18663 Ventura Blvd, Suite 202, Tarzana CA 91356

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.