Going Green

When I moved here, I was excited to be living in a greener community, one where people care about the environment. After all, I recycle everything I possibly can. It almost pains me to throw a piece of paper in the trash.

So, I was absolutely stunned to find out that my apartment didn't recycle anything! And neither did my office! Over the past few months I've collected my recyclables from home and hauled them up to my brother's place whenever I had the excuse to visit and play with my niece. In hopes that my apartment might consider recycling, I contacted the city to see if they might be able to talk our management into recycling.

Today I received a pleasant surprise -- a flyer on my door saying that my apartment now recycles bottles, cans and plastics! They don't recycle paper, but this is a nice start.

And, since joining the cardiology practice where I'm at, we now recycle pop cans. I've even gotten them to go vegan for lunch on my birthday, which is definitely a green thing to do. I'd love to see them recycle paper.

So, speak up -- you can make change happen.

Image source: www.bserecycling.com

Flat

That's the one word to describe my experience at the Long Beach Triathlon today.

I thought the race would be interesting for different reasons. I raced the day after Yom Kippur, the Jewish day of atonement, on which I fasted all day before the race, and I wondered if that would impact my race times. I entered in the Athena category, for women who weigh more than 145 pounds, when I normally race in my age group. The water was polluted and disgusting after a day of rain yesterday, which I thought was interesting, as all the other beaches in southern California are closed for this reason.

The swim went well. The water was gross, but I tried not to think about that. I got out of the water, onto the bike. "Your back tire is almost flat," I heard. And I could feel it, but I thought, maybe I can just finish this short 10-mile course with the tire being *almost* flat. No such luck. About two miles in, it was completely flat.

I was on the side of the road, panicked. I had two tubes. I had a lever to pull the tire off. But, I did not have a pump or a CO2 cartridge. I was absolutely panicked. My race is over, I'm going to quit. Then I saw a man fly off his bike and hit the pavement. I dropped my bike and ran over -- "Are you ok? I'm a doctor." Fortunately he didn't need my doctoring skills, or what little I could do out on a triathlon course, and he got back on his bike and kept going.

One woman helped me pull my tire off my bike, remove the tube, and put a new tube in. But still, I had nothing to inflate it. I yelled out to people riding by -- "Anyone got a pump?" A couple people threw me their pumps, but they didn't fit the presta valve on my tire. Another woman with two flat tires joined me on the side of the road. Then my hero, an 84 year-old man, pulled over. He had a few CO2 cartridges and was able to provide air to both me and the other woman with flat tires. "I'm 84 years old, just being here and finishing is all I want." Wow.

Next I fiddled with the bike and was able to put my back tire back on the bike. I sliced my finger and had chain grease all over my hands, but now about what felt like a lifetime later, though it was probably only 30 minutes, I had a functioning bike.

I thought about quitting. How embarassing a finish will this be? I'll be dead last. But I thought more about it. I'm no superstar. I just come here to do my best. And, I can cheer people on. I'm now officially at the back of the pack, with the people who need the most encouragement.

So, back on the bike, I rode past the Queen Mary ship, and finished my first loop of the bike course. There weren't many people out on the bike course, and I could have gotten away with pulling back into the transition area after doing only five miles on my bike. No one would have known, except me.

But I took the second loop. There were no bikes with me. I had an air pump in my back pocket to return to a racer who loaned it to me. I'm going to be last, I thought. Dead last. In this race, though, there is a prize for the last place finisher. That would be cool, I thought, last place prize. As I continued, I passed a couple dozen people on their bikes. When I rode by a photographer, I pulled the air pump out of my back pocket, waved it in the air and yelled "Whoooo hooo!" Yah! I'm the girl with the flat! And I'm gonna finish this stupid race!!!

Finally I got to the transition area. People were picking up their belongings and heading home. That would have been me. How frustrating. And I had three miles left to run. So I headed out for my run. Yelled for my back-of-the-pack brothers and sisters. Looking great! Way to go! Almost there! I was full of energy. Someone I ran past even asked, "Where do you get all that energy?" "I get it from sitting on the side of the road for 30 minutes with a flat!" Maybe I shouldn't have said that. Oh well.

Running into the finish chute, I was alone. The announcer had enough time to call out my name as I ran past. Cool.

And to top it all off, someone took my wetsuit home with them.

I would have loved to finish in style, no flat tire, giving it my best effort. What I've learned from this, first and foremost, is how to change a tire during a race, and to make sure I have all the equipment with me -- tubes AND CO2. Worse things have happened.

Hospital Cafeterias

When our patients are hospitalized, we work so hard to teach them how to eat -- low fat, low cholesterol, high fiber, and so forth.

But what does the cafeteria serve? Junk. The entrees are covered in calorie-heavy sauces. There are burgers, and fries, and onion rings. Maybe there's a vegetarian entree, and my hospital prides itself on always having at least one vegetarian option, but that item typically is smothered in cheese.

Yes there is a salad bar and garden burgers are available. But I believe we are sending our patients a mixed message by offering less healthful options.

It's a shame that hospital cafeterias sell out our patients.
Picture from www.roadfood.com.

Beaten Up in the Cath Lab

Reportedly, a physician at a San Diego hospital beat up on a patient during a cardiac catheterization procedure. While I don't condone this behavior in any way, I can understand as an interventional cardiologist how something like this could happen.

The cath lab is a stressful environment. The procedures that we do are very intricate and do carry significant risk. We're dealing with coronary arteries that are only a few millimeters wide. Often our patients are quite sick.

Further, we demand a lot of our patients. We ask them to lie flat and completely still on a narrow, hard table. This is uncomfortable, especially for older patients and people with back problems. While we give sedation medication, our patients are not completely knocked out and they do have to deal with the discomfort.

Often patients for various reasons find it hard to cooperate, and thus they move. Our equipment is literally laid out on top of the patient. So if they move their leg or arch their back to adjust themselves, they not only risk tossing important items on the floor, but they risk harm to themselves as they disrupt our delicate work.

While this physician who allegedly beat his patient is innocent until proven guilty, such violence toward a patient doesn't need to happen, and it shouldn't. The patient could be given more sedation. Or, soft restraints could be used. The patient could even be completely sedated and intubated to facilitate the procedure being done.

So, you combine the difficulty of a patient to lie still with the stress of a physician doing a complicated procedure. But beating up a patient is just not the right way to deal.

And the Birthday Celebration Continues

To celebrate my birthday, I had the opportunity to choose where we were ordering from for our Friday lunch -- we order out for lunch every Friday. I chose California Vegan. The office staff seemed to enjoy it, if you count second helpings, clean plates, and unsolicited "I've never eaten vegan but this is really good!"

And, going above and beyond the call of duty, they brought me a vegan chocolate cake! Mmmm yummy!

Happy Birthday to Me

Today I turned 32. My brother baked me a pineapple upside-down cake for the occasion.

How cute :)

Watch Me Finish the Triathlon!

This is too cool. Click on this, then enter my race number, 847. Then click my name and "select athlete".

You'll see me running about ten seconds into the clip.

My First Olympic Distance Tri -- Done!!!

Woo hoo!

Late Arrival
I couldn't find the shuttle buses in the morning. So I got to the transition area around 6:40 am. The announcer was talking about all athletes clearing the transition area. As he's saying this, I look around and see the very long lines for body marking (where race numbers and ages are written on our skin with permanent marker). As I was wearing my LA Tri Club gear, a woman comes up to me with her own permanent marker -- "LA Tri Club, can I mark you?" What a time saver! Membership has its privileges.

The Swim
The forecast calling for one-foot waves -- dead wrong. On top of this, we had a northward current. Watching the waves before me, I knew exactly where I had to sight while swimming in so as not to get taken off course. I started in the back of the pack for the swim, so as not to deal with thrashing limbs in my way. I relaxed, thinking about it as one of my leisurely training swims at Manhattan Beach. Venice Beach, however, has nasty water -- yuck. I kept a consistent pace, based on the people around me. When I finished and got out of the water, I didn't feel too tired.

Transition 1 -- Swim to Bike
While changing out of my wetsuit and into my bike shoes, I hear the announcer: "The last of the under 35 women are finishing in the water and the first of the over-35 women are getting out of the water now." Thanks for the inspiration. Not.

Bike
As usual, I am slow as molasses on the bike and everyone and their 65 year-old grandmother passes me. The ride was a nice course -- Venice Boulevard to Fairfax to Wilshire to Highland to Hollywood and Sunset and then into Downtown LA to the convention center.

Transition 2 -- Bike to Run
I was nervous that my bag that I dropped off yesterday with my running shoes wouldn't be there. Maybe it's my lack of luck with checked airline luggage. But I was pleasantly surprised. My bag, with my shoes and hat, was there. I still felt full of energy. And off to run.

Run
As I ran out of the transition area, I suddenly felt quite drained. Am I really going to now run 6.2 miles? Am I friggin crazy? And my stomach felt somewhat unsettled. Maybe I needed more fluid, or more Gu. But I just didn't feel like having it sitting there in my stomach. At the water stations, which were frequent, I grabbed a water cup from each, and would take maybe one sip before feeling the urge to get rid of the cup.

My pace was going to be an easy jog. I had no plans for speed. There were two loops. The first one took us way up the hill to the Disney Concert Hall. That hill was absolutely miserable. Many people walked it. I jogged it quite slowly. The second loop had us run halfway up that hill, which after 4 miles of running was also miserable.

But, being a club member does have its privileges. I don't know many people in the LA Tri Club, but "Go LA!" is always a good thing to hear on a challenging run. I yelled it to everyone in LATC gear, some yelled back, others ignored me, and some others just gave a thumbs up.

I finished in 3:33, three minutes off my projected time of 3:30. That's my stopwatch time; I have no idea what the official time is.

Relaxation
I spent my afternoon lounging on the beach. Ahh that felt good.

Next Race
Long Beach Triathlon on September 23?!?!?!?

Breakfast and my T2 Bag

Recently, I've changed what I eat for breakfast. Over the past year I've been working out most mornings before work, and I have found that just a bowl of cereal leaves me absolutely ravenous by 10 am. So, when I wake up I have a small bowl of cereal. Then, after my workout, I eat breakfast: oatmeal, soy yogurt, fruit, and orange juice. That keeps me full until lunch time.

The big triathlon is tomorrow!!! *fingers crossed* And this is the stuff that's going to go into my second transition bag, which I am dropping off at the race expo today. In a triathlon, there are two transitions: between the swim and bike, and between the bike and run. Because the LA Triathlon is a point-to-point course, and the bike begins at Venice Beach and ends in downtown LA, the second transition is in a different location as the first. So, today I have to pack my bag with everything I need for the second transition: shoes, socks, a hat, and Gu gel. And maybe a towel.

The "DB" hat was a gift from my program director back in Boston. It's a bizarre inside joke. But it's a good hat, fits well, keeps me cool during a run, so I use it a lot. And no one in LA knows what "DB" stands for :)

Hydration, klutziness, and other pre-race thoughts

I need sodium while racing. Worst case scenario, I'm on the course for four hours. Gu gel just isn't going to cut it, I'm told. And I hate Gatorade. I tried the PowerBar Fruit Punch drink, which I found to be decent. I'd rather have the taste of plain water for my hydration, but I know I need the sodium.

The sprained ankle is healing, I guess. It's been 3 and a half weeks, and it's still quite swollen. I can do everything on it -- run, bike swim, weights, etc. At the end of a work day, it does hurt, especially if I'm wearing heels. So I've been a bit lazy and wearing scrubs quite a bit to work.

And speaking of being a klutz, I faceplanted yesterday while running. I tripped on the sidewalk and landed on my right side, scraping up my right knee, hip, and both palms. I got up, shook it off, and ran another 45 minutes. I don't know how often normal people trip and fall while running, but it seems to happen to me about twice a year.

Oh and one other thing... I think my weight is fine at 159 lbs. I don't want to lose any more weight. I don't need to.

All this rambling... can you tell I'm a little nervous?

Sweat Rate

It was suggested that I calculate just how much I sweat in an hour. I decided to do this today, in 104 degree heat, as I rode my bike through Griffith Park up to the Valley.

I weighed myself before. Then, during my hour-long ride, I sucked down two 24-oz bottles of water and a Gu pack. I felt constantly thirsty. Normally the bike provides some air conditioning because you're moving at a decent pace. Not today. I felt hot and awful.

My worry with hydration during a long event, such as the upcoming olympic distance tri, is not only of drinking too little, but possibly of drinking too much. Slower endurance athletes like me are at risk of hyponatremia, a too low sodium concentration in the blood from drinking more fluid than what their body is losing.

Even after drinking so much, I weighed myself -- I had lost a half a pound! In that hour of cycling, I had lost fifty-six ounces of fluid. Almost two liters!

Maybe the moral of the story is to not ride in ridiculous heat like this. But at least now I know that in extreme heat, I sweat a LOT.

The Looming Olympic Distance Tri

After my ankle sprain, I thought seriously about whether or not to keep my spot in the LA Triathlon. My ankle was ridiculously swollen and black and blue. Running on it was painful, so I didn't run for the first week. Even kicking while in the pool hurt.

I changed my goal for the race to endurance, rather than speed. I've done plenty of sprint tris, now for my first olympic distance tri, I just want to finish. I may be DFL (dead f........ last), but I'll finish.

My training hasn't been crazy. I do weights for an hour three days a week with my trainer and then six cardio sessions, about 45 minutes to an hour and a half each. I haven't doubled up on workouts much either, in other words, usually just one workout a day. And I think I'm enjoying my training more that way.

One more week. I'm a little nervous.

Shunsh Kashish

That's Armenian for "Take a deep breath."

English is not the first language of the vast majority of my patients. In fact, more than half of my patients barely speak English. If only I spoke Armenian, the first language of 80% of my patients. Or Spanish. Or Tagalog.

I've developed a small vocabulary of Armenian. Just the medical basics. In chveses -- how are you? Lavay -- good. Tsav unis -- do you have pain? Barke -- lie down. Nustie -- sit up. Batz -- open. Pagai -- close. And a few others.

Pee pee and poop are universal words too.

I really do wish I spoke a second language. I took Latin in high school. Everyone told me how helpful it would be in medicine. What a waste. Don't believe the hype, kids. Learn Spanish.

Another Manipulated Story

I'm listening to the radio this morning, and I hear, "A mother in Phoenix is charged with starving her children. They were on a vegan diet."

Then the news man decides to editorialize, "You know, vegan diets just aren't good for kids."

Ok, who made the news man a nutritional expert? Further, there obviously was something missing from the story. There's a very detailed piece from a Phoenix newspaper here. I'll give you the highlights.

Yes, the family was vegan, but....

- The parents were terrified of childhood obesity.
- They shunned doctors. Their children had never seen a doctor, nor did they have any immunizations.
- The children had epilepsy, and even with that disease the parents would not take the kids to a doctor. Instead, they relied on a homeopathic woman who prescribed herbs.
- One child died of untreated grand mal seizures.
- The family limited the amount of time the kids could eat.

Vegan diets are getting more press and more acceptance. It is still frustrating to see stories like this manipulated to make veganism look irresponsible.

Riblet and Stir Fry

I'm all about preparing what's easy for dinner, as opposed to looking for new and cool recipes. Maybe if I cooked for other people besides myself I'd feel more adventurous. This is something a little interesting, I suppose. There's a Gardenburger Riblet, which is full of protein, and baby broccoli and shitaake mushrooms stir fried in a little canola oil and Soy Vay.

Sprained!

I'm on the disabled list again...

On Sunday, I was playing dodgeball. After hurling the ball at the opposing team, I ran backwards, landed on the outside of my left ankle, and fell to the ground onto my right wrist.

I sat down and iced for a few minutes. Then, bored, I joined back in. It didn't hurt too bad.

Now my wrist and ankle are sore. I'm limping and it hurts even to write.

And I'm supposed to meet with my trainer tomorrow morning.

This better heal fast. I have an olympic distance tri in 4 weeks!

Camp Pendleton Sprint Triathlon

It was a different kind of triathlon -- the first one that I've done that was entirely on a military base. It was also the longest bike in a triathlon that I've ever done -- 30 kilometers or 18.6 miles.

I'm awful on the bike. If I was good enough that I could contend for a medal, then this was the wrong race. But this was my usual performance: do well on the swim, get passed by lots of people on the bike, and pass a few people on the run.

I don't have the official results until Wednesday. But I know that based on the distance of the bike and the huge number of people passing me, this was not a shining race for me.

My next goal is to become better on the bike. I'm going to have my bike fitted, just to make sure that any mechanical issues that are slowing me down are taken care of. In other words, that involves taking my bike to a shop and having it fine-tuned to fit me. I think I need to raise the seat a bit, but I'm not sure. My trainer says he's going to be working with me on a spinning bike too.

Next Triathlon: Camp Pendleton Sprint

My next triathlon is on Saturday.

With all that has passed in my life recently, my training has at times been less of a priority.

My last triathlon was over a month ago. Before that triathlon, I put in all the hours, got in all the workouts, yet didn't do as well as I wanted to. This time around, I've done a few things differently.

I have been working out with a personal trainer three times a week. We do strength training, endurance, stability, and plyometrics. They're tough workouts.

Another experiment: I've lost a few pounds. At my last tri, I was 165 lbs (I'm 5'10"), and now I'm 159 lbs; in other words, my body mass index has dropped from 23.6 to 22.8. Both are well within the range of healthy for my height. But, theoretically, less fat moves faster. My goal is a 17% body fat percentage; at last measurement I had 27% body fat.

I can't wait to see how it all plays out on Saturday at Camp Pendleton.

Going in Peace

I don't share deeply personal stories on this blog. But I want to share this one because of the impact that it has had on me, being the family member of an ill patient rather than the physician.


My grandmother was the healthiest 92 year-old woman I knew. An avid shopper, she walked on the treadmill for 30 minutes every day and went out to dinner with her friends on Saturday night. She lived independently in her own apartment. She looked in on her 88 year-old little sister who lived down the hallway. Until last Thursday.

She was leaving the dining hall when she fell. She hit her head. She was confused. She was emergently taken to the nearby hospital. The CT scan showed "a little bleeding", I was told. Keep in mind that I'm in Los Angeles and my grandmother is in Michigan. She's waking up, my mom says.

The next morning, I'm told she has bleeding in her brainstem, but "they're still not sure" what is going on. But my grandmother was awake and alert, though she had a lot of bruising from the fall. My brother, who also lives in LA, and I booked a flight to leave that night.

The next morning, my brother and I were at my grandmother's side. I could barely recognize her, with the right side of her face drooping and bruised. She opened her left eye when I spoke to her and held her hand; she said my name. Then she said my brother's name.

Shortly after that, she recognized none of us. It became apparent that she was fading. Several doctors came in, none offering much explanation of what had occurred. But their optimism was disturbing. A brainstem bleed in an elderly woman who was clearly getting worse was very very bad. One doctor talked of the possibility of doing an invasive procedure called a transesophageal echocardiogram. The neurologist, when I asked him point blank what my grandmother's prognosis was (I had a pretty good idea, but wanted to hear his thoughts) said, "We'll see in a couple days."

I didn't feel like the doctors were realistic with us. I didn't appreciate the euphemisms and false hope. I wanted them to be more honest about what her prognosis was and not overly optimistic in fear of shocking us.

Then she had periods of apnea -- in other words, she would not breathe for up to forty seconds at a time. The ICU nurse, who took wonderful care of my grandmother, came in and asked what we wanted to do, did we want to consider having my grandmother put on a breathing machine. No, my mother said, my grandmother would not want that, and at that time, with none of her physicians there, we decided to pursue comfort care only -- no more invasive tests, no blood draws, accepting that this is a terminal process.

There were some terrific nurses who cared for my grandmother. But other caregivers were less than great. I overheard that my grandmother's primary physician considered more than two milligrams to be "way too much" morphine. She was grimacing in pain and needed more medicine. A nurse elsewhere refused to increase a morphine drip, insisting wrongly that the hospice physician would not permit more medication.

It's hard sometimes to be a caring family member and a doctor at the same time. The hospice nurse said to me when I was discussing my grandmother's medical status, "Be her granddaughter." But I couldn't just stand by idly and watch -- there were times when my knowledge as a physician led me to speak up. I requested morphine before my grandmother was moved from one bed to another, to cover the pain that the move would involve. When she started to have rattling with her breathing, I requested a scopolamine patch. When her mouth was dry and crusted, I asked the nursing staff to please swab her mouth. Would those things have been done for her comfort if I wasn't standing by? I'm not so sure.

Was I, a cardiologist, intimidating? Did my brother, the attorney, compound that? Perhaps.

My grandmother died in peace early on Tuesday morning. She was comfortable. Of course I am sad, but I know that she didn't linger in pain. She passed away surrounded by those who loved her.

From this experience, I feel more like I can empathize with family members of ill patients. I want to continue to be honest -- at times, I've feared that I'm too honest or too blunt, but that's what my family wanted, not false hope. And I hope I can better think about the details that matter in keeping patients comfortable.

New Toys

I walk into Sports Authority to buy goggles. Fifteen minutes later, I walk out with all this:


A heart rate monitor (upon the recommendation of my new personal trainer), a kickboard, and a pull buoy (keeps your legs afloat while you stroke with your arms, the opposite of a kickboard). Oh yes, and the goggles. They're great. I can get out of the pool and not have big circles around my eyes for the next few hours. Nice soft gaskets.

Tri training is coming along. In anticipation of the olympic distance triathlon in September, I've ramped up my training a bit. I have a personal trainer who I meet with three days a week at 5:30 am. In addition to this, I'm trying to run 3 times, bike 2 times, and swim 2 times each week. Oh yeah, and did I mention I have a job?

Last week, though, I think I really pushed it. It was my first full week of the new personal trainer, who is pretty tough. Then on Saturday, I rode my bike for 27 miles up some seriously killer hills (the most I've been doing is 45-minute to 1 hour spin classes) and on Sunday morning I swam a mile at Manhattan Beach, which is the longest open water swim that I've done yet. When Sunday afternoon came around and I was going to do an easy, 60-minute run, I ran out of steam a little more than halfway through and had to bail. Today I feel better, though.

Mexican Lasagna

I stole this idea from Mary Ruth, my brother's fiancee. Layer tortillas with various toppings -- refried beans, corn, mushrooms, salsa, peppers -- anything! Then bake in the oven. Serve with salsa. My brother was convinced that you can't do this without cheese to help everything stick together, but the refried beans are sufficient to make it work.

Tri'ing in LA

This town is awesome for triathletes!!!

I joined the LA Tri Club. At 1,450 members, they are one of the nation's largest triathlon clubs. They have multiple workouts every day for all levels of triathletes. It's also a great way to meet people. The day after I landed in LA, before I had even moved into my apartment, I swam in the ocean with the group. This morning I biked with the "beginner" cycling group. We traveled 27 miles, up two huge hills, one of which was five miles long. My legs are hurting big time!

People here are more active than anywhere else I've lived. At the beach, it's not just loafing people eating hot dogs. Groups of cyclists gather for rides along the ocean. Runners are everywhere. And under a tree, you might see someone doing push-ups or sit-ups. It's inspiring.

My next race is August 9, an evening Playa Del Run -- 1 kilometer swim and 5k run. After that is the Camp Pendleton sprint triathlon on August 11. Then, I'm doing my FIRST OLYMPIC DISTANCE TRI -- the Los Angeles Triathlon, on September 9.

Today in Cardiology

My blog got a mention in this month's issue of Today in Cardiology!

And here's tonight's dinner: A Garden- burger Breaded Chik'n patty on whole wheat bread, with lettuce and organic Vegenaise (that's an eggless mayonaise -- no cholesterol!)

Cardiologists, any words of wisdom for a just-graduated cardiologist?

Aversion Therapy

I am terrified of open water swims. Especially those with lots of waves. Like the ocean. And, let's just say there's a lot of ocean here in Southern California.

Now, somehow swimming is my best of the three triathlon events (swim, bike, and run). But still I can't keep from panicking. This caused me some serious trouble in the Hyannis Sprint when my panic triggered an asthma attack.

What better way to get used to swimming in the ocean than by throwing myself into the midst of a race? One with big waves and lots of flailing limbs? There's a race series called the Playa Del Run which takes place on several Thursdays. You can swim the one kilometer and then run five kilometers, or you can just swim or just run. As I've never swam a kilometer in open water, let alone a raging ocean, I did only the swim portion.

I lined up with about 120 people to run into the ocean. Off we went with the gun. The waves were BIG!!! I saw people dive right in, under big waves -- which is what you're supposed to do. I still turn myself sideways and hope it doesn't knock me over. After some breaststroke, I start to ease into freestyle. But every time someone knocks me, I get annoyed, look up, and go back into breaststroke.

But, I didn't panic! I just let the crazy people go ahead, and once it was more clear, I eased back into freestyle. Once we were around the first buoy, people spread out, and there were few limbs to crash into. From what I'm told, it was a really choppy day, but I felt okay.

I came out of the water a little tired, though pleased with finishing that distance of a swim, and watched as people ran ahead of me to the transition area for the 5K run.

That day, I couldn't imagine doing a 5K after the swim. I do feel proud of myself that I could not only swim that distance in the open water, but that I was able to do it calmly. My time was okay too.

Next time, I'll swim AND run!!!

Unsettled

Technically, I'm homeless.

I moved out of my Boston apartment over a week ago. My belongings are in a Bekins truck driven by a guy named Buck from Buffalo.

It's been a relaxing week, seeing my parents in Michigan. Now I'm loafing around in California. I should be studying for my radiation and fluoroscopy license exam. But I'm not.

More posts and stuff when I am moved in.... and I can download pics from my camera.

Boot Camp

Just to mix things up a bit, and because I don't have another triathlon in the foreseeable future, I'm taking a few boot camp classes this week. This morning I ran 2.2 miles in 19:45 (9 minutes per mile, not too bad for me on a humid early morning), did 57 push-ups in 2 minutes, and 55 sit-ups in 2 minutes. I'd love to run faster, but I'm content with the others.

The class is 13 weeks long -- I would love to stay for the entire length of the class, since it seems like it's going to be pretty challenging. But, I will be moving to LA. I'm going to try to find something like that there. That would be fun.

Second Tri of the Season

This one was MUCH better than my first this season.

The swim was 0.5 miles on a nice calm inland lake called Lake Chargoggagogmanchaugagoggchaubunagungamaugg, which will herein be referred to as Lake Cha. The start was very crowded -- legs kicking everywhere. I tried to keep moving, but I really like my personal space so all these people kicking me and swimming into me was really ticking me off. My breathing was really off too, and I was starting to get that panicky feeling again. So, briefly, I did the breaststroke, let the crazy people ahead, and once it was less crowded and I had my space, I swam again. I felt better, got into my groove, and finished off the swim. Lake Cha was nice and peaceful, without big waves, which was nice.

When I swim, I've tried to breathe every three strokes like I do when I practice in the pool. But it never works out that way. So, instead, at the suggestion of our tri club run coach, I decided to go with what I felt natural doing -- breathing every two strokes. It worked out well.

The distance from the water to the transition area, where our bikes and other equipment are stored, was long. So, it was a very long-seeming barefoot run in a wetsuit to get my bike.

The bike started off well. People who break the rules annoy me. One person was riding in the middle of the road, very slowly. I suggested to him to get over to the right. Then some woman passed me on the right (which is a huge safety no-no -- when you pass, you pass riders on the left), and was about to try to zig-zag through three riders. So I rode up next to her and said, "If you pass, you need to do it on the left." I don't think she was thrilled to hear from me. And she passed me again. Two miles later, there she was cursing at the side of the road with her bike upside down trying to fix a tire. Karma's gonna bite you, right?

The course got TOUGH!!!! Around mile four, we approached a huge hill. I put my bike in low gear, stood up, and powered through it. Some people walked. Then at the top of the hill, phew, that was tough, and around the corner was ANOTHER HILL, which was similarly steep. And then ANOTHER!!! Whew were my legs tired! Following these hills came a long downhill, steep at times, and my speed got up to 35 mph, which on a bike is damn fast. I hit the brakes at one point, which was good as the pavement went very rapidly from smooth to treacherous and bumpy and flying off the bike at that speed could have been really really bad.

The rest of the bike ride was considerably less hilly. I took it easier, so that my legs wouldn't be worn out on the 3-mile run. My pace on the 12-mile bike was 15.5 miles per hour, nothing to write home about, but faster than I could have done last season on this type of course.

The run flew by. I didn't feel like I was flying, but it went fast. I was breathing hard, but comfortably, unlike the triathlon two weeks ago. I remember catching up to a woman, who looked like she was struggling, and of course I said, "Good job, keep it up." She said, "My legs are so heavy... they hurt!" I looked down at the back of her leg, where our ages are written -- hers is 53. "Look, my mother is younger than you, and I could never see her doing one of these in a million years, so you are awesome! Keep going!" I think that got a chuckle out of her.

So I finished strong. I don't know when my next race will be, but it will likely be four weeks from now, once my bike and belongings arrive safely in LA and I have a better idea what my schedule will be.

PETA's Letter to Michael Moore

Michael Moore's new movie Sicko, which exlores the many flaws of the American health care system is coming out soon. In honor of this, Ingrid Newkirk, president of PETA, took the opportunity to write a letter to Michael Moore. Included in the letter is the following:

...there’s an elephant in the room, and it is you. With all due respect, no one can help but notice that a weighty health issue is affecting you personally. We’d like to help you fix that. Going vegetarian is an easy and life-saving step that people of all economic backgrounds can take in order to become less reliant on the government’s shoddy healthcare system, and it’s something that you and all Americans can benefit from personally.

The letter goes on to make some great points about the health benefits of a vegetarian diet. But, calling Michael Moore an "elephant" and insulting his weight are completely inappropriate. People are sensitive about their weights. Further, this type of language is more likely to infuriate him rather than to convince him to give vegetarianism a chance.

A vegetarian diet is no guarantee that one will be thinner either. While some people have lost weight by going veg, I know plenty of overweight and obese vegetarians as well. And, while I wouldn't consider myself fat, I do have to work to keep the pounds from creeping on.

Would I call any of my patients an "elephant"? No way!

A better tactic would be to congratulate Michael Moore on his movie, and to suggest that vegetarianism is a way to prevent many of the illness that we see today, rather than insulting his weight.

Finding Time to Work Out

Here's how I get the training in. This year I've had one of the most unpredictable schedules. I've been on call literally every other day for the entire year. So, my schedule has had to be flexible for those days when I stay late at work to finish a case, or if I get called in off hours.

I've gotten accustomed to running with my pager, putting my pager on the side of my spinning bike and checking it every few minutes because I know I can't hear it with the booming music, and bringing my pager poolside in case it goes off while I swim.

But, I've managed to fit in triathlon training. In fact, ever since my third year of medical school, ten years ago, I've exercised at least three days a week. Right now in the midst of triathlon season, I average six days a week.

For example, here's what I did this week (and what I plan on doing for the rest of the week):
Monday -- 6:30 am -- Master Swim, 1 hour, 2000 meters
-- 6:00 pm -- Outdoor bike ride with women's group, 21 miles, 1.5 hours
Tuesday -- 6:30 pm -- Speed training run, about 4 miles total, three speed loops of about 0.4 miles each
Wednesday -- 6:30 am -- Master Swim, 1 hour, 2250 meters
Thursday -- 7:15 am -- Tempo run, 50 minutes, about 4.5 miles with 2.5 miles of fairly hard pace running on the Esplanade
-- 6:15 pm -- Spinning class, 45 minutes
Friday -- 6:00 am -- Weights with my personal trainer, 1 hour, followed by a short run if the mood strikes me
Saturday -- DAY OFF (it always feels weird not to work out)
Sunday -- TRIATHLON!!!!!!!!

ADDENDUM -- Even after writing this, I had to change it up. I spent a few hours at the hospital in the middle of the night on Thursday, so Friday became my DAY OFF and my personal trainer was kind enough to train me on Saturday.

Runner Safety

On Saturday night around 11:15 pm, a young woman was sexually assaulted while she was jogging along the Boston Esplanade.

What on earth is she doing running alone that late???

I run on the Esplanade at least three days a week. But I sure don't run there in the dark.

I've been harrassed while running. About nine years ago, I was running through a densely wooded park near my parents' home in the daylight, but completely alone. A man walked up to me. "Excuse me, can you tell me which way is Commerce Road?" I pointed him in the correct direction.

He then ran toward me. I turned around. He said, "You have great #$%@. Do you mind if I squeeze them?"

I was so scared, I turned around and sprinted out of there, out of the woods and a half mile home to my parents. Winded, in tears, I called the police.

From that time on, I've been more cautious. A hard way to learn a lesson, and I was lucky that I wasn't hurt.

Gift Dilemma

I'm looking to purchase a gift for someone, on behalf of not just me, but from a group of us. Someone close to the recipient came to me and said, "Get him one of these. He's been begging me to get him one."

The item that has been suggested to me is made of leather. I do not purchase or wear leather -- it is a cruel industry that is not just a byproduct of meat and its production destroys the environment. I shopped all over the internet and in Boston for a non-leather version, and was not successful.



The route of least resistance would be to just buy the leather item, which I found in a store in Downtown Boston. And, for a moment, I thought about just buying it and saving myself time and aggravation. In good conscience, though, I just can't do it. I have another gift idea that I think will work well, and I'm going to go with that.

To learn more about where leather comes from, click here.

The End of Training

This week, I'll be finishing up my interventinoal cardiology fellowship.

It's an exciting time. I'll be moving to Los Angeles and joining a group there. And finally, I'll be earning a salary that matches with the amount of years of education and training that I have.

Now, after seven years of training after graduating medical school, I'll be an interventional cardiology attending physician. I must admit, it's a little daunting to be on my own. No longer will I have my attending scrubbed at the table with me to ask, "What do you think of that lesion? Should we use this balloon?" and so forth. It'll just be me and a radiation tech. But, I think I'm ready for the challenge.

Leaving Boston will be bittersweet. I'll be leaving friends, mentors, and coworkers. Boston has been a really fun place to be. For those of you who know me in real life, you know that the decision to come to Boston was a challenging one, but if I had to do it over I wouldn't change it in a heartbeat.

So, on to a new city and a new stage of life.

Salad

I had this as part of my dinner last night -- organic lettuce, beets, cannelini beans, and artichoke hearts. It was easy to throw together and very filling.

The Results are In....

I was 39th out of 65 in my age group.... putting me at 60% from the top. Did I predict that or what (Look at the post below)?

Strangely, in spite of all my panicking, the swim was my strongest of the three, the bike was in the middle, and yes indeed, I tanked on the run. My pace was about a 9:56 mile, when I typically run 9:00 miles in a 5k or triathlon.

So, I plan to focus more on running. More speed workouts and more tempo workouts.

Choppy Water and Asthmatic Wheezing

It didn't feel like a good day for me.

The ocean swim was really choppy and the field of swimmers was crowded. Normally, I get into my groove about a third of the way through and I get comfortable swimming the course. Not this time. I was short of breath the whole time. Wheezing, no less.

It's a little known secret, and something that I like to deny to myself, but I have exercise-induced asthma. I like to think I've outgrown it. In fact, I haven't touched an albuterol inhaler in four years; I haven't needed it. Every so often during a race, particularly if pushing myself at the end, I'll feel it.

Back to the swim -- the waves of the ocean landed salt water in my mouth far too many times. I couldn't keep my head in the water long enough to swim freestyle for much of the swim. And I was panicking. Panicking and wheezing. It'll get better. Let's get past this buoy. Or I'll pass this group of people. And I'd try to pass the slow people in front of me, but then I'd get winded and panic more.

I was so relieved when the swim was over! Still wheezing, I walked fast to my bike and hopped on. Even on the bike, my breathing wasn't great. But I felt strong. I got to do something I'd never done before -- pass people on the bike course. Granted, some of those ridiculously souped-up bikes passed me, but in the past, the bike has been the slowest part for me. Thanks to 2-3 spinning classes per week throughout the winter and spring, I've gotten faster. I biked the course at 18.3 miles per hour -- last summer, I was lucky to pull 15 mph!!!

Then there was the run. And the wheezing came back in full force. I was breathing loudly... really loudly. I passed no one on the run. Everyone passed me. And several people who passed me tried to encourage me, like I was some kind of invalid -- come on, you've got it, keep going, and so forth. I felt so slow running -- maybe it's that I'm coming off an injury, or maybe because I finished the bike in a faster time, I ended up with faster runners. I'll be surprised if I was anything faster than a 10 minute mile.

So, lessons from this tri:
-- Keep doing spinning classes
-- Swim in open water so I don't freak out when it's race time
-- Do more brick workouts -- running after biking, as in an actual race.
-- Do more running speedwork.
-- Stash an albuterol inhaler with my stuff, just in case.

The results aren't out yet, but my guess is you'll find my name about 60% down the list of women in my age group.

First Tri of the Season is Tomorrow....

.... and I'm a little nervous.

I've trained hard. My swimming has gotten faster with better technique that I've learned from Master Swim. I've been spinning at least twice a week, which I think will make me a faster cyclist. And, in spite of my iliotibial band issues, my running has been okay, with our run coach giving me some suggestions on tweaking my form and kicking my butt on a few tempo/speed workouts.

But, other than running, the vast majority of my training has been indoors. I've only cycled outside once all season. And I haven't done a single outdoor swim.

We'll see how this all translates tomorrow at the Hyannis Sprint Triathlon.

Dr. Flea

This is the ultimate blogger nightmare.

A Boston-area pediatrician is sued for malpractice. On his anonymous blog, he details the experience of being sued, what he thinks of opposing counsel, and how he's been told to behave on the stand.

His blog is brought up during the trial and he's outed as Dr. Flea. The next day the case is settled for an undisclosed amount.

Environmentalists and the Elephant in the Room

Did you know that raising of livestock for food produces more greenhouse gas than all of the automobiles in the world?

Or, did you know that in order to produce one pound of steak requires the amount of water that you would use to shower over an entire year?

So, it would make sense that organizations that care about the environment would encourage people to go vegetarian, or at least decrease their meat consumption. But they don't.

Environmental organizations like to camp out in the Back Bay area of Boston to recruit new members. Somehow, if I'm walking by with a Trader Joe's bag (but not if I'm empty-handed... go figure?), I look like an ideal target. And I ask -- what do you know about meat consumption and the environment? Most stare at me blankly, though one activist who says he once was a vegetarian gave me a good answer.

I care about the environment -- I recycle literally everything I can. I minimize the amount of driving I do. I use as little electricity as possible. I minimize the number of useless goods that I consume. And I'm a vegan, which comparatively may be the biggest thing I do for the environment.

But, in good conscience, I can't join an environmental organization that completely ignores livestock production, one of the greatest toxins to the environment, in order to pacify its members and potential members.

From My Empty Fridge

I am back from Cancun! It was a great time with lots of relaxation by the pool and ocean. The training was taken down a few notches too -- I did pool aerobics and beach volleyball, and only a little bit of running and spinning on the stationary bike.

Food in Cancun was no problem, but that's because we were staying at Club Med, which is all-inclusive, and is kind enough to list the ingredients of all their foods. There was tofu at every lunch and pasta and salads at every meal. I had some yummy refried beans, lentils, and sesame tofu.
This is tonight's dinner. My fridge is empty since I haven't had time to grocery shop since my return and I'm absolutely exhausted!!! So, I scrambled some tofu with frozen peas and broccoli, with a generous pinch of spices, including paprika, garlic, salt, pepper, chili powder, and Bac'uns (that's fake/vegan bacon bits). On the side is a sweet potato with a little Earth Balance margarine.

And finally, here is an impulse purchase: Skittles at the duty-free store in the Cancun airport. Skittles in the USA have gelatin while Skittles purchased elsewhere have hydrogenated vegetable fat. I'm not going to pretend they're healthy, but they do not contain animal collagen or bones.

A Vegan in Cancun

Since going vegan, I haven't traveled much. I was in Israel a year ago, where following a vegan diet was surprisingly easy. However, Mexico will likely be more challenging.

Soy vehetariana = I am a vegetarian.
Sin carne = Without meat. But, to most doesn't exclude lard, chicken, pork, meat broth, etc.
Es sin carne, pollo y pescado? = Is it without meat, chicken, and fish?
Es sin caldo de pollo o manteca de puerco? = Is it without chicken broth or pork lard?

I'm a little nervous about this aspect of the trip... I'll let you all know how it goes!

Physician Blogger

I walk a fine line as a physician with a blog.

I can tell you in general my thoughts about medicine. However, I can't tell you about my patients or coworkers. In this blog, I need to present myself well as a physician for any patient, coworker, or associate who may read it.

While my identity and photo aren't blazed all over this blog (I'm not about self-promotion, and heck, the picture is of the back of my head! But if you care, my picture is in a few places here), it's easy enough to figure out who I am. Even those physicians who have kept themselves anonymous have been discovered via tracing their IP addresses. Fat Doctor had a great blog, and now it's gone after an office member disclosed her identity. A physician friend with a blog was forced to change her blog settings to private because she was being harrassed. In a worst case scenario type of situation, Flea, a pediatrician, got himself into trouble detailing his experiences in going through a malpractice suit.

In the year and a half that this blog has been up, I've made many changes. I've gone back and deleted and changed posts that may not have represented me as the confident and caring physician that I want to be seen as. I've even changed the name of the blog to project a more professional image of myself.

I've thought about deleting the blog completely, for fear of professional repercussions. But, I enjoy having this creative medium. Further, as a physician, a vegan, and competitive athlete (I use that phrase quite loosely), I feel that I bring a unique perspective to the blogosphere.

Dr. Wes has some interesting thoughts on physician bloggers. Someone has even come up with a Medical Blogger Code of Conduct.

I think I can reach a happy medium, and hope to continue blogging as I continue on into practice.

I'm a mess

There are two voices in my head. One tells me to push myself. The Other One says to relax, not overexert myself.

At 5:30 am, when the alarm goes off on Monday morning, one voice reminds me to get to the gym by 6:30 for master swim. The Other voice suggests sleeping in a couple hours.

On Tuesday at 6:30 am, one voice pushed me out the door for a speed running workout. Six repeats of 400 meters on the esplanade. The Other voice reminded me of all the pain I had in my hip on Sunday evening after my attempted six-mile long run, which was cut to four miles because of the pain, and then the hours of icing, stretching, and rolling after that. Shut up, you big wuss, I said to the Other voice. And out the door I went.

One 400-meter sprint made my hip sore. And my back was sore too, which I had strained while riding 21 miles outside on the evening before. The Other voice said cut it out, jog home. I pushed on. After the second 400-meter sprint, I was in awful pain. Back and hip pain. I stretched by a tree. Not much relief. I jogged home, in pain. I iced my hip for a little while. Then got up -- OWWWW! Everything hurt more.

Luckily, later this week, the hip is better. I've been able to run a couple times since then, with much less discomfort.

I got a massage at my gym this evening too. He basically told me I'm a mess -- my IT band is sore, my lower back hurts, and I pulled something in my neck when kickboxing on Sunday. Oh yeah, and then there's the plantar fasciitis that just chronically waxes and wanes. After 50 minutes, things felt better, but he implied that there is much work to be done.

Moderation is something I need to do better when it comes to training.

First Outdoor Bike of the Season

I barely made it in time to meet the WOW (Women on Wheels) group at Landry's Bicycles. In fact, as I sat in traffic in Kenmore Square, I ended up putting on my bike shorts inside out -- guess it serves me right for trying to get dressed in the car!

In spite of these little snafus, it was a great ride. We rode for 21 miles through Brookline and Newton. It wasn't a very fast pace -- I would have gone faster on my own -- but the camraderie was nice.

I was a little nervous about this ride. I haven't been on my bike since last September, and instead have been doing spinning classes at my gym two times a week. It seems to have paid off -- I feel much stronger riding up hills.

"Steak" and "Chicken" Strips

This is my dinner from last night -- a steak strip and broccoli stir-fry in Soy Vay sauce.

Morningstar Farms makes "steak" and "chik'n" strips that are absolutely delicious! Of course they're not real meat, but they are made from textured soy protein and have a "meaty" texture. Nutritionally, they're quite good -- A serving of twelve strips has 140 calories, 3.5 grams of fat, no trans fats, and 23 grams of protein.

If you're looking to consume less meat, or eliminate meat from your diet, Morningstar Farms steak and chik'n strips are perfect substitutes for where you would typically use meat in a meal.

Dairy Council Ends Misleading Ads

The Federal Trade Commission has announced that the advertising campaign associating dairy with weight loss will be stopped because research does not support the claim.

Here is the New York Times article on this new development.

I am very pleased to see science win over false advertising.

Vegan Parents Starve Child

This story caught my eye on CNN -- because of a vegan diet, a six-week old infant starved to death.

There's more to it. The Atlanta Journal Constitution's article describes how the six week-old infant was fed apple juice and soy milk, with limited (if any) breast milk or formula.

Soy milk containers clearly state that they are not a substitute for infant formula. The apple juice acted as a diuretic, which futher dehydrated the baby. The child was born in an apartment bathtub and had never received medical care because the parents were fearful of hospital germs.

At the trial, a vegan diet expert even testified that a vegan diet can be healthy at any age.

A vegan diet didn't kill this child. These were parents who used bad judgement.

Let Them Eat Cake

This is not a foodie blog. But sometimes I cook. Less often than I used to. And I rarely bake. I have three desserts that I do well: chocolate chip cookies, carrot cake, and fudge brownies. This is the carrot cake, out of Dr. Pete's Eating For A Healthy Heart by Dr. Pierre "Pete" Aoukar, which I baked for the occasion of one of our nurses who is leaving our cath lab.

Pete is a cardiology fellow in Seattle and is also a vegan. He wrote this book when he was in medical school. Not only does it have great recipes, but it also has great advice on how to stay heart-healthy. I recommend this book for anyone who wants to get healthy and wants some healthier cooking and baking ideas.

It's a little healthier than a standard carrot cake might be. It is made from real carrots, flour, and sugar. The frosting is a mixture of Tofutti better than cream cheese and powdered sugar.

Nutritional information: 1 slice (1/16 of cake), 375 calories, 8 g fat, 3 g protein.

Training with the Group

I'm part of a triathlon club. It's mostly women, and I'd say I'm the least experienced and least athletic of the group. And I'm no slacker.

This morning at master swim, we were doing sets of 4 x 25 meters on 30 seconds. By the end of each of those sets, I was seriously sucking wind, and everyone else looked happy and content. That's ok, though, they're all faster swimmers than I am. If I'm pushing to finish 25 meters in 23 seconds, then 7 seconds just isn't enough rest. By the last time we did this, I lengthened the time to 35 seconds, so I'd have a little over ten seconds rest. Still tiring, but at least no one would have to pull my body out of the pool.

I wonder, as the least talented amongst this group of triathletes, should I feel like a loser? I don't. I train with them, and even if I'm not as fast, I know I'm getting stronger. Being around talented people really motivates me, and I'm going to use that motivation to do as well as I can in my first triathlon on June 9.

Running in May

May is my favorite month for running. Here in the northeast, it's the month when we finally get some nice weather after a blustery winter. The trees are in bloom, the weather is mild, not too hot, not too cold, perfect for running.

Today was my first speed workout in over four months -- now that I can consistently do three running workouts in a week, each at a distance of 3 to 5 miles, I decided it was time to try to get in some speed. I ran four two-minute pickups, or running at a faster than comfortable pace for two minutes, with two minutes of rest between each. Two of us ran together, and the girl I was with was a little faster than me, which pushed me a bit.

Quackery

Did you know that you can make just about any claim about a supplement and get away with it? As long as you don't say it's medicine, you can say ANYTHING!

I see a table with juice samples at my local Whole Foods, and wander on up for a sample. It is a supplement mixed in juice, with vitamins and amino acids, which are intended to boost energy. As I am a huge fan of free samples, I try some.

"This will boost your energy, if you take it with our vitamin B complex," the woman tells me.

No one expects that a woman with long hair wearing a tie-dye shirt, blue jeans, and big sunglasses wandering her local Whole Foods at 4 pm on a weekday is a cardiologist (we were done for the day in the cath lab, and I was out early). So, I ask: "Do you have proof?"

Her: "It has amino acids."

Me: "Okay, but do you have any scientific data that shows that ingesting amino acids will increase energy?" I know that the answer is no, but I'd love to hear what they have to say.

Her: "They're amino acids. The building blocks to proteins."

I'm realizing, not surprisingly, that this woman has no idea what she's talking about. Me: "What I am asking is, do you know of any trials from the scientific literature that prove that taking this supplement will provide more energy?"

Her (looking uncomfortable): "Ummm... no, I'm sorry, I don't think we have any of that here."

Her boss or co-worker overhears the exchange and offers me a brochure entitled "Energy", written by a physician who has written and researched on chronic fatigue syndrome and fibromyalgia. I'm offered brochures on chronic fatigue syndrome and on stress, but decline.

This brochure is interestingly done -- it talks about what various vitamins do, in a chart form that I've seen in a few medical textbooks, and the heading above the "what it does" column is changed to "effect on vitality and energy". Very fancy. The physician then claims that "most Americans are chronically dehydrated", which is completely untrue, and while he has over 100 references, not one to support that claim of chronic dehydration.

Another doozy: He talks about how stress will "...exhaust the adrenal reserve" and that "...it is important to supplement your adrenals with a glandular therapy regimen to ensure healthy cortisol levels and adrenal function." He has two references for his claim: one is his book, the other a study on sodium deficiency in guinea pigs!

The problem is, people actually believe this nonsense. A man with an "MD" after his name prints it. And even though most of his references are to books (as opposed to actual studies), including frequently his own "From Fatigued to Fantastic" book, it all looks quite scientific to the lay person.

All in all, this is a very expensive multivitamin. A multivitamin is okay to take, because we don't get everything every day in our diet in spite of our best efforts. This one is no better than any other one. Oh, and the amino acids? You get plenty of those in a balanced, varied diet. And if you want more energy, do more, exercise, push yourself.

Bottom line: If something sounds too good to be true, it probably is. Don't be afraid to ask your doctor before you spend lots of money on a seemingly magical cure to your ailments.

Animal-Friendly Accessories

The Today Show had a feature on eco-friendly accessories, featuring vegan accessories!

It's nice to see a mainstream media outlet talking about vegan products. If only they would discuss the cruelty involved in producing leather and fur, but this is a good start.

I was a little surprised at the mention of bboheme.com, which is a site based out of the UK, when there are plenty of companies here in the US that offer vegan accessories, such as Alternative Outfitters and MooShoes.

What I've Learned Since Going Vegan

-- It took me 16 years in life to go vegetarian, and another 13 to go vegan. As passionate as I am about veganism, I'm not going to convince anyone overnight.

-- When people say, "I could never be a vegetarian", it means the gears in their brain are churning.

-- As years pass, you'll find that friends and coworkers become vegetarian, and you can be proud that you were an influence in their decision.

-- Just because that 450-calorie chocolate chip cookie is vegan, that doesn't mean I have to eat it.

-- So many foods are vegan, including Oreos, Laffy Taffy, Cracker Jacks, Twizzlers, potato chips, and soda pop.

-- Simply being a vegan doesn't mean that I am healthy.

-- It's best to just eat the bread that might have a trace of egg or whey, rather than annoy the waiter with endless vegan questions. That trace amount won't harm me, barely harms even one hundredth of an animal, and the waiter and other diners won't think of veganism as insanely complicated.

-- Make it look easy to follow a vegan diet, even the few times when it's not.

-- Over dinner, when asked "So why are you a vegan?", it's best to avoid details of cholesterol-laden arteries, tethered veal cows, and unanesthetized branding and castration. A simple answer like, "I learned what the animals go through, and I was very disturbed and don't want to be part of that. And, it's much healthier and better for the environment," will suffice. A reference to look at later, like meat.org, will help them understand.

-- It's best to just laugh at questions about whether plants have feelings too.

-- I still don't have the perfect answer to, "Do you mind if I eat this steak in front of you?" My best response: "It's an omnivore's world, I'm just living in it."

How's the Training?

It's good. I'm swimming with a masters swim group 1-2 mornings per week, spinning 2 times per week, running when I can, and doing a little weight training and an occasional kickboxing class.

Running is a challenge right now, because every so often my iliotibial band gets inflamed -- that's the injury I've been dealing with since December. I'd love to do speed workouts, but our running coach says I should take it easy, and I think she's right.

Another bonus of getting back into training is that I'm finally taking off the 12 or so pounds I gained during the cold weather. I always gain weight in the fall and lose in the spring. It's not a good habit, I know.

My first triathlon is June 9, the Hyannis Sprint Triathlon. I think a couple of coworkers will be doing it too, which will be fun.

Spinach

This is my own version of the indian dish palak paneer, but without the cream or cheese. Sautee spinach in a little canola oil, with mustard seeds, cumin, coriander, salt, pepper, paprika, and a little Earth Balance margarine. Toward the end of cooking, add cubes of firm tofu. I ate this with Stacy's Simply Naked Pita Chips.

Marathon City

The Boston Marathon is on Monday. As a result, Boston is full of tourists this weekend, carrying their orange marathon bags or wearing their blue marathon jackets. It's exciting, yet a little bittersweet -- I had a marathon number through a charity and had to give it up because of an iliotibial band injury, which still intermittently nags me.

I attended a conference for work this week at the Hynes Convention Center, which conveniently is also where the marathon Expo is taking place. During breaks, I sneaked down to the expo, had my running gait analyzed, saw Katherine Switzer (the first woman to officially run the Boston Marathon), got free socks, and sampled many goodies.

It's all so exciting. If things are quiet at work on Monday, I might try to sneak out for a bit to watch the runners finish.

Tomato Matza Farfel with Veggies

Whole wheat matza farfel (crumbled up matzah into small pieces) cooked in tomato sauce, topped with fresh broccoli and mushrooms sauteed in olive oil, salt, and pepper.

Passover Pancakes

The pre-mix box of Passover pancakes has always been a big hit for my family. While the mix itself is vegan, the recipe on the box calls for a cup of milk and one egg to be added to one cup of mix.
I made these pancakes with one cup of mix, one cup of applesauce, one tablespoon of oil, and three tablespoons of water. Mmmm.... pancakes for breakfast....

Passover Seder, Vegan Style!!

I visited my family this weekend for Passover and contributed a few vegan dishes for our seder, the festive dinner where we tell the story of Passover. The recipes are all from Roberta Kalechofsky's The Vegetarian Pesach Cookbook.

This is the Sweet Potato Orange Pudding, which was good but I found to be too sweet.


This is a Vegetable Nut Loaf. It's time-consuming, with lots of vegetable chopping and peeling, but quite filling. It's a bit dry, like most Passover foods, as real flour can't be used, but it goes well with an apricot marinade.

And now for the best of the three: Multi-National Potato Casserole. It's a dish with a layer of mashed potatoes on the bottom and top, and in the middle a layer of sauteed onions and portobello mushrooms. This came out quite good. The pictures are staggered to show you the different layers.




Finally, what's a meal without dessert? And, better yet, a Passover dessert that doesn't have twelve eggs in it? Can it be done? The answer is a resounding YES! This is the No Bake Chocolate Matzoh Roll. Kind of an interesting concept -- melted chocolate, a little bit of coffee, sugar, margarine, and moist matzah, rolled up with chocolate glaze and strawberries on top. My 92 year-old grandmother, the ultimate food critic, enjoyed it, and I thought it was pretty decent too.
So, that was seder. Proof that you can be vegan and eat well on Passover.

I'm Back...

....and some food posts are coming. I cooked some stuff for Passover. Some of it was good, some of it was so-so, but all of it was edible. That is an accomplishment for Passover.

In the meantime, here's a little humor.

Staying Busy

There are no recent posts because things have been very busy. This past weekend, I was at the American College of Cardiology conference in New Orleans, learning about new trials, innovative ways to intervene on coronary arteries, and of course having a little bit of fun -- can't give you any bull about that!

So, with two busy days in the cath lab behind me, I am off to spend the holiday of Passover with my family.

Saving the Environment, One Burping Cow at a Time

This is about the most absurd thing I've heard in a while: A pill to decrease methane production from livestock cows.

Yet more evidence that a plant-based diet is better for the environment.

Calcium and Vegan Diets

There's new data about calcium, fractures, and vegan diets. This study showed that vegans overall are 30% more likely to have a bone fracture than lacto-ovo vegetarians, fish-eaters, or meat-eaters:

Appleby P et al. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr, Feb 7, 2007.

Jack Norris of Vegan Outreach has an excellent discussion of the results.

However, those vegans who consumed over 525 mg/day of calcium had the same risk of fracture as the other populations in the study.

When calcium is consumed with large amounts of protein, such as in milk, calcium excretion in the urine increases. Therefore, it has been suggested that vegans have lower dietary calcium requirements.

I think that this study suggests that perhaps we do need to be more diligent with our calcium consumption. Most people need 1000 mg/day of calcium; pregnant women, the elderly, and children may have higher requirements.

Also, be mindful of getting enough Vitamin D, which regulates calcium absorption. Fifteen minutes of sunlight a day will give you enough. But, if you are in a northern climate or do not get that much sunlight, make sure you are consuming either a multivitamin with Vitamin D or Vitamin-D fortified soy or rice milk.

My Talk at Boston Vegetarian Society

I gave my talk on "Vegetarian Diets and Heart Disease" to the Boston Vegetarian Society yesterday. The feedback that I've gotten is good. It's a good thing I did some reading in advance because there were some very challenging questions from the audience.

So, thanks for the suggestions of things you would want to hear about -- I did incorporate some ideas into the talk.

Back in the Pool

Master Swim is at 6:30 am. And I am not a morning person. So when the alarm went off at 5:30, I almost slammed it down, until I remembered that I had packed everything the night before.

I found a spot in the slowest lane, me and two other women. Having not swam in 2 months, I was apprehensive. The first 200 meters were tough; I wanted to just die about 150 meters into the warm-up. But then, somehow, it all came back. I think I swam about 1600 meters in an hour.

I was halfway through any given set, and I'd look over and the other lane swimmers were done, eagerly standing at the edge of the pool ready to do the next set. And here I'd have another 100 meters or so to swim.

I like our coach. She has lots of good feedback, even for us in the slow lane. For me, I guess I keep my arms straight under the water. I'll work on fixing that.

Tri training has begun.... Hyannis Sprint in June, here I come!

Rollerblading and the Law

It was a beautiful New England day, partly sunny and in the high 60's. Not typical for mid-March. I felt the urge to rollerblade.

So, I grabbed my bag with my rollerblades and pads and walked the mile or so up to the Esplanade, the paths that run along the Charles River. I put on my rollerblades and padding and headed down the path, leaving my bag with my shoes and other rollerblade equipment behind a tree.

A half an hour and an awesome workout later, I return to see that my bag is gone. There is a State Trooper vehicle parked nearby, with my bag sitting on top of it. I rollerblade over, and the trooper gets out of the car.

Trooper: Is this your bag?
Me: Yes.
Trooper: You know, you shouldn't be leaving bags out here.
Me: There's nothing valuable. It's just shoes...
Trooper: We don't know what's in it. What if it was stolen? You'd be calling us up. In fact, I could be calling out the bomb squad.

Oh my... a big deal over a bag! Next time I'll just have to carry my blades and tuck my shoes behind a tree, without a bag of course.

But seriously, I hate to be equated to the guys who paralyzed the city with their Cartoon Network advertisement devices. After all, there is real crime in this city to be fought too. People are getting stabbed on the orange line, among other things.

Leave me alone. Go fight crime, and let me rollerblade.

Getting Serious about Training

It's time to start triathlon training again......

I've taken the first step by joining the triathlon club at my gym. It's serious business -- there's a coach for each discipline, several group workouts a week, and they come up with a tailored workout plan toward our individual goals.

I have a ways to go. The iliotibial band is getting better, but isn't 100%. I can run 15 minutes at a time pain-free. I haven't swam in over a month, because I just don't like swimming by myself. It's the whole rat on a wheel feeling of swimming laps in a pool without external stimulation. However, I've been training my weakness, which is biking, by doing a few spin classes each week.

It's going to be tough, but I'm ready. I need the structure, and I'm excited for the challenge.

Advice for Doctors

My friend Dr. Krupali Tejura, a radiation oncology resident, submitted a question to Leroy Sievers, an NPR journalist who blogs about his fight against cancer. She asks what patients want from their doctors. The answers she gets are interesting. Read on.

It's great food for thought. If you don't know the answer to a question, you can always look it up. But personal interaction can't be replaced.

Spinach and Potstickers

Sometimes it's all about convenience... tonight's one of those nights. We just finished a complicated case in the lab, and I'm hungry and tired.

So, I sauteed some frozen spinach in olive oil, with sea salt, ground pepper, garam masala, garlic, and a little chili powder. The potstickers are Ling Ling brand, and easily heated in boiling water. The whole thing took ten minutes. Easy, filling, and delicious.

Bold Ideas for NYC Restaurants

The New York City Department of Health has made two recent proposals. The first is to eliminate trans fats from all NYC restaurants. Second, restaurants would be required to list the number of calories in each meun item clearly on the menu next to each item.

I think these are great ideas. Trans fats are more atherogenic, in other words are more likely to lead to plaque buildup in the arteries. I'm especially excited about listing calorie content of menu items -- I think that even the simplest of consumers would be wary of a menu item with 1,500 calories. Or, those who think they're having a "light dinner" by ordering an appetizer with 2,500 calories might think again.

Last night I was at a dinner with a few interventional cardiology fellows, and we were discussing this topic. One was particularly adamant that Americans could care less about the calorie content of what they're eating and would make no changes based on that information.

I disagree -- I think that with this information, people for the most part would make wiser choices. As a result, restaurants would have to think twice about how they're preparing food and consider changing their menues to include healthier items.

What if....

....a vegan cardiologist was coming to your local vegetarian society to give a talk. What would you want to hear about?

I am revamping my talk that I've given in the past. I have some great ideas, but would love to hear yours.

Tune in March 18 at Grasshopper in Allston. I'll be speaking to the Boston Vegetarian Society.

Hamantashen from Grandma

My grandmother sent these to me for the Jewish holiday of Purim. They are called hamantashen, to commemorate Haman, the bad guy who wanted to kill the Jews, but who was hanged instead. The cookies are in the shape of his three-point hat. And yes, Grandma made them vegan.

Grandma is 92 years old and still bakes. She's the healthiest 92 year-old I know. In fact, she walks on a treadmill for half an hour a day. People where she lives are in awe of her, and every so often she has "pupils" who join her to exercise. I can only hope I'm that healthy when I get to be her age.

Fitness Rituals

My weekend mornings are about working out. When I was actively running, one of those mornings was always a long run. As I've been recovering from my IT band issues, I've created new rituals.

Saturday morning is one and a half to two hours at the gym. There are two spinning classes, 9 am and 10 am, and I go to one of those, whichever I wake up in time for. Then I do some weights and abs for 30-45 minutes.

Sunday morning is kickboxing! There's a great 10:30-11:30 class at my gym, and lots of punching and kicking. I almost skipped kickboxing this morning to do my taxes, but I'm so glad I went -- I feel so energized!

Once I start running again, these rituals will change. But for now, they keep me charged up for my weekends.