist, I have a certain image to maintain.
But, the more I thought about it, the more I thought that being Supergirl for a race was something I wanted to share. Fitness has to be fun, and I think that this experience reflects that. If exercise was always serious and always hard-core, we would burn out, a lesson that I've learned over the past few months of training.
So here are a few pictures from my race. Through the wind and cold, I had much more fun running as a superhero than I would have otherwise.
But, the more I thought about it, the more I thought that being Supergirl for a race was something I wanted to share. Fitness has to be fun, and I think that this experience reflects that. If exercise was always serious and always hard-core, we would burn out, a lesson that I've learned over the past few months of training.
Sunday, December 06, 2009
CIM Marathon
Today was the CIM Marathon in Sacramento. I've been doing more cross training and a lot less running, and I wasn't sure what to expect from my legs or how long it would take me to finish.
I chose to run with the 4 hour and 15 minute goal time group. My last marathon seven weeks ago, that I was far better trained for, was a 4:12 finishing time.
But, for the first time ever, I ran the marathon in costume, as Supergirl. Complete with a cape. The day was cold and windy, so the long sleeves of the costume and the cape worked well to keep me warm.
Self-portrait with my camera. Better picture coming soon, hopefully.
At the start of the race, it was 29 degrees and maybe by the end the temperature was in the mid-40's. I started with the 4:15 pace group. Our leaders, Lisa and Mike, definitely made the running eperience unique. They had us shaking out our arms and fingers every couple of miles. It seemed silly, but they kept saying, "You'll thank us at mile 20", and yes they were right, it kept our upper body loose. They instructed us to take the tight turns on the course so that we limited the distance that we were running.
I felt good at mile 4, so I broke away from the group and went ahead. A few miles later, I stopped to use the restroom and the group caught up with me around mile 8.
The winds were strong and made running far more challenging. Our pace leaders told us to "tuck in" and run closer together to try to shield the wind. It helped a bit, but the cold and the wind definitely took their toll. With wind, there is more fluid loss, so I was mindful to drink as much as possible.
I pulled ahead of the pace group again at mile 12, and they caught me at mile 14. Lisa, one of the pace leaders said, "We caught up with Supergirl!" Part of me thought she was taunting me for thinking I could pull ahead.
I stayed with the group through mile 21 I needed that group support, positive energy, and shielding from the wind. It took everything in my being to keep up with them and not drop off.
At the water stop at mile 21, I choked on my cup of water, and as I choked, the group ran by. I tried to keep them in sight, but they kept getting farther and farther away.
Dressing as Supergirl definitely has its advantage in crowd support. Lots of people yelled, "Go Superwoman!" "Go Supergirl!" It really helped push me forward. But, my mile splits dropped below ten minutes. I felt tired. But I kept going. Three miles left. Two miles left. One mile. And then a strong finish. Even the announcer yelled for Supergirl!
My finish time: 4 hours, 16 minutes, thirty seconds. That's about three and a half minutes slower than my time seven weeks ago at Long Beach, when I was training harder. I'm proud of my time, and I had fun along the way.
I chose to run with the 4 hour and 15 minute goal time group. My last marathon seven weeks ago, that I was far better trained for, was a 4:12 finishing time.
But, for the first time ever, I ran the marathon in costume, as Supergirl. Complete with a cape. The day was cold and windy, so the long sleeves of the costume and the cape worked well to keep me warm.
At the start of the race, it was 29 degrees and maybe by the end the temperature was in the mid-40's. I started with the 4:15 pace group. Our leaders, Lisa and Mike, definitely made the running eperience unique. They had us shaking out our arms and fingers every couple of miles. It seemed silly, but they kept saying, "You'll thank us at mile 20", and yes they were right, it kept our upper body loose. They instructed us to take the tight turns on the course so that we limited the distance that we were running.
I felt good at mile 4, so I broke away from the group and went ahead. A few miles later, I stopped to use the restroom and the group caught up with me around mile 8.
The winds were strong and made running far more challenging. Our pace leaders told us to "tuck in" and run closer together to try to shield the wind. It helped a bit, but the cold and the wind definitely took their toll. With wind, there is more fluid loss, so I was mindful to drink as much as possible.
I pulled ahead of the pace group again at mile 12, and they caught me at mile 14. Lisa, one of the pace leaders said, "We caught up with Supergirl!" Part of me thought she was taunting me for thinking I could pull ahead.
I stayed with the group through mile 21 I needed that group support, positive energy, and shielding from the wind. It took everything in my being to keep up with them and not drop off.
At the water stop at mile 21, I choked on my cup of water, and as I choked, the group ran by. I tried to keep them in sight, but they kept getting farther and farther away.
Dressing as Supergirl definitely has its advantage in crowd support. Lots of people yelled, "Go Superwoman!" "Go Supergirl!" It really helped push me forward. But, my mile splits dropped below ten minutes. I felt tired. But I kept going. Three miles left. Two miles left. One mile. And then a strong finish. Even the announcer yelled for Supergirl!
My finish time: 4 hours, 16 minutes, thirty seconds. That's about three and a half minutes slower than my time seven weeks ago at Long Beach, when I was training harder. I'm proud of my time, and I had fun along the way.
Monday, November 30, 2009
Does work count as exercise?
I ask all my patients if they exercise. It's an important question since exercise is so important for cardiovascular health.
A common answer: "I exercise at work."
Unless you are a bicycle delivery person who covers large distances or a valet car attendant who spends most of your shift running to retrieve cars, it doesn't count. Construction and manual labor don't really count either, since those jobs involve short bursts of lifting or exertion as opposed to a sustained effort.
Granted, a job that has you moving on your feet is far better than a desk job in terms of promoting heart health. However, for true cardiovascular benefit, you should be doing something outside of your daily work that involves a sustained effort, preferably for at least thirty minutes on most days of the week.
A common answer: "I exercise at work."
Unless you are a bicycle delivery person who covers large distances or a valet car attendant who spends most of your shift running to retrieve cars, it doesn't count. Construction and manual labor don't really count either, since those jobs involve short bursts of lifting or exertion as opposed to a sustained effort.
Granted, a job that has you moving on your feet is far better than a desk job in terms of promoting heart health. However, for true cardiovascular benefit, you should be doing something outside of your daily work that involves a sustained effort, preferably for at least thirty minutes on most days of the week.
Wednesday, November 25, 2009
Tofu Pumpkin Pie
Happy Thanksgiving!!!
Tuesday, November 24, 2009
Teriyaki Bake
This is a similar, easy recipe to the one from a week earlier.
Chop up some veggies and extra-firm tofu. The veggies in here are eggplant, carrots, squash, sweet potato, and onions. Add teriyaki sauce. Mix it up, cover with foil, and bake for 40 minutes at 400 degrees.
Monday, November 23, 2009
Cranberry Sauce
1 bag of cranberries, 1/2 cup of orange juice, 1 large sliced apple, and 1 1/2 tablespoons of agave nectar. Heat it in a saucepan for about thirty minutes, until the cranberries all burst.
Sunday, November 22, 2009
Where I'm At
I've been coach-less for three weeks and doing mostly what I want for exercise.
Needless to say, I didn't qualify for Boston. However, I am proud to say that in the course of eighteen months that I cut my marathon time down from 4:57 to 4:12. I'm proud to say that through much effort and good coaching that I'm a better runner. One day I'll qualify for Boston, it just won't be this year, or likely next year since I'll be shifting my focus to Ironman training.
However, I decided to run the CIM Marathon after all. I'm already signed up and I love doing long training runs, so I'm going to just do it.
I have only been running three days a week. Last week, I ran 4 miles on Monday, six miles of hills on Friday morning, then twenty miles on Saturday morning. Perhaps the six miles of hills on Friday made Saturday's run more painful than it needed to be. Nonetheless, I finished the long run.
Another thing I've noticed with less exercise is that I can't get away with eating quite as much. In peak training for my 70.3 (half-Ironman distance) races, I could easily maintain my weight on 2700-2800 calories per day. Now, doing only about an hour of cardio 5-6 days per week and two days of weights, it's more like 2400 calories per day.
I feel great. Relaxed. Eager to start Ironman base training in January.
Needless to say, I didn't qualify for Boston. However, I am proud to say that in the course of eighteen months that I cut my marathon time down from 4:57 to 4:12. I'm proud to say that through much effort and good coaching that I'm a better runner. One day I'll qualify for Boston, it just won't be this year, or likely next year since I'll be shifting my focus to Ironman training.
However, I decided to run the CIM Marathon after all. I'm already signed up and I love doing long training runs, so I'm going to just do it.
I have only been running three days a week. Last week, I ran 4 miles on Monday, six miles of hills on Friday morning, then twenty miles on Saturday morning. Perhaps the six miles of hills on Friday made Saturday's run more painful than it needed to be. Nonetheless, I finished the long run.
Another thing I've noticed with less exercise is that I can't get away with eating quite as much. In peak training for my 70.3 (half-Ironman distance) races, I could easily maintain my weight on 2700-2800 calories per day. Now, doing only about an hour of cardio 5-6 days per week and two days of weights, it's more like 2400 calories per day.
I feel great. Relaxed. Eager to start Ironman base training in January.
Tuesday, November 17, 2009
Dr. Shenkman Goes to Washington
I spent a few days in Washington DC last week. As you can see, it was quite rainy and cold, not at all resembling the weather that we are accustomed to here in Los Angeles.
We also had the opportunity to meet with representatives of our members of Congress to discuss a couple of important issues: hunger in Los Angeles and Iran.
In Los Angeles, one in eight people face hunger every day. That's a very sad statistic for a wealthy country like ours. As I discussed in an earlier post, this is the role of the Jewish Federation's Fed Up With Hunger campaign -- to bring attention to hunger locally and to raise funds to combat it.
As a cardiologist, I had the opportunity to give my perspective on hunger: Those who face hunger are poor and as a result eat unhealthy foods that are high in calories, fat, and sugar, and hence obesity is becoming more and more prevalent, especially amongst the poor. Obesity leads to high blood pressure, diabetes, abnormal cholesterol, and as a result to heart disease.
Diseases like hypertension and dyslipidemia that once were thought to occur in middle age are being seen in younger and younger people. I took care of a 25 year-old man with a heart attack and have a handful of patients who are younger than me who have suffered heart attacks. I see teenagers with high blood pressure, diabetes, and dyslipidemia.
To help to combat obesity, we need to fight hunger by providing healthy options to cheap junk food.
I traveled with a Young Leadership group from the Jewish Federation of Los Angeles. We went to the White House, Capitol, Supreme Court, State Department, Holocaust Museum, and US Treasury Department.
In Los Angeles, one in eight people face hunger every day. That's a very sad statistic for a wealthy country like ours. As I discussed in an earlier post, this is the role of the Jewish Federation's Fed Up With Hunger campaign -- to bring attention to hunger locally and to raise funds to combat it.
As a cardiologist, I had the opportunity to give my perspective on hunger: Those who face hunger are poor and as a result eat unhealthy foods that are high in calories, fat, and sugar, and hence obesity is becoming more and more prevalent, especially amongst the poor. Obesity leads to high blood pressure, diabetes, abnormal cholesterol, and as a result to heart disease.
Diseases like hypertension and dyslipidemia that once were thought to occur in middle age are being seen in younger and younger people. I took care of a 25 year-old man with a heart attack and have a handful of patients who are younger than me who have suffered heart attacks. I see teenagers with high blood pressure, diabetes, and dyslipidemia.
To help to combat obesity, we need to fight hunger by providing healthy options to cheap junk food.
Sunday, November 15, 2009
Veggie and Tempeh Bake
Tuesday, November 10, 2009
Low Carb Diets Won't Make You Happy
A study in this week's Archives in Internal Medicine (Nov 9, 2009, Vol 169, No 20) looked at the effect on mood and cognition of a low-fat versus a low-carb diet. Patients on both diets lost the same amount of weight, 14 kilograms. However, those on the low-fat diet had greater improvements in mood compared to those following a low-carb high-fat diet.
Interestingly, the "low fat" group got 30% of its calories from fat. I'd call that more of a moderate fat diet, but clearly that diet has less protein and fat than the "low carb" diet.
Why the difference in mood? Serotonin may be suppressed by a low carbohydrate diet, while it may be upregulated by a lower fat diet.
Thee bottom line: It doesn't matter what you eat to lose weight. But, what you do eat in your weight loss obviously has an impact on how you feel.
Why the difference in mood? Serotonin may be suppressed by a low carbohydrate diet, while it may be upregulated by a lower fat diet.
Thee bottom line: It doesn't matter what you eat to lose weight. But, what you do eat in your weight loss obviously has an impact on how you feel.
Sunday, November 08, 2009
What I'm Reading
Caldwell Esseltsyn Jr. is a cardiovascular surgeon at the Cleveland Clinic who asked twenty-four patients with severe coronary disease to make radical changes to their diets and follow a low-fat plant-based vegan diet.
The results are incredible. Through diet alone, these patients were able to halt the progression of their heart disease and save their lives. It also includes several very simple recipes for low-fat heart-healthy meals and snacks.
As this book demonstrates, diet is so important in heart disease. This is why I discuss food at just about every patient encounter.
If you're not sure whether you can change your diet to improve your heart health and change your life, read this book!!!
Wednesday, November 04, 2009
New Adventures
On my first day of exercising for fun, I ran.
On my second day of exercising for fun, I biked.
Sound like a broken record of a triathle's life?
But, when I went running, I didn't have my GPS or my heart rate monitor. I just went out and ran up and down a few hills for fun.
And, for my bike ride, someone asked me, "How far are you going?" Normally, I know exactly how far I need to ride that day. My answer was, "I don't know, I'm just going up." It ended up being a fun 15 mile round-trip ride from the LA Zoo up to the Griffith Park Observatory.
Yesterday I tried a boxing boot camp class. I hadn't been to a boxing class in a couple of years, so I was a bit rusty with the punches. However, given my running and triathlon background, I had no trouble keeping up with the class physically.
Unfortunately, since boxing uses muscles that we don't use to swim/bike/run, I am still pretty sore. Even taking a deep breath strains a few muscles!
I am enjoying my new exercise program, in spite of the soreness.
Image from blog.mtviggy.com
On my second day of exercising for fun, I biked.
Sound like a broken record of a triathle's life?
But, when I went running, I didn't have my GPS or my heart rate monitor. I just went out and ran up and down a few hills for fun.
And, for my bike ride, someone asked me, "How far are you going?" Normally, I know exactly how far I need to ride that day. My answer was, "I don't know, I'm just going up." It ended up being a fun 15 mile round-trip ride from the LA Zoo up to the Griffith Park Observatory.
Yesterday I tried a boxing boot camp class. I hadn't been to a boxing class in a couple of years, so I was a bit rusty with the punches. However, given my running and triathlon background, I had no trouble keeping up with the class physically.
I am enjoying my new exercise program, in spite of the soreness.
Image from blog.mtviggy.com
Friday, October 30, 2009
I Am Burned Out
I haven't been enjoying running lately. While I love to run, as of late I absolutely dread getting on the treadmill.
Today I came to a realization: I have been training for something for over two years. A half marathon. A marathon. A half ironman. Another triathlon.
I need a break.
I exercise and train beause I enjoy it. I do it for me. So, when it ceases to be a fun challenge, I think that means I need to take a break.
I am dropping out of the CIM Marathon that I signed up for on December 6. For the next two months, I will be exercising for fun. Though I may do a few short 5k or 10k races, there will be no big events to train for. I'm going to do things that I haven't done in a while -- kickboxing, rollerblading, and spinning. I may even try some new things, like pilates or yoga.
I hope to come back refreshed in two months and ready to start base training for Ironman Lake Placid in July 2010.
Today I came to a realization: I have been training for something for over two years. A half marathon. A marathon. A half ironman. Another triathlon.
I need a break.
I exercise and train beause I enjoy it. I do it for me. So, when it ceases to be a fun challenge, I think that means I need to take a break.
I am dropping out of the CIM Marathon that I signed up for on December 6. For the next two months, I will be exercising for fun. Though I may do a few short 5k or 10k races, there will be no big events to train for. I'm going to do things that I haven't done in a while -- kickboxing, rollerblading, and spinning. I may even try some new things, like pilates or yoga.
I hope to come back refreshed in two months and ready to start base training for Ironman Lake Placid in July 2010.
Wednesday, October 28, 2009
Fuze Tropical Punch
I love pop / soda, and not the diet variety -- the full-calorie drinks, and I love fruit juice. However, they're empty calories, so it is best to drink as little of these beverages as possible.Recently, I discovered Fuze. One bottle has ten calories. It's flavorful and has vitamin C. It doesn't even taste low-calorie!
Saturday, October 24, 2009
Atkins
A patient once described to me his diet which included healthy meals, such as "good foods like steak." He experienced initial success with the Atkins Diet in rapidly losing fifteen pounds, and then, unfortunately gained back all of the weight within months.
The Atkins Diet was popular early in this decade as an easy way to rapidly drop weight. True, the diet will allow you to lose a large amount of weight at first, most of it in water. But, in the long-term, it isn't successful. How many people do you know who have lost weight, kept it off for several years, and attribute their success to the Atkins Diet? I don't know a single one.
Ingesting a diet high in saturated animal fat and protein is not good for the body. Diets high in saturated and animal fat have been shown time and time again to increase the risk of heart disease and cancer.
The European Prospective Investigation into Cancer and Nutrition, a multi-national study of thousands of people, demostrated that high-protein, low-carb diets increase mortality risk.
A low-fat, vegetarian diet, with lots of fruits, vegetables, and whole grains, with lean protein, really is the best option for health and permanent weight loss.
The Atkins Diet was popular early in this decade as an easy way to rapidly drop weight. True, the diet will allow you to lose a large amount of weight at first, most of it in water. But, in the long-term, it isn't successful. How many people do you know who have lost weight, kept it off for several years, and attribute their success to the Atkins Diet? I don't know a single one.
Ingesting a diet high in saturated animal fat and protein is not good for the body. Diets high in saturated and animal fat have been shown time and time again to increase the risk of heart disease and cancer.
The European Prospective Investigation into Cancer and Nutrition, a multi-national study of thousands of people, demostrated that high-protein, low-carb diets increase mortality risk.
A low-fat, vegetarian diet, with lots of fruits, vegetables, and whole grains, with lean protein, really is the best option for health and permanent weight loss.
Monday, October 19, 2009
New Moon Century -- 100 mile bike ride
As of late, my training has been focused on running. Cycling has been reserved for recovery days. My last 40+ mile ride was over a month and a half ago! So, needless to say, I was a bit worried.
However, this event supported a good cause, the Jewish Federation's Fed Up With Hunger campaign to feed hungry people in Los Angeles. It was also an all-vegan ride!
The ride started in the West Valley community of Oak Park, headed south to Agoura Hills, west toward Thousand Oaks, south to Pacific Coast Highway, PCH into Malibu, then up Mulholland and when I say up I mean up up up with some serious climbing. We stopped for lunch at mile 56. The last 44 miles were full of climbing -- on Mulholland and up Topanga, and then back to the start.
I felt okay at the start. I went out with a group that seemed at my level. A couple riders were a bit faster. I ended up riding much of the way with one person, who was on a commuter bike, and when it started getting windy on Las Posas Road and at the westernmost edge of PCH near Poing Mugu, I drafted off of him. I'm not sure he realized I was drafting him, but when I gained enough energy, I rode in front to give him the chance to draft off me, but I'm not sure he took advantage because I'd turn around and see him behind and to the left of me. Is there shame in a man drafting off a woman cyclist? I'm not sure.
Once we reached Mulholland, around mile 39, the ride really began -- in other words, the climbing! I really surprised myself that I had it in me to climb those mountains given my lack of recent cycling, but I passed a few riders in our group.
I was so thrilled to get to mile 56 and enjoy some lunch. Since all the food was vegan, it was easy -- I fixed myself a whole wheat Tofurky sandwich with avocado, tomato, and Vegenaise. Yum!
The last 44 miles were rough. I found a couple of men who were about my pace to ride the last 35 miles with. When struggling to achieve a goal, it's great to be around others -- that's why I do my long training runs or track workouts with a group -- I get energy from being with other people with the same goal. I'd say I "hit the wall" at mile 85, climbing on Mulholland heading west back to Las Virgines Road. My legs were tired, my knees ached, and my energy was sapped. One of my riding companions flatted at mile 90, which made for a good excuse to stop and wait for him to change his tire.
When we finally finished, it felt so good to be done! I slept so well last night. Yesterday's ride helped me gain the confidence that I need going into training for Ironman Lake Placid, knowing that I can complete a long hilly course. Also, I got to practice staying fueled while training, with both electrolyte solution and food.
No more endurance races for me for a while... not until the California International Marathon on December 6.
Sunday, October 18, 2009
Three Runners Die in Detroit Half Marathon
Sadly, three runners died at the Detroit Half Marathon today, as reported in The Detroit News.
Two runners collapsed and died around mile twelve, and the third shortly after finishing. All three were men, ages 26, 36, and 65. All received prompt medical attention and had defibrillators applied to them, all unsuccessfully.
In addition, a 23 year-old man died at the Baltimore Marathon last week, and two runners died at the San Jose Rock N Roll Half Marathon just a few weeks ago.
Why are apparently healthy athletes dying, and why is this a more common phenomenon recently?
A person can feel well, train for a race, but unknowingly may have heart disease. In younger athletes, those under age 40, the most common cause of sudden death during a race is a structural abnormality of the heart, such as hypertrophic cardiomyopathy, dilated cardiomyopathy, or arrhythmogenic right ventricular dysplasia. The presence of those structural abnormalities of the heart, combined with the stress of a competitive athletic event, can trigger a deadly arrhythmia. Amongst older participants, unknown coronary artery disease may be present, and could lead to a heart attack or arrhythmia that could then lead to death.
Statistically, the odds of dying while competing in a marathon range from 1 in 50,000 to 1 in 150,000.
What should an athlete do? How can we find these things before someone dies?
This is a controversial question amongst the cardiology community. I believe that everyone who wishes to compete in any type of endurance sports needs a full physical before participation. This includes a physical examination, blood pressure check, full panel of blood work including fasting cholesterol levels, and an EKG. A physician should also inquire as to whether there is family history of heart disease in any first-degree relatives.
In Italy, guidelines are even stricter. All young competitive athletes have a complete echocardiogram, or ultrasound of the heart. As you can imagine, the vast majority of these echocardiograms are normal, and thus this recommendation is quite controversial.
Despite the risk in participating in competitive athletics, I hope that these recent events will not scare people away from being active, because an active lifestyle, in spite of these risks, is far better than a sedentary lifestyle.
Two runners collapsed and died around mile twelve, and the third shortly after finishing. All three were men, ages 26, 36, and 65. All received prompt medical attention and had defibrillators applied to them, all unsuccessfully.
In addition, a 23 year-old man died at the Baltimore Marathon last week, and two runners died at the San Jose Rock N Roll Half Marathon just a few weeks ago.
Why are apparently healthy athletes dying, and why is this a more common phenomenon recently?
A person can feel well, train for a race, but unknowingly may have heart disease. In younger athletes, those under age 40, the most common cause of sudden death during a race is a structural abnormality of the heart, such as hypertrophic cardiomyopathy, dilated cardiomyopathy, or arrhythmogenic right ventricular dysplasia. The presence of those structural abnormalities of the heart, combined with the stress of a competitive athletic event, can trigger a deadly arrhythmia. Amongst older participants, unknown coronary artery disease may be present, and could lead to a heart attack or arrhythmia that could then lead to death.
Statistically, the odds of dying while competing in a marathon range from 1 in 50,000 to 1 in 150,000.
What should an athlete do? How can we find these things before someone dies?
This is a controversial question amongst the cardiology community. I believe that everyone who wishes to compete in any type of endurance sports needs a full physical before participation. This includes a physical examination, blood pressure check, full panel of blood work including fasting cholesterol levels, and an EKG. A physician should also inquire as to whether there is family history of heart disease in any first-degree relatives.
In Italy, guidelines are even stricter. All young competitive athletes have a complete echocardiogram, or ultrasound of the heart. As you can imagine, the vast majority of these echocardiograms are normal, and thus this recommendation is quite controversial.
Despite the risk in participating in competitive athletics, I hope that these recent events will not scare people away from being active, because an active lifestyle, in spite of these risks, is far better than a sedentary lifestyle.
Monday, October 12, 2009
Dr. Oz -- Cowboy Goes Vegan to Save His Life
Rocco is a cowboy. He's overweight, diabetic, and has a large amount of plaque in the arteries of his heart as demonstrated by a CT scan. Dr. Oz challenges him to go vegan for 28 days with the goal of reversing his coronary disease and prolonging his life.
Watch the video here
Now, Rocco is similar to so many of my patients whom I see every day. If he can become a vegan, then I'd say just about anyone with the right motivation can make important dietary changes to improve their health.
Watch the video here
Now, Rocco is similar to so many of my patients whom I see every day. If he can become a vegan, then I'd say just about anyone with the right motivation can make important dietary changes to improve their health.
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