18663 Ventura Blvd, Suite 202, Tarzana CA 91356

Tuesday, December 15, 2009

Losing a Patient

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.

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.

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.

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.

Wednesday, November 25, 2009

Tofu Pumpkin Pie

I baked this from a recipe from Vegweb.  It's a whole wheat crust, which I bought from the store, and a filling made from pumpkin puree, maple syrup, cornstarch, silken tofu, nutmeg, and cinnamon.  I'll be serving it up with Soyatoo whipped cream.

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

A less sugary, lower-calorie, easy version of a Thanksgiving favorite.  I concocted this on my own to make sure it tasted good before subjecting my family to my cooking.

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.

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.

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.

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.

Sunday, November 15, 2009

Veggie and Tempeh Bake

I chopped up some yellow squash, sweet potatoes, a green pepper, red onion, and coconut-flavored tempeh mixed it with some Liquid Bragg's and a little agave nectar and sprinkled with pepper.  I baked this at 400 degrees for about 35 minutes and served it over whole wheat pasta.

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.

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

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.

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


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.

Monday, October 19, 2009

New Moon Century -- 100 mile bike ride

Physically, I'm always looking for something tougher, something bigger to accomplish.  Yesterday I rode 100 miles, including 9000 feet of climbing.  This is the most I have ever ridden in one day.

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.

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.

Sunday, October 11, 2009

Long Beach Marathon

Today I ran the Long Beach Marathon.

I wasn't sure whether to run with the 4 hour pace group or go it alone.  As the gun went off and the 4 hour pace group dashed ahead, my choice was made for me and I started on my own.  I easily settled into a pace of 9:15-9:20 per mile.

I was nervous about being able to keep that pace, but for the first 13 miles it felt comfortable.  Then my legs felt heavier, and I slowed down, averaging 9:59/mile for the second half of the race.

Highlights of the race were running through Cal State Long Beach during miles 17-18 and all the enthusiasm of the students cheering us on, and the nursing home that brought their residents outside -- I've never seen a row of twenty elderly people in wheelchairs bundled up cheering at a marathon, it was awesome!

At mile 25, one of the stomach cramps that I have been plagued with came upon me.  I ended up slowing to a walk for about two minutes until it passed, and then I ran the rest.  The last mile felt so long, and it felt so good to finish!

My finishing time was 4 hours, 12 minutes, 55 seconds.  It's my personal best by almost six minutes over my San Diego Marathon.  But, I'm not that pleased.  I feel like I missed my goal, and could have gone faster.  Maybe I needed more longer runs.  Nonetheless, a personal best is a personal best, and I'll take it.

I think that before I race California International Marathon in Sacramento on December 6 that I will do a few things differently:  I hope to do more long runs, and I will take two Immodiums instead of my usual one.

Wednesday, October 07, 2009

Vegetarian Diets Reverse Diabetes

Improving control of your diabetes can be as simple as changing your diet.

In this interview from the Huffington Post, Kathy Freston talks to Dr. Neal Barnard, whose research has demonstrated that diabetes can be controlled and even reversed with a vegan diet.
Image from

Sunday, October 04, 2009

Cooking Less... Eating Vegin' Out!!

Today I ran the Race for the Rescues 5K in 24:29, a new personal best for me, 1st in my age group and 6th woman overall.  I definitely have increased confidence going into next weekend's marathon.

With work, running, triathlon, and time with family and friends, it's tough to prepare healthy meals.  I don't feel like cooking when I get home.  And, living alone, fresh produce has a habit of going bad. is a vegan home food delivery service.  They bring three different main dishes, four entrees, a soup, and five cookies.  It's enough food for eight or nine full meals, all for $110/week.

The food is healthy stuff, relatively low in oil and fat, and delicious.  I would love to see them provide calorie and nutrient information, but perhaps that's something they can provide in the future.

Check them out at  And, if you sign up, tell them I referred you!

Saturday, October 03, 2009


A Taper is a period of time during which we back down the amount of exercise that we are doing in preparation for an upcoming race.

I've never truly embraced the concept of a taper.  When I decrease the amount of exercise that I am doing, I feel sluggish.  Invariably, I gain a pound or two because I'm not as active.  But, when I stick with the taper plan and am rested before a race, I do well.

Last weekend's 18 miler went much better than the one before it.  I had some good runs this week.  This morning, I ran a total of 8 miles, six of those miles with the LA Leggers 9-minute per mile pace group, which is the first time that I have run with this faster group.  It was a challenge  running 8:20 per mile for eight minutes and then walking a minute, and keeping that pace while running up a couple of steep hills, but I was able to do it.

Tomorrow I'm doing a 5K race, just to get an idea of how much I've improved since July, when I had a personal best of 24:55.  I would love to break 24 minutes.  Then I'm going to go for an easy hour-long bike ride.

My strategy for Race Day at the Long Beach Marathon next Sunday:  Coach Jamie wants me to start at a 9:15/mile pace.  I think that's a little aggressive, but if I'm rested up enough, maybe I can keep that pace up for the race.  If around mile 7-8 I feel like that's a little too fast, I'll back it down.  My goal is to run in under 4 hours and 5 minutes.

Sunday, September 27, 2009

Why I Do What I Do

This weekend, while rounding in the ICU, I looked up and saw a picture of one of my patients, smiling with his wife, standing next to two nurses who cared for him.

He was a previously healthy man in his early 30's.  A few days earlier, he had a fever, and then developed shortness of breath.  I had come in to the ER to see him at 1 am, saw that he had congestive heart failure and a weak left ventricle.  We stabilized him temporarily, but the next day, he was intubated, his blood pressure was dropping and he was requiring multiple medications to support his blood pressure.  This previously healthy man's life was in danger.  I cancelled half of my morning's patients to emergently place a central line to sort out what was going on.

In the days to come, he gradually improved, his heart function strengthened, and a week later he was discharged.

I see him in my office, and he's sitting on my exam table, smiling, and you'd think he'd never been ill.  He feels great.  He's back to work and back to playing basketball

And, I swear, when I saw that picture of him, smiling with the team who helped save his life, I smiled.

Wednesday, September 23, 2009

Got my Mojo Back

I was very disappointed after my long run this weekend.  Read below -- it was awful.  But I'm better now.

My coach was right.  I needed a few days off.  Monday was an hour of weights, Tuesday was a 30 minute run with a few accelerations, and today was a track workout.  We did 800's, and mine were all consistently between 3:34-3:37.

I think I'm back.

Monday, September 21, 2009


I'm trying to figure this out.....

I've been running 40 miles per week for several weeks.  Most of my runs have been on the treadmill because of the heat and because of my work schedule.  And, most of those runs have been great -- I had a personal best last Tuesday, where I was able to run 8 miles in 1 hr 11 minutes and 50 seconds on the treadmill, just under 9 minutes per mile.  I was thrilled!

And, I set the treadmill at a 1% incline, to best emulate running outdoors.  So, I felt like I was ready for my 18 miler on Sunday.

My goal was to run the 18 miles at 9:10 per mile.  The first three miles were at 9:30/mile.  I wasn't feeling fabulous, but I was chugging along.  At mile 5, I had an awful stomach cramp.  I stopped for a few minutes, rehydrated and slugged down a Hammer gel and kept going.  But, as the run progressed, I kept getting slower.  My legs felt heavy and I felt a bit tired.  By mile 14, I was just forcing myself to keep going, and my pace was down to 10:30 per mile.  I pushed to 16 miles and called it quits early.  There was no point in torturing myself to get the extra two miles out.

I've been agonizing over this not-so-stellar performance.  What went wrong?  Am I doing too much treadmill running?  Does this mean that the Long Beach Marathon is going to be a miserable experience too?  And my little Boston Marathon dream -- forget it!

I was so glad to talk to Coach Jamie today.  It was quite reassuring.  He thinks I'm overtrained, and has more confidence in me than I probably have in myself right now.

I'll have a day of easy running tomorrow, some track work on Wednesday, a 10K time trial on Friday, and an 18 mile run Sunday.  Coach Jamie thinks that if I can nail this 18 miler then I will be okay.  I've also vowed to do all of my running this week on the roads, not on a treadmill.  Maybe that will help.  I hope.....

Monday, September 14, 2009

Malibu Pictures

Pre-Race, in the transition area.

Running out of the ocean after the swim.  I may be smiling, but I am absolutely sucking wind!

On the podium at the Awards Ceremony --
Fourth Place Athena (since the first place girl started in the wrong wave, she was dq'ed)!!!!

Sunday, September 13, 2009

Malibu Triathlon

Today I celebrated my 34th birthday by racing the Malibu Triathlon!!!

Me and April, a teammate, in the transition area before the race.

Half mile swim, 18 mile bike, 4 mile run.  Lots of celebrities.  I saw David Hasselhoff (looks far older in person), Mario Lopez (looks gorgeous even in a wetsuit and swimcap), and Jeremy Piven.

I did something different -- instead of racing as an age group athlete, I raced as an Athena, the category for women 150 pounds and higher.  My weight hovers between 148-150, and on the morning before the race, I was 150 so I decided to go for it.  Coach Jamie didn't agree with my decision -- he says I'm "competitive" and should "be fair", while another coach suggested I should use my size to my advantage and race in the Athena category.  While I admit that I am a normal weight for my height, being tall (5' 9 1/2") presents a definite disadvantage in triathlon, since long legs biomechanically are horrible levers on the bike and serve as somewhat of a disadvantage for running.

The swim was a bit choppy.  Some of the waves got some big swells, while ours didn't seem so bad.  I felt my swim was good, though I must admit I crashed into the third buoy before I went around it.  Yes, clutzy, but only cost me a couple seconds.  Even getting out of the water, it was a bit choppy.

I was pretty breathless getting out of the water, probably because of all the chop, and was having a heck of a time running through the sand to the transition area.  My bike ride was good, for me.  One benefit of being in a late wave is that I get to pass people on the bike, which isn't a common occurrence since the bike is my weakest leg of the race.  One girl on an archaic bike with no pedal clips kept passing me, and then I would pass her.  Every time she pulled up next to me, I laughed to myself, "I have a Cervelo!  Your bike isn't supposed to pass mine!"  But in the end, pride took over -- I wasn't going to let THAT bike beat me :) and I passed her for good.

I enjoyed the run.  Coach Jamie wanted me to run it in 8 minute splits.  I didn't quite hit that goal, but did run about 8:30/mile, and saw great friends and teammates on the course.  Best of all, my 4 year-old niece had just run the Tot Trot, and I saw my family near the finish line -- with about 200 feet to go, my brother yells, "Good job -- 2 more miles!"  I laughed, and dashed for the finish.

In the end, I finished in 2 hours and 3 minutes, five minutes faster than last year.  I placed fourth in the Athena category, which means I got to stand on the podium, which I have never had the chance to do at a large race.

I couldn't have had a more thrilling birthday!

Wednesday, September 09, 2009

No Soup For You! -- Watching out for Salt

There seems to be a common theme this week:  My patients love soup.

Unfortunately, soup is full of sodium.  Sodium causes fluid retention, which can lead to edema (swelling), increased blood pressure, and in those susceptible patients, congestive heart failure.

Some may believe that if the soup is homemade then it must be healthy and low in sodium -- not true.  A homemade chicken soup is made from the drippings of a chicken or another animal, which naturally are full of sodium.

Unless the broth is made with just water and vegetables, or is specifically labeled with a low sodium content, the soup is high in sodium, and if you have hypertension or congestive heart failure, then it is best to just stay away.
Image from

Monday, September 07, 2009

Spinach Dip

I love this spinach dip and will be bringing it with me to a Labor Day party this afternoon.  It's easy to make, healthier than a standard spinach dip, and tasty.
Here's the recipe:
3 pounds chopped frozen spinach, thawed and drained of extra water
1 small can of chopped water chestnuts
1/2 cup Vegenaise
2 tablespoons of imitation Chicken soup mix

Mix all ingredients in a bowl.  Refrigerate overnight.  Serve with chips.

Sunday, September 06, 2009

Saturated Fats and Cholesterol

A common conversation that I have with my patients is how they've altered their diet once they have learned that they have elevated cholesterol.  Most will tell me that they've cut back on beef, but are eating more fish and chicken, and unfortunately, their cholesterol levels have not improved.

All animal foods contain cholesterol, because like us humans, their livers produce cholesterol.  In fact, beef and chicken and fish all have just as much cholesterol in them, so by switching to fish and chicken, dietary cholesterol consumption will not decrease.

More importantly, though, is saturated fat, which raises our bodies' cholesterol levels.  Interestingly, animal foods tend to be higher in saturated fat than plant foods.  These values are taken from the USDA National Nutrient Database:

Small Hamburger               3.56 grams saturated fat
Lean beef (1/8" fat trim)    1.38 grams
Large egg                          1.63 grams
Salmon, 3 oz                      1.63 grams
Roasted chicken breast       1.76 grams

However, here are the quantities of saturated fat for several vegetarian sources of protein:

Kidney beans, 1 cup            0.13 grams
Tofu, 1/4 pound                 0.69 grams
Veggie burger                     0.11 grams

Animal products tend to be high in both saturated fat and cholesterol.  So, if you have elevated cholesterol, it is especially important to limit your consumption of animal products.

Tuesday, August 25, 2009

Santa Barbara Triathlon -- In Action

A friend snapped this picture at the beginning of the bike course. I'm out of focus, which is ok, because you can see that the scenery along the bike course was really beautiful.

Sunday, August 23, 2009

Santa Barbara Long Course Triathlon

My season was essentially over, with two small races to go. And then the e-mail two weeks ago from Jessica, with whom I travel to most of my races, which began...

"Feeling impulsive?"

Next thing I knew I was signed up for the Santa Barbara Long Course Triathlon. With less than two weeks until the race -- 1 mile swim, 34 mile hilly bike, and 10 mile run -- I knew I had the fitness base to do it, but also realized that this would not be an "A" race.

It is also late in the season. I find it harder and harder to get to the pool and go swim. So I haven't been to the pool lately, and my swim training has consisted of an ocean swim each week of no longer than one mile. Biking is always fun, and I've continued to ride hills. But as the fall approaches, I've focused more on my running to prepare for fall marathons. So my training for race day wasn't exactly ideal.

The swim was in ice-cold water. Halfway through, my hands and feet feeling like icicles, I just wanted to quit. I trudged through it and could not have been more glad to be running on the sand pulling my wetsuit off and heading to pick up my bike.

The bike was fairly hilly, but certainly not nearly as challenging as the hills of Wildflower earlier in the season. I dropped my bike chain about a mile into the ride. After what happened last year, there were a lot of people on the course cautioning us on the descents to be careful. My ride wasn't fabulous -- I got passed all over the place.

Lastly was the run. It was an out and back. The first two miles were flat, then miles 2-4 were all uphill. I love the run. For me it's the opposite of the bike. I get to pass people. On the entire run, I passed dozens of people, but only two passed me, and one was a man who I'll bet had a flat tire. My run time was pretty good -- 1 hr 31 min 30 seconds -- about 9:10 per mile.

My finishing time was 4 hours 31 min 31 seconds. 33 out of 47 in my age group.

One more triathlon, or maybe two, I may be racing with a friend who is doing his first triathlon.

Tuesday, August 18, 2009

Meat and Cancer

Consumption of meat increases the risk of cancer and heart disease.
This was reported on Good Morning America this morning. The suggestion is that parents should not be packing their kids' lunchboxes with slices of deli meat, since deli meat is high in sodium and saturated fat.

Alternatives suggested: Peanut butter and jelly on whole wheat. Or how about a sandwich with hummus and avocado? Or perhaps Tofurky?

Want more lunchbox ideas?
Vegan Lunch Box or Vegcooking are great resources.
Photo from

Tuesday, August 11, 2009

Health Care Reform

I don't want to get political here. However, my experiences as a physician have shaped my opinion on this topic.

There are too many uninsured and underinsured in this country. They do not get the care they need for preventing diseases, and they present when it is too late, when their condition is out of control and the cost to treat it is far higher than what it would have cost to prevent the disease in the first place.

The rumors and scare tactics are absurd. One of my patients told me today that he, as an otherwise healthy elderly man in his 80's, with health care reform may not be treated for his hypertension, but instead would get "death counselling". Simply untrue.

The current health care system will bankrupt our country. There needs to be change. The melodrama and scare tactics need to stop and there needs to be intelligent discussion on this topic.

Thursday, August 06, 2009

21-Day Kickstart to a Healthier Diet

Want to eat healthier but don't know where to start?

Have you thought about trying a vegan diet?

If so, then check out the PCRM 21-Day Vegan Kickstart. This looks like a great program!

Wednesday, August 05, 2009

Motivation to Exercise

I tell my patients to go exercise most days for at least 30 minutes. But what's to keep you going?

As I practice what I preach to my patients, I exercise just about every day. And there are days when my motivation is lacking. Sometimes when the alarm goes off at 4:30 am, I just want to roll over and go back to sleep. And, were I to be completely honest, every so often that's what I do. But, 99% of the time, I get up and go.

My goals keep me on track. In the next two months, I have two triathlons, and I want to perform my best. If I miss a workout, I fear that may impact how ready I am for my races.

Yesterday morning, on the treadmill at the gym, five miles into an eight mile tempo run, with my heart racing and sweat dripping on the treadmill, I was tired out. I thought, I can end this at six miles.

What kept me going was thinking of my long-term goals -- I want to qualify for the Boston Marathon for 2010. To do that, I need to get faster, and hard workouts like this have made me a faster runner and a better athlete.

Somehow I got a second wind and finished off my 8 miles with a sense of true accomplishment.

Goals are important for keeping us on track. If I didn't have goals for myself, I don't think I'd be able to wake up early and exercise.

A goal can be as simple as wanting to finish a 5K race. Another great goal is having the stamina to keep up with active grandchildren.

Whatever it is, find a reason to get out the door and exercise.
Image from

Friday, July 31, 2009

My Interview

This past Thursday, July 30, I was interviewed on the Simon Gowen Show on LA Talk Radio. I discussed the heart and exercise and my own triathlon experiences.
Listen here.

Monday, July 27, 2009

I'm going to be an IronWoman!

I decided to take the plunge..... I just registered for Ironman Lake Placid 2010, on July 25, 2010.

I had signed up for an ironman-distance race last year, but I wasn't feeling ready to put in the training. With my heart not being in it, I decided to drop out and wait until my heart was really in it.

In this sport, and really in anything in life, there's always bigger and better. When I started this sport and was doing sprint races, I thought one day I might do an olympic distance race. Now having completed four half-ironman distance races, I'm ready and excited to take the next big step.

Tuesday, July 21, 2009

Another Trip to the Farmers Market

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

Vineman 70.3 Race Report

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Friday, July 17, 2009

Wednesday Morning Ocean Swim

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

Wednesday, July 15, 2009

Juicy Ladies

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

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

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

I think I have a new favorite lunch stop!

Wednesday, July 08, 2009

Can You Trust Vegan Restaurants?

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

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

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

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

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

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

Sunday, July 05, 2009

Hungry Duck 5K

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

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

I was even quoted in the local paper.

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

Wednesday, July 01, 2009

Could it be... Seitan?

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

Sunday, June 28, 2009

Breath of Life Triathlon Race Report

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

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

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

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

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

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

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

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

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

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

Monday, June 22, 2009

Heart Rate Monitors

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

This is my heart rate monitor that I wear on my wrist:

And this is the strap that is worn around the chest:

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

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

Sunday, June 14, 2009


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

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

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

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

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

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

Wednesday, June 10, 2009

Welcoming New Patients!

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

Monday, June 08, 2009

Grain Meat

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

Wednesday, June 03, 2009

Shojin -- Organic Macrobiotic Japanese Cuisine

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

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

The food was absolutely delicious and healthy.

Click here to visit Shojin.

Tuesday, June 02, 2009

Hemp Milk

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

Sunday, May 31, 2009

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!

Sunday, May 24, 2009


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

Tuesday, May 19, 2009

"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.

Thursday, May 14, 2009

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.

Tuesday, May 12, 2009

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!