18663 Ventura Blvd, Suite 202, Tarzana CA 91356

Saturday, December 31, 2011

Happy New Year!

I hang my head in shame.... it's been a month since my last post!

I'm on a little break from work, and will be back on January 3.  In the meantime, I'm relaxing, spending time with family, and doing some fun workouts.

With my extra time, I had the chance to try out Barry's Bootcamp.  It's a challenging aerobic workout that mixes in bursts of cardiovascular exercise with weight training.  Try it!

Happy new year!!!!

Monday, November 28, 2011

Not a Great Day at the Santa Barbara Marathon

My first question to the organizers of the Santa Barbara Marathon:  Where's my shirt???  You ran out of shirts, and your volunteers asked me for my name, bib number, and t-shirt size, and said it would be coming in the mail.  It hasn't.  Size medium in women's, please.  Thank you.

I was ready.  Or, better yet, I was ready to run the Santa Clarita Marathon the week earlier, but I ended up sick and missed it.  So I was still sort-of ready.

I signed up for the Santa Barbara Marathon three days before the event, knowing that I wanted to do a race with the fitness I had accumulated from months of marathon training.  Hence the high bib number of 1348, not otherwise accounted for by my name being at the end of the alphabet, and no name on my bib either.

Luckily, my friend Lenny was going to be running the half marathon, so I had a travel companion.

I stayed at a chain hotel in Carpinteria, the closest hotel that I could get to the race parking area, about 20 miles away.  The hotels were all booked up with race participants and the two hundred or so weddings taking place in the greater Santa Barbara area that weekend.  So I was stuck at said unfancy chain motel.  Cars on the freeway kept waking me throughout the night.  So, I wasn't terribly well rested.

On race morning, I parked at UCSB, then took a shuttle to Dos Pueblos High School, which is where the marathon started.  Unfortunately, the buses dropped us off a half of a mile away, which is a minor annoyance when you are running, oh, another 26.2 miles later that day.

Someone must have been reading the comments about the race because contrary to previous complaints of lack of facilities, there were more than enough port-o-potties, an important matter for someone like me who likes to empty her bladder three or four times before the start of the race.

With only eight hundred or so of us running the race, it felt a little silly to line up under a "Start" banner.  Nonetheless, off we went, to run a 9-mile loop around Goleta.  Boring.  Completely boring.  The first few miles were a slight downhill, then a slight uphill for the next few miles.  At mile nine, we pass the high school again, and I'm thinking, have I really gone anywhere?  I wasn't feeling terrific, perhaps a bit tired, and I was struggling to keep my mile splits at 9:30 per mile, which was my goal.  I was worried because my heart rate was staying in the high 160's, which I knew for me was a bit high.

Around mile 8 was a photographer.  I'm not sure what came over me, but I decided I needed an interesting race photo of me with my arms stretched out and my tongue sticking out.

In spite of not feeling awesome, I figured I'd stay the course.  Miles 10-12 felt like I was moving downhill, and after downing a Gu gel or two I felt a second wind.  I enjoyed all the locals standing out on the roads cheering us on.  I smiled and thanked them of course.  I was annoyed by the guy on a mountain bike who passed me within just a few inches, to then ride next to his girlfriend (presumably) for the next three miles, passing her food and water.  Granted, this girl wasn't going to win anything, and neither was I, but seriously, if we want food or water when we want it, we have to carry it with us, and I didn't want any near misses with this guy's stupid mountain bike crashing into me.

So perhaps my annoyance with Mountain Bike Guy was a bit over the top.  I may have been getting cranky because I was feeling tired and lousy.

The "wall" came around mile 16.  My mile splits had dropped off and I decided from then on that any time goal was out the window and I was going to ignore my Garmin.  The goal at this point was to put one foot in front of the other and run the rest of this race, avoiding the temptation to walk, and just get this 26.2 miles done.

The next 7 miles were no fun.  The scenery continued to be uninteresting for the most part.  And I maintained my fatigued shuffle of a jog, walking only through aid stations.  Then at mile 23 was a huge hill, which I managed to run up, or more accurately shuffle up at a whopping pace of 15 minutes per mile.  But the reward at the top of the hill was what a marathon based in Santa Barbara should be -- a nice view!!!!  The ocean!!!!  Finally!!!

I think the next couple miles were downhill, and were kind of pretty since we could see the ocean.  I slugged through, and finished as strong as I could.  One benefit of doing all these races is that I know a couple of the local race announcers through the LA Tri Club.  Tim Bomba was announcing finishers, and typically he'll give me a shout out, which is kind of cool, "Here comes Heather Shenkman, of LA Tri Club, cardiologist, so if you want your heart checked...." or something like that.  It's good to hear when you feel like crap, completely spent, and need an extra push to get across the finish line.

My finish time:  4:27 and a few seconds that actually put me closer to 4:28.  But let's round down and call it 4:27.  I feel better about that.

I believe that under better circumstances, I could have pulled a 4:05.  So what happened?  I have learned to never take a trans-continental trip within the weeks before a marathon.  I think that led to me getting sick  And I can't say I was completely recovered, even if it was a week later.  There was an extra week of taper and being sedentary, which may have helped an extra pound or two creep onto my frame.  The peak of my training was too far in advance of this race.  And then there was the noisy freeway in front of my motel.

I've learned my lessons, and I will continue on in my quest to become a faster marathon runner.  My next full marathon is the LA Marathon in March.  I have two half marathons in the meantime.

My suggestions to the people who run the Santa Barbara Marathon:
-Please make the course more interesting.  Goleta is beyond dull to run through.  Last I checked you have an ocean nearby.  Can we maybe run near that instead?
-Your volunteers are enthusiastic, along with the locals.  They couldn't have been nicer.
-Thanks for ample port-o-potties.  Really.
-More aid stations with Gu and food.  And how about some banana or orange slices at aid stations?
-More food at the finish line.  No, I don't mean places where we can spend money and buy lunch.  I mean, more than just orange and banana slices.  How about granola bars, fruit salad, something a bit more filling so we don't have to binge on food from the vendors giving out free samples?  Note to Pure Bar people -- thank you for letting me take 4 bars.  They were awesome.  I'm sold on them.
-Please send me my t-shirt, women's medium.  And that's how I'll start and end.

Friday, November 25, 2011

IronDoc Reporting for Duty!

 I went to another Ironman race.  But, this time, unlike in July 2010, I came as a volunteer, not as a participant.

Several members of my Fortius team were racing at Ironman Arizona this weekend.  Twenty-five of us (!) came along to support.  It's a cheap, quick flight from Los Angeles, I was excited to support my team, and it's always been my dream to work in the medical tent for an event like this.

From 10 am - 3 pm, my team worked at the Bike Special Needs station.  Because the race consists of a 112-mile bike ride, many participants might want to have their own special items available, like a specific bottle of sports drink, a sandwich, a spare bike tube, and so forth.  Our whole Fortius volunteer crew -- all 25 or so of us, stood out on Beeline Highway, yelling out race numbers and handing off bags.  Overall, people were grateful (except for one athlete who chose to yell at us for not having his bag available immediately as he whizzed by at 20+ miles per hour).

That's me and my teammate Nikki holding an athlete's bag while he finds exactly what he needs.  It's a great feeling to help an athlete during a tough race like this.

For more about the Bike Special Needs volunteer experience, I refer you to my teammate Ryan "the Ironmadman" Schneider's terrific blog.

Following our five hours at Bike Special Needs, I spent a couple hours sitting and relaxing by Tempe Town Lake catching up with an old friend who lives in Arizona while cheering for athletes running by.  Some looked strong, some looked a bit tired, and others appeared completely ragged.  I yelled as loud as I could for my friends who were racing, and yelled for many strangers.  I think they all appreciated the encouragement; I know that I did when I raced Ironman Lake Placid last summer.

Later in the day, I volunteered in the medical tent.  This was a very different experience from what I ever imagined.

The tent was basic -- multiple folding chaiselounges covered in white sheets, with IV poles nearby.  In the middle of the tent was a table covered with basic medical equipment -- IV fluid bags, band aids, stethoscopes, blood pressure cuffs, ibuprofen, acetaminophen, and aspirin.  There was no cardiac monitoring equipment, no anti-nausea medications, no I-Stat machine to check electrolytes.  Just the basics.

Our volunteer team consisted of all sorts.  There was a crew of nurses from one of the local ER's, a paramedic instructor who loved putting in IV's, a smattering of other medical professionals, a very eager aspiring medical student, and a couple of physicians.  I worked alongside a pediatrician, a family practice doc, and a physicians assistant.

I saw a lot of dehydrated athletes.  He or she would come in, propped up by 1 or 2 volunteers, eyes glazed over, pale.  We would obtain vital signs.  Then I'd wander over and introduce myself, "I'm Heather, I'm one of the doctors" (no need for formalities in this setting).  I'd see if they could drink -- broth, Ironman Perform electrolyte drink (which they had been drinking all day long during the race and most laughed if I suggested it), or water.  If they couldn't drink, they'd get an IV.  We'd give up to a liter of normal saline.  If, after that, they were vomiting, or unable to tolerate oral liquids, or if they had been in the tent for over 20 minutes, they were sent via ambulance to the hospital.  In my six hours in the medical tent, I sent three athletes to the hospital.

There are some tough people who race the Ironman.  I think some are too tough for their own good.  One woman, in her late 40's, raced with a stress fracture and some sort of gastrointestinal issue that was requiring an endoscopy the following week.  She was badly dehydrated, and teammates who saw her cross the finish line hunched over looking like she was in terrible pain.  She was racing against the instructions of all of her physicians, and I think she got her Kona slot, but at what cost of tearing apart her body.

Another man, a physician in his 60's, with multiple medical issues including a recent prolonged hospitalization, also raced.  He finished spectacularly, I believe in under 12 hours based on his arrival time in the medical tent.  After a liter of IV fluid, he was doing fine, but should he really have raced that day?

One woman received a liter of fluids and still couldn't keep any liquid down.  I gave her an hour to perk up and then told her we needed to send her to the hospital.  At her request, I went outside to update her husband, who told me that she ended up in the ER dehydrated after last year's Ironman.  What????  If you do something once and you end up in a hospital, should you do it again???

The Ironman is a grueling race, based on the distance covered in one day.  I finished my race last year with a severe tendinitis that kept me from running for two months.  That was nothing compared to some of the stuff I saw during my day in Arizona.  This is an event where one third of all participants require medical attention in one way or another, only 95% finish, and about 100 athletes end up in the hospital.

Is the human body meant to do this?  In addition to the oxidative stress placed on the body from the hours of training and the long race day, there is such a huge potential for injury and illness.

I've sworn in the past that I would never do another Ironman.  However, a part of me has always wondered, if I'm more fit now, could I blow away my finishing time of 14 hours and 45 minutes?  I could.  But, I don't want to destroy my body to do it.  Watching the race has definitely changed my perception.

Friday, November 11, 2011

It's a Messed-Up, Unhealthy World

Americans are fatter than ever.  Nearly a third are obese, and two thirds are overweight.  Michelle Obama leads a campaign against obesity.  And yet, the same US government has funded Domino's Pizza to produce a pizza with 40% more cheese, of which one slice has two-thirds of the limit of artery-clogging saturated fat as a person should consume in an entire day.  And you can bet that slice of pizza is loaded with sodium, leading to elevated blood pressure and increased risk of heart attack and stroke.

You'd think we would feed our kids healthy meals in school?  And yet, the National School Lunch Program meals are laden with animal fat and fried foods.  A third of kids are overweight and obese, and half of all children between the ages of 2 and 15 have fatty streaks in their arteries.  Often, the meals that a child gets in school are the only meals that he or she eats in an entire day.

And, being busier than ever, Americans are eating more food outside the home than ever.  In one fast food meal, there may be more than a day's worth of blood-pressure raising sodium and a huge quantity of artery-clogging trans and saturated fats.

There's a big lack of physical activity, which leads to health problems.  Only half of Americans exercise regularly, and the definition of "regular exercise" is a pathetic three sessions per week of thirty minutes of exercise.

And then, as a result of being heavy and eating all this junk and not exercising, our patients come in and they're obese, and their blood pressure is high, and their cholesterol is too high.  What do most doctors do?  Do we ask what our patients are eating?  Do we ask if they're exercising?

No, usually we don't.  We look at the unfit, overweight specimen in front of us and we assume, often incorrectly, that this person is set in his ways, that he doesn't have the capacity to change.  We as doctors might even have the same physique as our unfit patient.

We reach for that magic cholesterol-lowering pill that we can give "when diet and exercise aren't enough," a medicine that might very well give our patient debilitating muscle cramps.  And, your doctor probably won't tell you this, but if you have never had coronary artery disease, that magic pill likely won't prevent an event. 

In low-risk patients with elevated cholesterol levels and no prior heart problems, you would need to treat 250 of them with a cholesterol-lowering statin pill every day for five years to prevent a single cardiac event!  In the most optimistic of studies, you would need to give a statin drug to 40 people every day over the next five years to prevent just one event.  This pill won't prolong your life and probably won't improve your quality of life either.  This is why I rarely prescribe statins for primary prevention of heart disease.

And then rather than counsel our patients on the benefits of fruits and vegetables and decreasing dietary sodium intake, we hand over a prescription for atenolol, the most commonly prescribed blood pressure medicine.  Atenolol lowers blood pressure in the arms and legs but not the pressure seen by the heart and brain, increases risk of diabetes and stroke, and does nothing to reduce risk of cardiovascular events.  Or, the second most prescribed blood pressure medicine, hydrochlorothiazide, also known as HCTZ, which when given at "appropriate doses" raises glucose levels and increases risk of diabetes, has limited evidence to demonstrate prevention of cardiovascular disease.

Or maybe your doctor does tell you to eat healthy, exercise and lose weight.  But what's the drug rep bringing the doctor and his or her staff for lunch today?  Pizza?  Barbecued ribs?  A tray full of cookies and brownies?  Take a peek in the break room.  You may be surprised by what you see.

We seem to have become a pill-pushing profession.  We give our patients a band-aid in the form of atorvastatin or atenolol, and we refuse to address the poor lifestyle habits that make our patients sick in the first place.  And as a whole, we're pretty lousy role models too.

I believe we have clout.  I believe our patients aren't stupid, and I believe they're receptive to us.  If we with our MD or DO or NP or PA initials after our names talk to our patients, I think they'll listen.  And, if more of us do this, then I think we have the power to heal.

Thursday, November 10, 2011

Eating (Sometimes) Healthy in the Holy Land

I just got back from a weeklong trip to Israel.  Beside all the great historical things to see, the food was amazing.

One thing to observe in Israel is that the people there are thinner than they are here.  Part of it may be how much they smoke, but I think much of it has to do with diet.  They seem to eat a lot of salad.

Breakfast was our biggest meal of the day.  The hotel had an abundant array of cheeses and yogurt, and an omelette bar, which I didn't touch.  But, there was also a huge salad bar, with fresh lettuce and vegetables, and also with prepared salads that had nuts and seeds and fruit.  Another thing I loved at breakfast was a date and sesame spread to put on bread, which was absolutely delicious.  I also enjoyed a couple slices of halvah, which I won't even suggest is a health food, but it is a mixture of sesame and sugar.

Here's a typical lunch.  We had fresh hummus, baba ghanoush, pita bread, salad, chik peas, and I indulged and had a little bit of falafel.

Another treat for lunch was a Sabich sandwich.  Inside the pita, we had grilled eggplant, tahini, mango chutney, cabbage, and some other veggies.  Normally it comes with egg, but I had mine without.
I enjoyed some street falafel in Jerusalem.  I wasn't a big fan of the greasy french fries on top, so I didn't eat them.  Inside the pita was some of the best falafel I've ever eaten, along with hummus, tahini, and veggies.

Another bonus of eating in Israel, where most of our meals were kosher, is that if it's a "fleshig" meal, also known as a meat meal, there will be no dairy.  So, any ice cream served with a fleshig meal is by default dairy-free and vegan!

There was only one meal where I had no options, a bag lunch with "American-style" cheese or tuna sandwiches.  Luckily, we stopped at a gas station (!), and this is what they had to offer:

A gas station with a whole bunch of salads, hummus, and baba ghanoush.  I asked for hummus with some tomato and cucumber slices.

Needless to say, I ate well on my trip.

Saturday, November 05, 2011

Plan B

I signed up to run the Santa Clarita Marathon tomorrow.

My training was spot-on.  I ran 20.5 miles in 3 hours and 20 minutes, including a jaunt up Temescal and up and down the hills of the Pacific Palisades.  I've been doing my track workouts, strength training, cross training, listening to my coach, staying on my program.  If it's 5:15 am on a weekday, odds are I'm up and getting ready to workout before a long day at work.

Then, I spent 8 days in Israel during my two-week "taper" before the Santa Clarita Marathon.  In spite of a few evening indulgences of alcohol, I had some amazing runs -- 6.25 miles, and 8 miles, as morning runs along the Mediterranean coast in Tel Aviv just after sunrise.  I ran ten miles one morning in Jerusalem, where even in warm weather and on a hilly course I was able to keep a 9:30 per mile pace.  I even "ran" Masada -- up to the top, turned around and came halfway down, then back to the top, in 80-90 degree heat.
At the top of Masada
My taper running in Israel couldn't have been better.

Then, I flew back home on Monday night.  The flight was about 15 hours, and I sat next to an older man who kept sniffling.  Maybe he got me sick, I don't know.  I had a heck of a time adjusting to the time change -- the first few nights home, I found myself falling asleep by 8 pm and waking up at 3 am.  Then I developed a cold.

I thought this cold would pass, but it hasn't, and I feel lousy.  I don't get sick very often, but during the last race I ran, the Long Beach Half Marathon on October 9, I was getting over a viral gastroenteritis.  I finished with what most would consider a good finishing time (2:09), but it wasn't up to what I should have done.  After the race, I landed in the med tent for half an hour, unable to stand up for fear of vomiting or passing out, and it took an hour to walk the mile from the finish line to my car.  Long story short, I should not have run that race. 

And I'm taking that lesson to heart -- Santa Clarita is an important race for me, and I want to have my best marathon finisher time yet.  If I try to run tomorrow, I will feel lousy and be disappointed with my performance.

So, I'm completely bummed out, but I am skipping tomorrow's marathon.

However, I will not let my base training go to waste.  I am contemplating three different options:
--Santa Barbara Marathon -- Saturday, November 12, next weekend.  Rolling hills, similar to Santa Clarita, a point-to-point race that isn't all too scenic until the end.
--Malibu Marathon -- Sunday, November 13, next weekend.  Very hilly, especially over the last 8 miles.  Not a race where I will post a very fast time, but at least it's local and I might be able to talk my family into cheering me on at the end.
--California International Marathon -- December 4, a month from now.  It's relatively fast, with great crowd support, and a few rolling hills.  But it's in Sacramento, it's cold (28 degrees at the start line when I did the race 2 years ago!) and would require flying to the race.  And I don't feel like waiting another month to run.

I am leaning toward doing Santa Barbara.  In the meantime, I'll be resting (which I'm not very good at) and hoping this cold passes.

Monday, October 10, 2011

Coney Dogs and Detroit Lions

When I heard that Coney Dog, a Detroit-style hot dog joint, was opening up on Sunset Boulevard, I had mixed feelings.  It's always good to see my hometown represented in Los Angeles, but not as a restaurant that typically offers nothing for a vegan.

But.... when I heard that the place serves vegan hot dogs and vegan chili, I knew I had to try it out.  Tonight was the Detroit Lions' first appearance on Monday Night Football in ten years and seemed like an appropriate time to visit.

I had a California Jack.  Actually, I had two.  It's a vegan hot dog on a bun, topped with vegan chili, grilled onions, and mustard.  It's got a bit of a spicy kick to it, and it's good!!!  As the owners and their daughter worked the huge crowd filling the restaurant on this momentuous evening, one of the owners explained that they have a relative named Jack who moved to California and became a vegan, and hence the name of the hot dog.

You can also get several Detroit standards like Faygo cola (by the way, it's POP not soda), Vernors, and Stroh's beer.

Now, I'm not about to suggest that this is the healthiest food option around, but compared to a cholesterol-laden chunk of saturated fat that is a beef and pork hot dog, I'd say this is a pretty tasty choice.

P.S. The Lions won tonight!!! 5-0!!!

Sunday, September 18, 2011

Malibu Triathlon 2011

This was my last triathlon of the season... and while it's been a great season, I couldn't have asked for a better race to end things with.

I decided to race as an Athena (women 150lbs+) -- Malibu Classic Triathlon is a competitive race, and here is a place where I could have a chance of placing high.

Conditions were perfect, with the day starting a bit overcast, air temperatures in the mid-60's, and a water temperature of 65 degrees.

One of the down sides of racing Athena is that I start the race in the absolute last wave group.  As the gun went off, I ran into the ocean.  This is my first ocean race since my mishap south of Venice Pier a couple of months ago where I nearly drowned.  My once fearless approach to ocean swimming is now tempered with a significant amount of trepidation.  As we ran into the ocean, I dove under one wave.  Then a larger wave came, and I said, out loud, "oh my g-d", dove under it, came up hyperventilating.  It was quite a crowd of us swimming, so until I got around the first buoy, I stuck with breaststroke.  Once that turn was made, my breathing calmed down, and I swam toward the last buoy, sighting every four strokes.  After making the last turn and heading to shore, I was grateful to the lifeguards who yelled to us that there were big waves behind us.  I turned around, panicked for a second, dove under the wave, then turned around and came to shore.

Picture taken by Paul Hekimian of LA Tri Club, as I'm trying unsuccessfully to yank myself out of my wetsuit and run at the same time.

Coming out of the water, I was a bit disoriented, and I started running in the wrong direction.  I couldn't get my wetsuit zipper open, and once I finally did, I couldn't free up my left arm.  So, running into transition with my left arm pinned inside my wetsuit, I looked like a woman in a straitjacket.  It was an awesome look.  After that, to complete the whole klutz act, I couldn't get my bike off the rack, and then in moving my items one of the snaps came loose off my race belt and went flying off (I found it when I returned after the bike ride).

Swim time -- 16:09.  Last year's time was 18:55.

As I ran in from the swim, I saw one of the Athena racers running off with her bike.  As the bike has always been my limiter sport of the three, I considered her to be gone in all likelihood, with the possibility of maybe catching her on the run.

I guess I've gotten stronger on the bike, because I passed just about everyone on the course.  Over the entire 18 miles, only three passed me.  And, at mile 7, I passed the Athena woman who I knew was ahead of me.

And a point of bike etiquette:  When you pass, say "On your left".  Or "Hi."  Or "I'm passing you."  I spent many years being the slow girl on the bike (and amongst some groups I still am) and having people whizz by me within inches and not say a word to warn me.  I said "On your left" maybe a hundred times.  Clilmbing PCH out of Leo Carillo, gasping for air, it was shortened to "Left."  But, out of courtesy, I still warned those that I passed.
Bike time -- 58:49.  Last year's time was 1:03:37.

I love the run course -- along Zuma Beach and back.  The fact that it's out and back means I get to see many of my friends and teammates who are both slower and faster than me, which is always fun.  My first miile was 8:13, and I got slower from there, which wasn't good, but I still averaged 8:34 per mile over 4 miles.

Photo courtesy of Paul Hekimian of LA Tri Club

Run time -- 34:16.  Last year's time was 36:45.

Crossing the finish line.  Photo courtesy of Marvin Suntonvipart.

Overall time:  1:55:11.  Last year's time was 2:05.

I won first place out of 32 women in the Athena category!  But it gets better -- had I raced in my age group, I would have taken 8th place out of 83, which is the top 10% of the age group, which means that I have qualified for USA Triathlon Age Group Nationals 2012!!  The race takes place in Burlington, Vermont, and I've always vowed to myself that if I ever qualify for an event that I will go there and do it, so it looks like I have a little summer vacation for next year!

Some fabulous friends who raced, and even more awesome friends who cheered us on today.
I could not have asked for a better ending to my triathlon season.  Thanks Coach Gerardo for your coaching wisdom, thanks Team Fortius for being awesome training partners, thanks Kiki my personal trainer for pushing me to be stronger, and thanks to all the plants that I eat that give me the fuel to be an athlete. :)

Thursday, September 15, 2011

Vegans are the ONLY Normal Weight Population!

When classified by diet, a recent study found that people who are omnivores, who follow the Standard American Diet, are the heaviest, with an average body mass index of 28.8.

Flexitarians, who eat meat infrequently, weigh less, but are still overweight. 

Vegetarians, who do not eat meat, but may eat dairy or eggs, weigh even less, but even they are on average within the category of being overweight.

Vegans, who do not eat any animal products, are the only one of these four groups who are on average a NORMAL weight!

Watch a video discussing the findings from this study from the Journal of the American Diabetes Association here:

And while you're there, explore Dr. Michael Greger's web site,  There's some great information there, and Dr. Greger delivers the facts with his unique sense of humor.

Monday, August 29, 2011

Coronary Calcium Screening -- Does Everyone Need One?

I watched Sanjay Gupta's special "The Last Heart Attack" yesterday.  I had eagerly awaited it because I knew he would be talking to Bill Clinton, Dr. Dean Ornish, and Dr. Caldwell Esselstyn about plant-based diets and heart disease. 

We heard from one woman with a prior heart attack who turned down bypass surgery and is doing well by taking her medications and following a plant-based diet.  And, Bill Clinton discussed how he's changed his diet to improve his health as well.

An interesting aspect of the show was the discussion of coronary calcium scans.  Sanjay Gupta interviewed Dr. Agatston, the physician who came up with the concept of the scan, and ironically is the author of The South Beach Diet.  Dr. Agatston states that coronary calcium scans are "the standard of care."

I would disagree strongly.

A coronary calcium scan looks for calcium in the arteries of the heart.  If the scan finds zero calcium, that would indicate that a person's likelihood of a cardiac event in the next four years is essentially zero.  However, if you have a score greater than zero, you do have some risk.  The higher the score, the greater the risk.

But, it's not a harmless test.  It comes with a significant dose of radiation -- 2 to 3 milliSieverts, or the equivalent of 8 to 12 months of environmental exposure.  Further, the test doesn't tell us how tight narrowings are, and can't accurately state that a patient needs angioplasty or bypass surgery.  For these reasons, your HMO insurance likely won't cover it either.

Stress testing is still the standard of care because stress tests identify functional abnormalities -- in other words, they identify portions of the heart that may not get enough blood with stress, and these areas when revascularized (with bypass surgery or angioplasty) will provide symptomatic relief.

I had a patient recently come to me with just about every risk factor imaginable -- he's diabetic, high blood pressure, high cholesterol, strong family history of heart disease, and a history of smoking.  He wanted a calcium scan.  He didn't need a calcium scan to tell me that he's high risk.

I think a coronary calcium score might be reasonable to better risk-stratify someone at intermediate risk, or to help motivate someone who otherwise would not make lifestyle changes.

But, the bottom line (as it often is):  If you don't want a heart attack, live clean -- eat healthy, exercise, maintain a healthy weight, and don't smoke.

Monday, August 22, 2011

Heart-Attack Proof Diet??

Bill Clinton has been a vegan for one year. As a result, he's lost weight and feels well and has had no further need for invasive interventions to his heart.

Tune in to CNN on Saturday, August 27.  Sanjay Gupta is hosting a special called "The Last Heart Attack".  He talks to President Bill Clinton about his new diet, and to Dr. Caldwell Esselstyn, author of the book Prevent and Reverse Heart Disease.

See a clip from the special here.  I'll defnitely be tuning in.

Sunday, August 21, 2011

Hansen Dam Triathlon

I've done an Ironman and several half-Ironman distance races.  But I still love small races too.  It's a chance to just go full-steam and give it what I've got.

Today's Hansen Dam Triathlon was a 500 yard swim, 11 mile bike, and 5k run.

This is me and my friend Kenny, who was doing his first triathlon today!!
I decided to take a slightly different strategy on the swim -- start at the front of the wave, go all out on the start, and push myself all the way through.  When the gun went off, there were about a dozen or so women who powered in front of me, but shortly thereafter I think I passed a couple of them as we rounded the first buoy.  On this rectangular course on a man-made lake, sighting the buoys for the turns was not a problem.  Swim time:  10:55 -- a minute and a half faster than the last time I did this race.  I was the fifth woman (out of 33) in my age group out of the water.  I credit my coach Gerardo Barrios with leading an awesome swim workout on Tuesdays and Thursdays and scheduling me to (begrudgingly sometimes) swim 3-4 times per week.

Not my strength.  Long legs=crappy levers.  That's my excuse.  One woman who finished the swim at the same time that I did went flying away on the bike.  I tried to keep her in sight but she was gone!  The bike had a couple of hills, but most of it was flat, along the roads around the park and over the Hansen Dam.  Two women passed me on the bike.  I was surprised there weren't more people who passed me.  Bike time: 33:22.  Over 3 minutes faster than my 36:43 of two years ago.

There's an important rule in triathlon -- Never try anything new on race day.  Which would suggest that maybe I shouldn't have decided to try running without socks.  I figured it would take some time off of my second transition.  And it did.  But now I have a couple of blisters in my arches.

In short races, the run is my strength of the three sports.  I managed to catch the woman who flew ahead of me on the bike course.  The run took us through some trails of the Hansen Dam Recreation Center.  Now, the run is supposed to be a 5k, but I measured 3.21 miles on my Garmin.  At water stops, I'd grab a glass of water, take a sip and dump the rest on my head.  There were a few inopportune hills, like the one that is a quarter mile from the finish line.  I powered through that last hill, joked with the guy who I had run the last half of the trail with by yelling, "Don't let yourself get chicked at the finish!" as he, as a result, sprinted to the finish line just ahead of me.

(the definition of the word "chicked" is allowing oneself to be beaten in a race by a woman)

Run time:  27:47.  Two years ago was 24:49, but I really believe they made the run longer this year.

Overall time:  1:14:45.  Two years ago: 1:17:37.

Awards Ceremony -- "Podium"!!!!

Second place (out of 33) in my age group!!!  This would be my first time racing in LA in which I have podiumed in a triathlon in my age group.

So, getting older, getting faster -- a great day at Hansen Dam!!!

Sunday, July 31, 2011


Chef AJ is one of the most interesting people you'll meet.  At the beginning of her classes, you will hear "I Will Survive," with her own singing and lyrics, dancing, and even a handstand in front of her food processor as she sings (yes sings!) about the benefits of whole, plant-based foods.
While her teaching methods are certainly unorthodox, her message is clear:  Processed foods are unhealthy, and following a whole-food, plant-based diet is not that hard.  And, if you can't get to one of her classes, you can read her book, Unprocessed

Chef AJ talks about the many challenges she has faced in her life -- eating disorders, a miscarriage, and a health scare -- that led her to the way of eating that she so passionately preaches.  As she says it, on page 2:

My simple rule of thumb is this:  If I can make it in my kitchen, using whole ingredients, it's unprocessed.  I can cook lentils and add carrots and and onions and spinach to make a soup, so that's unprocessed.  I can blend fruits together to make a smoothie, so that's unprocessed..... But I can't make a Fruit Loop.  I can't slaughter a cow.  I can't make vegetable oil, so any recipe calling for oil involves a processed ingredient.
It's simple, but it makes sense.  Not only does she tell you how to become "unprocessed", but she includes several of her simple yet delicious recipes.  An invitation for dinner at AJ's house is one I'll never turn down, because I know I'll get healthy food that tastes incredible.  Her recipes are straightforward, and I've made several of them, including a couple that I've blogged about.  My favorites are her Hail to the Kale Salad (page 122) and Chef AJ's Disappearing Lasagna (page 100).

If you're looking to improve your diet and get healthy, this book is for you.

Monday, July 18, 2011

Vineman 70.3 Race Report

I've raced this three times, and this was my best performance.  But I could have done better.

If something could go wrong during the week leading up to the race, it did.  You can read below about my misadeventures in the ocean from last Sunday.  That managed to truly screw up my left shoulder, and on the following day while swimming with my niece I felt pain with every single stroke in the water.  Then shortly thereafter I got sick with a cold.  Coach Gerardo basically had me stop working out, which of course was the right thing to do, but when I go from my usual daily exercise to zero exercise, my mood changes and I feel like a sloth.

On Sunday, my shoulder still felt a little funny.  I joked that the worst case scenario would be that I would do a 1.2-mile one-armed drill.  Or, since the Russian River, where the Vineman swim takes place, is so shallow, I could walk the whole thing.  And, though I felt better from my cold, I was still bringing up some funky-colored mucus.

My goal was 40 minutes.  The swim start was a mess as usual.  The shoulder felt a little funny at first, but any discomfort was gone within ten minutes.  I finished the swim in 39 minutes.

My weakness.  I was consistent, but I got passed all over the place.  One woman in my age group decided to pass me on the right.  When I suggested that was unsafe, she yelled "Bitch!" at me.  I love our sport most of the time, but such unsportsmanlike conduct is just unnecessary.  I have never had so much snot come out my nose during one bike ride.

I'm a decent runner, and in a sprint or olympic race I can fly by dozens of people on the run.  But, my runs during my last few long races have been less than stellar.  Coming out of T2, I felt great.  I ran the first mile at what felt like a comfortable pace, which ended up being 8:50.  Mile 2 was completed in 9:30.  Mile 3 was 10:00.  And my mile splits got worse from there.  I didn't feel tired, but my pace fell.  The balls of my feet hurt like hell, especially running the trails around  the vineyard.  Gradually, as we got back onto solid pavement and downhill running, the feet hurt less.  Then my stomach began to grumble.  For those of you who don't know, distance running increases gastrointestinal motility.  My stomach grumbled more.  Then, around mile 11, I made a rather urgent port-o-potty stop.  Thereafter, my stomach felt so much better, and the last two miles flew by.

I was grateful to see Fortius teammates Mike, Karen, Joe, and Ray just around the corner from the finish line.  Their encouragement really pushed me, though I had to ask Joe and Ray to stop running with me so I didn't get disqualified for outside help.

My Finish Time:  6:27:08. 
That's eight minutes faster than my previous attempt at Vineman 70.3, and my best half Ironman time ever, all in spite of still being sick and injuring my shoulder.  I wanted to go 6:15, and under better conditions, I could have done it.  But I also want to troubleshoot my run, why I'm so much relatively faster running a shorter course than I am on a longer course.  That will come next season -- I'm done with long course triathlons for the year.  I have two shorter races, Hansen Dam and Malibu, and plan on running a fall marathon.

Sunday, July 10, 2011

I'm No Chicken of the Sea

The ocean is a funny place.  Some days it's quiet, and then without warning it's not.

I have a race one week from today, Vineman 70.3, which is a half-ironman distance race.  At this point, as my coach likes to remind us, you can't do anything to make your race better, so now is the time to taper and be ready for race day.  To that goal, I had a 45 minute open water swim on my schedule for today.

The "Chicken of the Sea" swim with the LA Tri Club takes place at 8:30 am on Sunday mornings.  It is called "Chicken of the Sea" because the location is sheltered by the Marina, and is considered ideal for those who are nervous about waves in the ocean.  We swim north toward the Venice Pier, about a mile away.

Now, I'm no "Chicken".  I've lived in Los Angeles for four years and during that time have done numerous ocean swims.  I join the Tower 26 group every Wednesday morning during the summer, where we practice entering and exiting over and over again.  I was on call until 9 am, so I entered the ocean a bit later than everyone else, so I was swimming alone.  But, I did see a member of my team there and said hello to him at the start, so that someone knew I was there.

I entered alone and swam alone, though there were several swimmers in the area.  The water was a bit wavier than usual.  I did my swim on my own.  I kept it at a leisurely pace since I have a race coming up next week.  It was uneventful.

About forty minutes later, just a few hundred yards from the Venice pier, I prepared to exit.  Initially, the water was pretty flat.  And as I headed to shore, I swam looking behind me periodically so I would not be surprised by any major waves.

A few hundred feet from shore, a rather tall wave approached.  I'd say it was about six feet high.  I prepared to dive under it.  As I dove under, I got caught in the wave and was dragged forward.  My left arm twisted and I felt it pull hard.  I think I was dragged to the floor and it felt like eternity before I came up again.

But as soon as I could stand up, another big wave came.  Barely having caught my breath from the previous wave, I tried to dive under, but similarly, I was dragged with it.  And I stood up again coughing, not sure which direction I was facing.  Another wave was coming.  I thought I was in front of a lifeguard tower, but might have been dragged in one direction or another, because I didn't see the tower any more.  I could barely speak but I put my hands overhead hoping to get attention from someone on the shore.  But I didn't get a chance as another huge wave pounded me.  As I was dragged underwater this time, I lost my swim cap and goggles.

I was absolutely wiped out, gasping for my breath.  Again I put my hands overhead and yelled "Help!"  I have no idea how loud I yelled.  Probably not very loud.  Unfortunately, I didn't get anyone's attention.  Fortunately, the waves calmed down and I was able to get to shore.

I sat down on the sand, heart still pounding, still gasping.  As I sat there, another club member came by, and asked if I was ok.  I was calm by then, and I walked with him back to where we had started our swim.

In the end, I have a strained left shoulder and right groin muscle, which seem to be calming down after I iced them.  I had a throat full of sand, my ears were packed with sand, and even hours after this adventure, whenever I lean foward salt water and sand drain out of my nose.

The ocean and I need to spend some time apart for now.

My lesson from today is that even if I know people at a swim, I can't be swimming alone, even if I am experienced.  Another swimmer with me might have been able to pull me in when I tired out, or could have been more effective at getting the attention of a lifeguard.

The other lesson is that no matter how calm the reputation of the water where I'm swimming, conditions can change, and I need to be ready.

Tuesday, July 05, 2011

Diet Myths

There are a few statements when it comes to food that I have issues with:

"Don't eat carrots.  They have too much sugar."
How many people are too heavy due to eating too many carrots?  If carrots are the true culprit of your diet, then you eat far better than I or anyone else does.
"I avoid pasta and bread."
There's no need to avoid bread and pasta.  Stick to whole grains.  And remember what a portion size is -- 3/4 of a cup of dry pasta, or 56 grams, is 210 calories.  Measure it out.  You'd be surprised how small it is compared to a standard restaurant serving size of pasta.  And, when you go out to dinner, stay away from the bread basket, especially if you are getting a pasta dish or meal with bread  in it.

"I don't eat red meat.  I eat lots of chicken and fish."
I wrote a whole post on this subject.  An animal is an animal is an animal.  Why should an animal of one species be so "good" for you an another be "bad"?  Beef, chicken, and fish have the same quantities of cholesterol.  And, lean beef and chicken have similar quantities of artery-clogging saturated fat.  So, if you really want to do yourself a favor, cut back on or get rid of the animals from your diet.

Monday, June 27, 2011

Come Take My Class!!!

I will be teaching a three-session class, along with Jeri Gertzman, a Registered Dietitian, on "Plant-Based Nutrition for a Healthy Heart".
It is a three-session class where you will learn why a plant-based diet is optimal for health, and how this diet can prevent and even reverse heart disease. We will even feed you with delicious food!!!

There are two three-session classes scheduled: July 18, 25, and August 1, and September 12, 19, and 26.
The cost is $15 per session or $40 for all three sessions.
Classes will take place at my office from 6:30-8:00 pm -- 7325 Medical Center Drive, Suite 300, West Hills 91307.

Call (805) 210-7411 or email to register.
Image from

Sunday, June 26, 2011

Breath of Life Triathlon -- Race Report

Today I raced the Breath of Life Triathlon, an olympic distance race -- 0.9 mile swim, 24.8 mile bike, and 6.2 mile run.

The race took place in Ventura Harbor and along nearby roads.  Previously, the race was held at San Buenaventura Beach, which meant the swim could be choppy, but the run was scenic along the boardwalk.  This time, the swim was calm and the run had unexciting views.

I had my goals -- 28 minute swim, 1:25 bike, and 53 minute run.  I met them all -- 26:48 swim, 1:23:38 bike, and 52:50 run.

The swim start wasn't too crowded, which is always nice, to avoid getting kicked and elbowed.  But there were some very aggressive women in my group, so it was a tough start.  We swam two loops, jumping out of the water and running across a timing mat on the sand between the loops.  I sprinted out of the water after the first loop, perhaps showing off, and dove right back in.  This expenditure of energy ended up being counterproductive because after landing in the water again, I ended up pretty winded for the next minute or so, and spent about 15 seconds doing breaststroke catching my breath.  That said, none of the 3 or 4 people who I passed on land passed me in the water.

The bike was flat and dull.  One woman coming out of the transition area at the same time remarked that she didn't have a gel with her.  I gave her one of mine.  She then proceeded to draft off of me for the first four miles of the race.  When I passed her, she acknowledged she was drafting me and suggested we draft off each other for the remainder of the race.  While drafting was a tempting proposition, drafting is not legal in this race, so I pulled ahead and stayed away from her. 

We rode three loops around a few farms on a mostly flat course.  I have definitely become a faster cyclist, as I was able to maintain an average speed of 18.2 mph on my bike.  I was passed by lots of men with fancy wheels and helmets, but not by too many women.  If I'm riding 18-20 mph, I think I can get over someone flying by me on their bike.

The run was an out-and-back, through the harbor and then along a really boring road with not much to see other than the strawberries across the street and runners and cyclists.  But, on an out-and-back, it is easy to know who is in front of you and who is behind you, in case you feel competitive.  Which, sometimes I do :) Though I know I'm not going to win the race, I like to see how I'm doing relative to others.  And I like giving the occasional high-five to my friends who are racing.  I dropped my pace a bit toward the end of the run, but stayed between 8:15-8:43 per mile.

Total finishing time: 2 hours and 48 minutes and 39 seconds.  This was my best time on an olympic distance course, so I am very happy.

Thursday, June 23, 2011

Do Patients Really Listen?

Am I wasting my breath when I suggest eating better, exercising, and losing weight?

A lot of doctors think so.

I was discussing this with another physician this evening.  Often, our solutions are pills -- you have high blood pressure, you get a prescription for amlodipine.  You have high cholesterol, you get a script for simvastatin.  You have palpitations, you get atenolol scribbled on a prescription pad.

But, what about diet and lifestyle?  If, to lower your blood pressure to a normal range, you could cut back on the sodium in your diet, eat less fast food and more fruits and vegetables, would you do it?  Or what if cutting back on (or better yet, eliminating) animal foods would slash your LDL cholesterol drastically without the need of a pill?  Or, if cutting out your morning latte would eliminate your palpitations, would you do it?

True, many patients are set in their ways, or have emotional barriers that keep them from living a healthy lifestyle.  But, I think patients are more motivated than we give them credit for.  If the option is lifestyle change or a pill, I don't believe that most people will chose the pill.

Friday, June 17, 2011


Running track is one of my favorite workouts.  It's full of adrenaline and pure speed, and yet also of learning to pace oneself.

I had not run track in over a year and a half.  I was busy training last year for an Ironman, and there has also been the barrier of my office being far from the track.

But, the track is what has helped me go from being a 4:57 marathoner to a 4:12 marathoner, and hopefully even faster than that in the near future.  I am grateful for all of my gains in running over the past couple of years, but I still want to one day run a marathon fast enough to qualify for the Boston Marathon.

Recently, I made a decision:  I love the track, and as I need to get faster, I need to get back to the track.  Unfortunately, my workplace is in West Hills, and the Los Feliz Flyers track workout is at Caltech in Pasadena.  And I have two dogs at home eager to go outside.  It's a tight commute, but I make it to track by 7 pm.

There are two groups at the track:  The fast group, and the TOG's (aka The Other Group), the slower group.  My pace makes me one of the faster TOG's, or it makes me the caboose of the fast group.  When I last ran track, I was running with the faster group.  And upon returning, I thought that's where I would start again.

The first track workout in a year and a half was a bit of a disaster.  The workout was 400 repeats, or one lap around the track.  I nailed the first one in 1:36, and smiled at our coach Don, like "hey look at me, I haven't gotten slower, I still have it!".  Then the next lap was 1:39.  Then 1:42.  Then 1:44.  I kept falling farther and farther behind on each lap.  My heart rate was approaching 190 on each lap and barely came down with the short rests between laps.  I was beat!  I knew I'd blown up, and ended up quitting mid-workout.

Over the past several weeks, I've been running with the TOG's.  I'm still one of their faster runners, but running with that group has helped me to not go out all guns ablaze, so to speak.  And, even in six weeks of track, I'm faster than I was before I started this little stint.  I ran a track mile in 7:09, my fastest ever, and my brick runs (running after getting off the bike) lately have been consistently faster.

My short-term goal is to get a bit faster and join the fast group.  Long-term, my goal is to qualify for the holy grail of marathons -- Boston. 

Boston 2013, look out, here I come!

Tuesday, June 07, 2011

AIM-HIGH? Not so high apparently.

Some things in medicine seem like common sense, but they are not.

Since heart disease and osteoporosis increase after menopause, when estrogen levels drop, it was thought that supplementing estrogen would help.  Then the WISE study demonstrated that there may actually be harm in taking estrogen.

Diets high in fruits and vegetables, which in turn are high in vitamins, nutrients, and phytochemicals, lead to decreased risk of heart disease.  So, it would make sense that vitamin supplements would help, right?  Many studies and meta-analyses have looked at whether supplementing B vitamins, vitamin E, folate, or coenzyme Q10 would reduce the risk of heart disease.  Not a single study has shown that vitamin or mineral supplementation reduces heart disease.  In fact, vitamin E supplementation may increase the risk of stroke.

But niacin was thought to be different.  Niacin raises HDL ("good cholesterol") levels and lowers triglycerides and LDL levels.  Several small studies showed that niacin alone might reduce risk of cardiovascular events.  Therefore, it was thought that if some is good, then more is better.

The AIM-HIGH trial of more than 12,000 patients already on statins with controlled LDL cholesterol sought to determine whether addition of long-acting niacin would further reduce cardiovascular events.  However, the trial was recently stopped early because patients showed no decrease in cardiovascular events, but did experience an increase in risk for stroke.  This increase in stroke was somewhat surprising, and there is no obvious explanation for the small but significant increased risk of stroke.

Another drug, torcetrapib, a CETP-inhibitor, which raises HDL, was studied a few years ago as a hope for patients with heart disease.  However, studies showed increased all-cause mortality amongst patients on a combination of a statin and torcetrapib.

Dr. Neal Barnard of PCRM, the Physicians Committee for Responsible Medicine, has an interesting take on the subject. Artificially raising the HDL with medicine like niacin may not be what helps people live healthier and longer. The key may be healthy diet and exercise, which in turn raise HDL levels.

Better living doesn't necessarily come from better pharmacology.  Healthy diet and lifestyle are still the cornerstone of reducing heart disease risk.

Saturday, June 04, 2011

Go See Forks Over Knives!

I finally saw Forks Over Knives this week.  It's a movie about how eating the right foods can reverse disease and save your life.

The message is simple:  You are not doomed to a life of disease, even if it runs in your family.  You have the power over what you put into your body.  And, if you choose the right foods, particularly by following a plant-based (or as firefighter Rip Esselstyn puts it, "plant-strong") diet, you can avoid and reverse many diseases.

As a physician, the part I found interesting was observing Dr. Matt Lederman of the Exsalus Wellness Center conselling patients.  The Exsalus Wellness Center, based in Los Angeles, is run by Dr. Lederman and his wife Dr. Alona Pulde.  Their approach to health includes a plant-based diet.  I think the concept of a wellness center is pretty cool.  From hearing Dr. Lederman speak, I understand that he spends two hours of time with a patient for a new consultation.  And, the patients who come to Exsalus are in many ways self-motivated -- as Exsalus does not directly accept insurance, the patients who are there have directly sought out Drs. Pulde and Lederman.

I'm a bit envious of them -- I'd love to have two hours to spend with each new patient.  And I'd love to have a patient population eager to soak up knowledge about a plant-based diet.  But, perhaps that's part of the challenge of what I do.  While many patients seek me out knowing my approach to patient care, many see me by default because they are sent to me by their primary care physician.

Nonetheless, I think that the message of self-determination can ring true in just about any patient.  When given the option, "I can give you a pill for this, or we can try to reverse this with diet and exercise," most patients will choose the latter option.  And, this is an opportunity to get across to patients that they CAN change their lives just by what they choose to eat.

Forks Over Knives is one powerful movie -- it can change your life.  No joke.

Monday, May 30, 2011

BBQ -- Vegan Style

I could talk your ear off about how tasty a healthy vegan meal can be.  Or I can just feed you fabulous food.  Yesterday, I threw a backyard BBQ.  Here's what I served up:

Kebabs with peppers, tofu, baby bella mushrooms, grape tomatoes, and pineapple, marinated in Soy Vay sauce.

A big salad full of organic lettuce, grated carrots, peppers, cucumbers, pear, mango, cinnamon almonds, cilantro, and dried cranberries.

Hors d'oeuvres -- cut up veggies, jicama, hummus, salsa, and (in the upper right corner) Texas Caviar, which consists of peppers, black and pinto beans, cilantro, jalapeno, vinegar, and date syrup.

More hors d'oeuvres -- to the left is a bean dip with vegetarian refried beans, guacamole, Tofutti sour cream, and Daiya vegan cheese.

"Crab cakes" made by Lisa K., from tempeh and some other ingredients, baked not fried.  Yum!

Mom's chili -- made from a mix by Fantastic Foods, but with a few variations, including canellini beans and Muir Glen fire-roasted tomatoes.

And, you can't forget dessert!!!  Chocolate brownies with chocolate frosting, and carrot cake.

Sunday, May 22, 2011

Chest Pain

If you have new chest pain, see your doctor.  That's the most important thing I'm going to write today.  Plain and simple.

Some people are embarrassed that they're making a big deal out of nothing.  And to be honest, less than half of the new patients that I see with chest pain actually have pain due to heart disease.  But, I have encountered a man in his mid 30's who attributed the pain in his chest that he got whenever he exercised to "gerd", or reflux.  At 37 years old, he had a heart attack and underwent emergent bypass surgery.

Many things cause chest pain, other than heart disease -- a pulled muscle, inflammation of the cartilage of the ribs, esophageal reflux, esophageal spasm, anxiety, depression, injury, amongst other possible causes.  But do not wait -- get it checked out.  See your primary care doctor, and if needed, come see me or another cardiologist for an evaulation.

Sunday, May 15, 2011

Tofu Scramble

This is so easy, and so healthy!
Microwave a sweet potato until soft, allow to cool, remove the skin, and cut into cubes.  Combine in a wok: Cubes of extra firm tofu, sweet potato, spinach leaves, salsa, turmeric, garlic, and either a splash of soy sauce or Bragg's liquid amino acids.  Cook for about ten minutes and serve.  

Thursday, May 05, 2011

Steak House Dinner

I eat healthy, and so do a lot of people.  Not everyone else in this world does.  But I realize I need to be able to roll with the punches in life, so to speak.

Last week, I attended a cardiology educational meeting at Arnie Morton's steak house. Now, I won't even start on the irony of learning to treat coronary disease in the setting of a steak house. I do realize, though, that every so often we end up by social necessity eating at a restaurant that we would not typically choose on our own.

As you might imagine, Morton's doesn't have a tofu stir-fry or lentil loaf on the menu. However, I spoke with our server Heather (fabulous first name, no?) and asked her what the chef could prepare. I ended up with the chopped salad with no bacon, eggs, or cheese, and with a mustard dressing, and for my entree a plate of steamed vegetables, a baked potato, and a side of soy sauce:

I must say, the steamed veggies were quite delicous.  It was a huge plate and I didn't finish everything, but I did polish off all the spinach, broccoli, tomatoes, mushrooms, and about half of the asparagus and brussel sprouts.

Would I have enjoyed a more interesting dinner, perhaps with a protein, just like my colleagues enjoying their steak or fish?  Sure.  But, I think that as a vegan, it's important to go to restaurants that don't solely cater to non-meat-eaters.  If they have enough of us as customers, perhaps one day they'll put something on the menu for us.

The most important point:  You can get a good healthy meal at just about any nice restaurant.  You are the customer.  Just ask.

Tuesday, May 03, 2011

Wildflower 2011 -- A Tough Day for a Personal Best

Wildflower is a favorite race of mine -- the second toughest half-Ironman distance course in North America (1.2 mile swim, 56 mile bike, 13.1 mile run).  The course is infamous for its hilly bike and challenging trail run.  Wildflower is also known for its camping experience.

I've raced Wildflower previous years, and I've camped out in my tent, shivering and miserable, barely getting any sleep.  That has made racing even more challenging, and particularly led to a less than stellar race for me last year.  I vowed that if I ever came back to race that I would not be camping.

When a couple of friends  invited me to join them in renting a house, I decided that I wanted to give Wildflower Long Course another shot.  And, with eight hours of good sleep and weeks of hard training, I was ready on race morning.

The beginning of the swim was more crowded than I had remembered.  Perhaps it felt crowded because I haven't been in open water since September.... oops :)  But, after rounding the first buoy, the crowd dispersed and I settled into my stroke.  Halfway through the swim, I felt waves.  I could see a Sheriff's boat circling, and a couple boats next to them.  I have enough open water experience that even though I was expending some extra energy, I had no trouble getting through them.  I could see a couple of women around me who had started the race before I did and I could tell they were having a tough time with the choppiness of the water.

As I swam, I noticed one of my old bad habits -- I use the swim caps in front of me to determine which way to swim, as opposed to sighting off of a landmark like a buoy.  If I ever become a swimming frontrunner in a race, I will be in big trouble.  But that likely won't ever happen.

My goal was to swim in 40 minutes.  I finished in 40 minutes and change.

The Wildflower bike course presents challenges of its own.  Coming straight out of the transition area, riders head straight up Beach Hill.  That's me beginning the climb:
Beach Hill is steep and it's nearly 2 miles long.  It would be easy to stand on the bike, grind out the hill, and trash my legs, but then again there are 54 more miles to ride. After that are some rollers. Lots of people pass me. I'm used to that -- the bike is my weakness. Then the road flattens out.  And then we picked up a really strong headwind.  I'm pedaling hard and I feel like I'm barely moving, but my bike computer tells me I'm only moving at 10 miles per hour!  So of course I'm thinking, what's wrong with me, but as I think about it more, no one is passing me, so it must be the wind.

After 8 or so miles of miserable headwind, we turn right onto Jolon Road, where the headwind becomes a side wind (is that the term for it?  I don't know, but I think you understand what I'm saying).  The wind is blowing me to the right, and at times I have trouble staying upright on my bike.  And finally, the wind seems to settle down just as we reach the infamous Nasty Grade hill at mile 42.  I felt okay, and after weeks of hill riding, I sailed up the hill, passing at least 20 riders, and not a single one passing me.

My goal was 3:40.  This took me 3:53.  I blame the wind.

After that grueling ride, we now get to run 13.1 miles of trails.  The first six miles are the toughest, with plenty of steep hills.  A lot of people walk at this point, but I ran up all of them except for three particularly steep hills that I power-walked.  The balls of my feet were absolutely burning -- if I stepped on a rock, they would hurt even more.  But, as I kept running, the pain got to be bearable.

After the trails, we run through the campground, with plenty of cheering.  And that's about where this picture was taken:
Next was an out-and back uphill and down, and then back up and down again, and a small hill and then a long descent of about half a mile into the finish.

I finished the run in 2:22, which was around my goal of 2:20.

My time:  7:04:11, beating my personal best by seven minutes.  A tough day, but a good race for me.

Saturday, April 23, 2011

Forks Over Knives -- The Movie

If you are concerned about heart disease, you need to see this movie:
"If the truth be known, coronary artery disease is a toothless paper tiger that need never, ever exist and if it does exist it need never, ever progress." -Caldwell Esselstyn, M.D.

Thursday, April 21, 2011

My Big Fat Vegan Passover Seder

"What do you mean, you don't eat no meat?.... That's ok, I make lamb!"
Quote from My Big Fat Greek Wedding

For my first seder that I prepared on my own, I thought I'd have my family and a couple of friends, and it would be a small festival.  But, as I put the word out, many people were looking for a seder, some had never attended one and wanted to know more about Passover, and others were just curious what a vegan seder would be like.  Next thing I knew, I had twenty guests in my home!!!

Seder Table -- Seder plate, matzah, and small glass of wine for Elijah the Prophet

My 5 1/2 year-old niece painted the seder plate.  She painted all the spots on the plate except for the spot for the shankbone, "Because we don't eat meat."  Cute.  In place of the bone, I placed a few beets on the plate, and a vegetarian friend brought his very own "tofu shankbone."  Traditionally there is an egg on the plate to represent the spring; instead we had a flower.

Passover has become a holiday of excessive processed foods, cottonseed oil, fat, and too many eggs.  Clearly, this is not the case in my home.  This is a Vegetable and Matzah Casserole from The Vegetarian Pesach Cookbook by Roberta Kalechofsky:

Matzah farfel, layered with sauteed eggplant, tomatoes, mushrooms, and peppers, covered with more whole wheat matzah farfel and tomato sauce.

Russian Potato and Mushroom Croquettes from Debra Wasserman's The Lowfat Jewish Vegetarian Cookbook:

I also served matzah ball soup based on the Post Punk Kitchen recipe, using tofu instead of egg to hold the balls together (I observe a sephardic Pesach, so I do eat soy and other kitniyot).  Mrs. Feinberg's Kugel, one of my favorites, made from sweet potato, apple, and carrots also made an appearance and was polished off quickly!

And you cannot ever ever ever forget dessert!!!!  One friend brought one of the infamous box mixes of brownies, but she used flax seed instead of eggs.  It came out quite good!  This is the No Bake Chocolate Matzoh Roll from The Vegetarian Pesach Cookbook.

And, what kind of holiday is it if the pets don't get to participate?  Here, my dog Curves eagerly finds the afikoman, or hidden matzah! :)
It should be the youngest child who finds the afikoman, not the youngest dog, right?  My mischevious dog Curves.

Have a joyous Pesach, and please, go easy on the eggs!

Sunday, April 17, 2011

Training for Wildflower Long Course

It's been a bit too long since I've posted.... so I will update you on my training.  Coming soon, you'll get to read about my first Passover seder that I've hosted.  I will be having about 18 people at my home and the seder will all be vegan (and cardiologist-approved!)

51 mile bike ride yesterday -- climbed both Latigo and Mulholland!

I am again doing Wildflower Long Course -- a half Ironman-distance race (1.2 mile swim, 56 mile bike, 13.1 mile run) which is one of the toughest in North America.  The bike course is hilly, as is the run which more than half of it is on trails.

This year, I've switched coaches to Gerardo from Fortius Coaching.  He's definitely having me train harder than I ever have for a half-ironman distance race.  Rather than the 12-hours per week that I've become accustomed to when getting ready for one of these races, I'm doing 16-17 hours per week of training.  He also has me doing far more hill work on the bike and running.  I can't remember the last training run that was completely flat!

Two years ago, I finished in 7 hours 11 minutes.  Last year was a disaster due to a busy few days at work beforehand, and my inability to get any sleep at the campground before the race.  This time around, I'm not camping -- after all, I hate camping.  A group of us is renting a house.  So, I plan on being well-rested with the chance of finishing in under 7 hours.

Saturday, April 02, 2011

Time to Start Exercising!!!

What's your excuse?

I've heard them all.  But, it's time to see the excuse for what it is, realize that exercise is crucial to good health, and start or get back to making it a habit.

A good goal for everyone is to get at least thirty minutes of cardiovascular exercise most days of the week -- this is exercise that is sustained and keeps the heart rate elevated.  This means a heart rate of 60-85% of your predicted maximal heart rate, though an easier gauge of exertion is that you should be able to carry on a conversation, but talking should be just a little challenging.

Here are some of the excuses I hear every day:

"I'm too tired"
Exercise gives you energy.  The more you move, the more energy you have.  If you don't move, you have less energy.

"I have no time"
Your body and your arteries could care less how much "time" you have.  Make the time, it's important.  Do you have ten minutes during your lunch break to get outside and walk?  Do you have a couple minutes before dinner, or after dinner?  I'm sure you do.  I fit it in by getting up early in the morning, often 5:00 am, to get my workout in before I see patients.

"I have arthritis -- my knees/hips/back hurts"
Again, your arteries don't care about your aches and pains.  And, in fact, for some of those pains will benefit from exercise and range of motion.  If walking hurts, then get on a bicycle, or swim or walk in a pool.

"I have an active job"
Occasional lifting of heavy items or intermittent walking are not the sustained cardiovascular exercise that your heart benefits from.  Unless you are a valet who is literally running for hours to fetch cars, a bike courier, or you're doing some sort of continuous exercise for thirty or so minutes of a time, your job doesn't count as exercise.

"I stretch"  "I lift weights"
Great, I'm sure you're very limber or strong.  But that's not the sustained cardiovascular exercise that will keep your heart healthy.

"I'm lazy"
Really?  Don't be.

That's me, at about 25 1/2 miles into the LA Marathon, setting a good example for my patients and exercising :)

Sunday, March 20, 2011

LA Marathon 2011 -- Cold and Rainy

Today was far from an ideal day.  In a race where hundreds dropped out due to hypothermia, I'm grateful to have finished as well as I did.

My Marathon Bib -- Keeping it Unique!!!

My morning started at 3:20 am.  By 4:20, I parked my car at my friend's condo in Santa Monica and walked to the shuttle buses.  I arrived at Dodger Stadium by 5:15 am, with over two hours to kill until the race.  In avoiding the morning chill, I intermittently sat, laid down and napped, ate bananas and soy yogurt, and used the port-o-potties about five times (yes, really).

Around 7 am, I checked my gear bag and fought through the crowd to get to my seeded corral, for runners who had previously completed sub-5-hour marathons.  The crowd of us was told that the corral closed at 7 am, which of course we had never been told, and created chaos and anxiety, and finally we were permitted to enter the seeded corral area.

Unlike last year, in which we waited forty-five minutes for shuttle buses to get off the jammed up freeway and drop off the rest of the runners, we started on time.  It was kind of funny because I think the gun went off earlier than it was supposed to -- the announcer gave a "Runners......" like he was going to say "get set" or something like that, but then *BOOM*!  And, the "We Love LA" song that plays at the beginning of every marathon started late and was skipping all over the place.  It was definitely an awkward start.

With the help of my coach Gerardo of Fortius Racing, I had decided that my strategy for a goal race time of 4:05 would be to run 9:20 per mile splits.  The first three miles were downhill, and I probably did each one in 9:10.  People were passing me all over the place.  But, as a seasoned marathoner, I know to let them go.  To paraphrase my first triathlon and running coach Mary Eggers, "There are two kinds of people who will pass you at the beginning of a marathon -- people who are faster than you, and people who will be walking at mile 22."

Less than a mile into the race, it began to rain.  This would be the theme of the day -- rain and cold.  At mile one, I ditched my waterproof jacket and was running in a tank top singlet and shorts.  I kept my gloves on, but by mile five, I tucked those into my shorts and ultimately disposed of them mid-race.  While it may have been fifty degrees and pouring rain, I didn't feel cold.

Mile four presents the biggest hill of the course -- a short, steep hill up to Disney Concert Hall.  I practice hills regularly, so this was no big deal to me.  With another uphill at mile five, and a port-o-potty stop, the next few splits were a bit slower.  Around the seventh mile, I ran into an LA Tri Club member who I know who was out on the course doing a training run.  He paced me for the next four miles into Hollywood and gave me someone to talk to, which made the run a bit easier. 

The rain poured harder, and at times felt absolutely torrential.  While I felt okay, I found out after the race that hundreds of runners dropped out, and several runners were taken to local hospitals with hypothermia.

I love running through Hollywood.  We ran along the Walk of Fame on Hollywood Boulevard, and then down the Sunset Strip.  This was about midway through the race.  Though my socks and shoes were soaked and the rain was pouring, I felt good and strong.  My time was a bit off at 2:04:00 at the half marathon point, so I thought that since I felt well I might still be able to hit my goal if I got back on my 9:20 pace.

And, I continued to feel pretty good.  The bottoms of my feet were sore, I had a mild ache in my right hip, but compared to other marathons I've done, I felt great.  But my splits were off -- they were more like 9:45 than the 9:20 that I was aiming for.

I continued to feel good running down Santa Monica Boulevard in West Hollywood, and then down Burton and Rodeo Drive in Beverly Hills.  Once I reached mile 18 in Century City, I had a brief pep talk to myself:  Look, you feel good, now is the time to pick up the pace and try to hit your goal.  If nothing else, let's at least try to get a PR (personal record -- my best prior marathon was Long Beach 2009 which I ran in 4:12:55). 

About now, I started passing people.  A seasoned marathoner, and as this was my tenth marathon I think I can call myself "seasoned", knows how to pace herself.  Though I was passing more than I was being passed, and I still felt good, I just couldn't get much faster.

The toughest part of the race is about mile 20, through the VA Hospital grounds.  There's a significant uphill, and the scenery is blah at best.  The rain was absolutely pouring, I had given up on trying to run around puddles and landed right in them without caring as my feet were already drenched, and my legs were starting to ache.

Next is the turn onto San Vicente Boulevard.  The Hirshberg Foundation had an enthusiastic group with loud upbeat music and I would consider them the highlight of the entertainment on the course -- it's impossible to pass them and not feel energized.  They're also an organization that I support since the father of one of my closest friends died of pancreatic cancer.  So, from here, most of the course was downhill on San Vicente Boulevard.  In spite of my legs feeling heavy and tired, I was moving along at a good pace.  I passed far more runners than passed me.  There were lots of spectators and a number of people that I knew, and their encouragement pushed me toward the finish line.

Turning the corner from San Vicente onto Ocean Blvd, the end was in sight with about a mile left to go.  Fortius Coaching had an enthusiastic group cheering us on, and from there on out, I just pushed to the finish line.

My finish time:  4:12:59.  Just four seconds slower than my best marathon, Long Beach 2009, which was run in much sunnier conditions.

It felt so good to be done!!!  I must not have looked so good because one of the medical staff approached me, and I smiled, said I'm a doctor, and I'm okay, and he let me be.  However, hundreds who crossed the finish line, mostly those who finished after me and likely weren't running the whole thing and thus didn't keep their core temperature up, were treated for hypothermia shortly after finishing.

I walked the long three-quarters of a mile or so to the marathon finisher's festival area.  It was pretty empty since not many people wanted to make the trek in the cold and rain.  I was shivering.  The music was horrible, the gear check was horribly disorganized so I decided not to wait for my bag for fear of becoming hypothermic.  However, since there were so few people at the finisher's festival, I received about ten bags of potato chips and a dozen Clif bars because so few people came to take them.

All in all, it was a tough day with pouring rain and cold temperatures.  I didn't hit my goal, but I think I did well given the extremes in the weather.  I feel like if this was a warmer day without rain that I could have done better.  But, as I know others fared worse than I did with respect to their goals and the weather, I am grateful.