Malibu Pictures

Pre-Race, in the transition area.

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

On the podium at the Awards Ceremony --

Fourth Place Athena (since the first place girl started in the wrong wave, she was dq'ed)!!!!

Malibu Triathlon

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

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

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

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

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

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

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

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

I couldn't have had a more thrilling birthday!

No Soup For You! -- Watching out for Salt

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

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

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

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

Spinach Dip

I love this spinach dip and will be bringing it with me to a Labor Day party this afternoon.  It's easy to make, healthier than a standard spinach dip, and tasty.

Here's the recipe:
3 pounds chopped frozen spinach, thawed and drained of extra water
1 small can of chopped water chestnuts
1/2 cup Vegenaise
2 tablespoons of imitation Chicken soup mix

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

Saturated Fats and Cholesterol

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

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

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

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

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

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

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

Santa Barbara Triathlon -- In Action

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

Santa Barbara Long Course Triathlon

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

"Feeling impulsive?"

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

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

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

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

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

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

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

Meat and Cancer

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

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

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

Health Care Reform

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

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

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

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

21-Day Kickstart to a Healthier Diet

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

Have you thought about trying a vegan diet?

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

Motivation to Exercise

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

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

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

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

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

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

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

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

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

My Interview

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

I'm going to be an IronWoman!

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

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

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

Another Trip to the Farmers Market

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

Vineman 70.3 Race Report

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wednesday Morning Ocean Swim

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

Juicy Ladies

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

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

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

I think I have a new favorite lunch stop!

Can You Trust Vegan Restaurants?

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

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

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

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

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

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

Hungry Duck 5K

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

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

I was even quoted in the local paper.

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

Could it be... Seitan?

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

Breath of Life Triathlon Race Report

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

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

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

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

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

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

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

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

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

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

Heart Rate Monitors

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

This is my heart rate monitor that I wear on my wrist:
from DicksSportingGoods.com

And this is the strap that is worn around the chest:
from www.smoothfitness.com

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

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

Exercise

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

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

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

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

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

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

Welcoming New Patients!

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

Grain Meat

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

Shojin -- Organic Macrobiotic Japanese Cuisine

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

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

The food was absolutely delicious and healthy.

Click here to visit Shojin.

Hemp Milk

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

San Diego Rock' 'N' Roll Marathon

Today's San Diego Rock 'N' Roll Marathon was my fifth marathon, and now I can finally say that I've run a marathon like it's supposed to be run. In every marathon that I've done up to this point, I've started too fast and found myself miserable from mile 20 onward. Not today.

One key to my success today was that I rested this week. I learned from my Wildflower race a few weeks ago just how important it is to not overexert in the days before the race.

My friend Ray, an ultramarathoner, who was doing the marathon as a "training run", agreed to pace me to a 4:20 finish. That was my goal for the day. We started at a 10 minute mile pace. I stayed consistent at that pace for several miles. I felt great.

Around mile 19, I still felt good. I gradually picked up the pace. For miles 22-24, I was hitting a 9:30-9:40 pace. I was passing just about everyone; it felt great!!! At mile 25, Ray turns to me and says, "Here's where you're going to give it everything you've got." I picked up the pace to 8:30/mile, and for the last two tenths of a mile, I hauled it in to the finish line.
My finishing time: 4:18:32. A minute and a half faster than my goal. And, I did it in negative splits, meaning that the second half of the race was faster than the first. Overall, a great day!

Change

I spend a lot of time talking to my patients about lifestyle change. I truly believe that a patient is not treated by pills alone. If a person commits to a healthful lifestyle, he or she will live longer. And I believe that people can change.

But change does not come easy. It comes a few small steps at a time.

I don't expect a patient with out of control blood pressure and lipids, who does not exercise, and who eats no fruits or vegetables, to come back to me a month later having become a vegan who exercises five days a week and with normal blood pressure and cholesterol. If he or she returns to me a month later with an improved blood pressure, perhaps a pound or two lighter, and is now eating a salad every now and then and walking two days a week, I consider that success, and we can improve even further from there.

Diet change is especially tough. Someone who consumes a lot of meat and not many fruits and vegetables cannot overnight adopt a plant-based diet. A great way to start is to give up beef and aim for two vegetarian meals a week. Then give up dairy, and try new things like soy milk and rice milk and hemp milk. And then another change towards eating healthfully, and another....

I can recall a time back in college when a grilled cheese sandwich, a large order of fries, a 24-ounce Coke, and a large ice cream sundae was a normal dinner. At that time, I thought that by putting on my Rollerblades a couple of days a week for a few minutes to get to my classes that I was exercising enough. I was overweight and had so little energy. It took years and many small steps along the way to become a healthier person.

Small steps can be the key to long-term success. Celebrate small successes, and keep moving forward.
Image from www.35unger.com

"It's in my chart"

Be an active part of your health care. Know your medical history. Carry a list of your major health problems and medications and their doses with you at all times. Consider getting a medical alert bracelet.

Just because something is "in the chart" doesn't mean that I have it in my records, especially if I'm meeting you for the first time. I do not rely on "the chart" for what doses of medications you take -- you are the keeper of the pill bottles and you are the one who puts the pills in your mouth, so you are the one who knows exactly what and how much you take. Further, all of your records may not have come to me yet if I am meeting you for the first time.

And, finally, imagine this scenario: You end up sick in an emergency room where none of your doctors practice. Your medical information is absolutely crucial to your treatment in the next few minutes and hours.

My New Favorite Workout

Exercise is a habit. If we enjoy exercising, it's easier to stick with it.

My favorite workout right now is the Ocean Speed Circuit. At 6:30 am, nearly 100 people from my triathlon club gather in Santa Monica to swim in the ocean. We swim out to a buoy, swim back to land, run a few hundred feed on land from one cone to another, and then get back in the ocean and do it all over again.


It's a great workout -- getting into the ocean, diving under waves, and running on the sand definitely gets the heart rate up. Swimming in the ocean always reminds me that I'm from the Midwest -- I am not entirely confident swimming under and over waves, and with the quick entrances and exits from the water, my ocean swimming has improved.

And really, what better way to start the day than a dip in the ocean?

Here's what it looks like from a traffic helicopter.

Wildflower Triathlon Pictures

Getting out of the water after the swim


Climbing that first big hill out of the transition area



Cruising along on the course... with a smile

Running the course... trails and hills... very challenging

Dashing to the finish line

And the big finish!

Farmers Market

I love a trip to the farmers market. The produce is locally grown, less expensive than at the grocery stores, and absolutely delicious! On top of that, supporting your local farmers market is kinder to the environment, because your produce was transported from somewhere nearby, like San Luis Obispo, California, as opposed to, say, Chile.

This sandwich is created from my farmers market trip today. Fresh whole-wheat pita bread with avocado hummus, cucumber slices, and a chopped tomato. Don't mind the few bites taken of the sandwich -- it's the best way to show you what's inside. Paired with a salad and some strawberries also purchased at the market, a very filling lunch after my long run this morning.

Big Lunch Salad

This is my typical lunch: A big salad.

The base of the salad is dark lettuce with carrots. Sometimes I'll add some beets, celery, cucumbers, or sunflower seeds. I always include some form of protein, such as kidney beans, chik peas, lentils, or tofu. Here, I've added Follow Your Heart's Chicken Free Chicken. The salad is topped with two tablespoons of Follow Your Heart's Thousand Island dressing.

I pair the salad occasionally with a slice of bread or a side of pasta and always include fresh fruit for dessert.

Follow Your Heart is a favorite stop of mine. They are a vegetarian grocery store in Canoga Park, just a mile and a half from my office. In addition, there is a fantastic cafe in the back of the store with delicious healthy vegetarian items.

Follow Your Heart is located at 21825 Sherman Way in Canoga Park.

Pictures from Wildflower

This is me climbing the hill called Nasty Grade. I'm almost at the top.


On the run, near the end. Fighting a stomach cramp and finding some adrenaline knowing that the finish line is less than a mile away.

Wildflower Race Report

It' s been a crazy year in my athletic life. I started by DNF'ing a marathon, coming back two weeks later to race a marathon where I achieved a personal record, and then being derailed from racing by an arrhythmia known as supraventricular tachycardia.

Eight days after my arrhythmia ablation, I raced Wildflower Long Course, one of the world's toughest half ironman distance races. I am pleased to say I had a great time and a great day as an athlete.

Wildflower is the only reason that I own a tent. It is known as the Woodstock of Triathlons. The only feasible way to race is to camp there the night before, and then of course celebrate the night after with my team at the campground.

My goal time for the race was 7 hours and 15 minutes. I thought that was a pretty ambitious goal and wasn't sure I could make it.

We started with the swim, which I estimated would take me 43 minutes. After accidentally following a swimmer into an embankment, I straightened myself out and had a good consistent swim. There were a lot of us out there in the water and I managed to avoid being elbowed or kicked too much. I followed a sea of different colored caps. But, toward the end, as I was getting out of the water to run to the transition area, I suddenly noticed a sea of men in pink caps that I had not seen before! I thought I was in the wrong place, until I realized that they were all the frontrunners in the shorter mountain bike triathlon race that was taking place that day.

Time for swim portion: 44 minutes. Close to my goal.

I pulled off my wetsuit, put on my bike shoes, helmet, and sunglasses, and hopped on my bike. I heard several friends and club members cheer me on as I rode out of the park. One person who knew about my arrhythmia issues yelled, "Surgery one week ago, racing today, no big deal!" Well actually it wasn't a surgery, it was a percutaneous procedure through the vein in my leg... ummm never mind. It's the thought that counts.

I had a tough time on the bike course when I tried it out a month ago. My goal was to finish in 4 hours and 15 minutes, or maybe 4 hours if I was doing really well. Since then, I put a new rear cassette on my bike that would make hills easier. What a difference!! I glided up the hill known as Nasty Grade with more ease than last time, passing several riders. As it turned out, I finished the bike ride in 3 hours and 50 minutes, taking forty minutes off my previous time!

On to the run. This is my favorite of the three sports. I had hoped I could finish in 2 hours 24 minutes, an 11 min/mile pace. This run course is TOUGH!! It is really hilly and mostly on trails. I passed a lot of the athletes who had passed me on the bike. Many people were walking. Other than a few very brief steep portions, I ran the entire course, though at many points my run was more of an uphill shuffle. I ran past Blaine from NBC's The Biggest Loser, who was competing with his cousin and fellow Biggest Loser contestand Dane, and this time around no one drove them to the finish line.

I had a sudden stomach cramp at mile 12. It hurt so badly that I started walking, until a member from my club yelled behind me to stop walking and to run. So I picked up the run again, and before I knew it, I saw the finish line, and the adrenaline kicked in and I had no more side pain. I heard "Dr. Heather Shenkman is coming across the finish line!"

Finish time: 7 hours, 11 minutes. Four minutes faster than my goal.

My run time was 2:29, a little slower than my goal, but actually faster than a lot of athletes in my age group.

I have to say, I just had a great race. For the most part, I felt great, even to the end. I had fun and achieved my goal time.

Ironically, I think some of my success was due to the rest that I had to take because of my heart procedure. I came into the race feeling well rested, which I think really helped. That's a lesson that I will take with me to my upcoming races.

Ablated!

I had my SVT ablation today (for more on that, read the post below this).

It was a long procedure -- about three and a half hours, since I had an atypical electrical pathway. I now understand why adenosine is so uncomfortable and how isoproterenol makes the heart pound. I recall lying on the cath lab table, in a fog of versed and fentanyl (sedation medications), as my heart would intermittently pound. But in the end, it was a success.

The staff in the cath lab and the nurses on the floor were great.

I definitely have a new appreciation for what my patients go through.
Image from heartrhythmguide.com

Seeing the Other Side

As of late, I find myself in the role of the patient.

About six weeks ago, I noticed some short bursts of palpitations and lightheadedness. Then during a weight training workout, I felt my pulse racing for about a minute before it would stop. I had only four hours of sleep the night before, it was 5 am at the gym, and I figured it was just due to fatigue.

A week and a half later, it occurred again while lifting. I looked down at my Polar heart rate monitor -- 180 beats per minute. That can't be right. My first instinct was to keep on exercising and hope it would stop, but trying to do squats with a racing heart doesn't work so well. I tried carotid sinus massage, pressing on the neck to try to stop the racing heart rhythm. Then I laid down, and by bearing down I was able to break the endless loop, watching my heart rate monitor flash from 180 suddenly to 73 beats per minute.

Being a cardiologist, I knew that this was likely a supraventricular tachycardia -- in other words, an abnormal circuit in the heart that can cause the heart to race. I obtained a portable heart rate monitor that I could carry with me wherever I went -- on long runs and bike rides, or in my lab coat pocket. If the palpitations recurred, I could capture the electrical impulses so that the rhythm could be diagnosed and appropriately treated.



Two and a half weeks went by without any palpitations. I hoped that meant that I was cured, but that was quite unlikely. Then, after a challenging bike climb, it occurred again. I pulled out my trusty event monitor to record the rhythm and sent in the recording.

My suspicions were correct. I have supraventricular tachycardia, also known as SVT. And the episodes are becoming more frequent, and at times are lasting longer, up to 25 minutes at a time!

There are two ways to treat this. The first option is medication. That would decrease the frequency of the attacks. However, it would cause my heart to be slower all the time and would limit my capacity to swim, bike, or run, and in all likelihood would not cure me. The second option is an invasive procedure called an ablation, which involves feeding a catheter from the large vein in the upper leg up to the heart, localizing the abnormal rhythm, and burning through that abnormal electrical circuit. The cure rate with the latter option is 90-95%.

I'm opting for the latter, more invasive procedure. I need a cure. If I had SVT while running or bicycling, it would be disruptive, and I'd have to stop. Worse yet, if I had SVT while swimming in open water, that could be downright dangerous.

Until my ablation procedure is done, I cannot race. Which absolutely kills me, because I was looking forward to my first race of the season this weekend.

I am nervous -- even though the complication risk is very low, normally I'm the one performing the procedure, and now I will be the patient on the table. I think this will give me a different appreciation for my patients' experiences.
Image from http://kirstyne.files.wordpress.com

More Passover Dishes

The recipe is called Mrs. Feinberg's Kugel. I have no idea who Mrs. Feinberg is, but her kugel is fabulous! The recipe includes 1 cup grated apple, 1 cup grated sweet potato, and 1 cup of grated carrots, and one cup of matzah meal. Then add 1 tsp salt, 1 tsp cinnamon, 1 tsp of baking soda. The recipe also calls for 1/2 cup of margarine -- I only used 1/4 cup, but probably could have gotten away with even less than that. There is also an optional addition of nutmeg and sugar, but honestly, the dish is sweet enough that it doesn't need added sugar. Bake for 45 minutes at 325 degrees.

Mushroom and potato casserole. Boil redskin potatoes, mash, and put them at the bottom of the dish. Then saute sliced mushrooms and onion, just until the mushrooms give up their juice. Pour the mushroom and onion mixture on top of the potato layer. Top with almond slivers and raisins. The dish calls for 2 tablespoons of margarine, which I omitted.

Matza Farfel Pasta

Tonight is the first night of Passover. Passover is a Jewish holiday on which we do not eat leavened bread, nor do we eat items that may resemble leavened bread. This includes soy, lentils, and peanuts, all of which are normally staples of my diet as a vegan.

I enjoy the holiday because it challenges me to prepare food that I would not normally make.
This is whole wheat matzah farfel with baby bella mushrooms, pasta sauce, and carrots. I sauteed the sliced mushrooms in 1/2 cup of pasta sauce, then added sliced carrots, and last 1/2 cup of matzah farfel. 320 calories.

Triathlon and Risk of Sudden Death

Research presented at the American College of Cardiology 2009 Scientific Sessions demonstrates that the risk of sudden death is higher during a triathlon than during a marathon. Most deaths occur during the swim portion of the race and the average age of those who died was 42 years old.

I think that the take-home message here is that athletes, particularly those who do not compete regularly in races or those who have cardiovascular risk factors, should be screened by their physicians before racing.

They're Not Mashed Potatoes....

but they're healthier and still really tasty!
I made mashed cauliflower. I boiled 12 oz of cauliflower for about 20 minutes, poured it through a drainer, and then mashed it. I added just one teaspoon of Earth Balance margarine, salt, and pepper.

Peanut Butter Cup Smoothie

1 banana, 1 cup soy milk, 1 tablespoon peanut butter, and 1/2 scoop of vanilla soy protein powder. It's 17 ounces of smoothie, 370 calories, 11 grams of fat, 20 grams of protein. For a thicker shake, try using half a cup of soy milk. For a lower calorie shake, cut everything in half.

Destination: Wildflower Long Course

My next big race is the Wildflower Long Course Triathlon on May 2, 2009. It is known as the second toughest half-Ironman distance course in North America. This will be my toughest race yet.

Last weekend, I went up to Lake San Antonio for a long weekend training camp. We swam, biked, and ran on the terrain that we will be racing on. The training was great, but it was a huge wake-up call to me that I need to improve my cycling skills.

This would be me riding the 56-mile hilly course. I'm smiling because I know I'm almost done. Whew!






















The 56-mile bike course has lots of rolling hills at the beginning, then levels off for several miles. Around mile 43, there's a hill called "Nasty Grade". It can best be compared to "Heartbreak Hill" in the Boston Marathon -- when you're done with much of the course and a bit tired out, up ahead is a long hill to conquer. Nasty Grade is several miles of climbing. It levels off and you think you're done, but then there's more climbing to do. At the top, some joker spraypainted on the road, "What hill?". I laughed so hard when I saw that, after sweating through that long climb.

Swimming is.... swimming. I don't really love to swim. I am tall and have broad shoulders, so I'm not too terrible. My attitude, or perhaps attitude problem, toward swimming in triathlons is that it's so low yield -- even with tons of practice, a swimmer will only shave a minute or two off her race time. However, with running and cycling, many minutes can be saved. I attend an hourlong coached swim session once a week, but soon I'll be doing an open water swim also.

Running.... I love to run. I could run all day. Like Forest Gump. Except I like my music and can't live without my Garmin 305 GPS to tell me how far and how fast I am running.

The next few weeks will be some tough training.

The Art of the Tofu Scramble

Craving scrambled eggs? Try this healthy alternative:

Saute chopped onions in a frying pan with a little bit of water or Bragg's liquid amino acids (but go easy if you're watching your salt consumption!). No need for oil or margarine. Then add garlic.

Then add mashed or cubed extra-firm tofu. Mix in the vegetables of your choice -- I like spinach, peas, carrots, or sweet potatoes.

Add some spices for flavor -- I like coriander. oregano, black pepper, turmeric, and chili powder.

Saute for another 5-6 minutes and enjoy!

Heart Healthy Guide

For a long time, I've wanted a good, concise sheet to give to patients on lifestyle and heart disease. I haven't found any publication that is concise and hits upon all of the main points of diet, exercise, weight loss, and smoking cessation.

I put this together on my own. Read it and feel free to share your thoughts.

Exercise and Mood

I know that exercise improves my overall well-being.

Running helps me problem solve. It also boosts my mood when I'm feeling less than chipper.

Swimming, though it's not my favorite, destresses me. Perhaps it's the calming effect of the water, but when I get in the pool, I feel like the weight of my life is lifted from me.

Biking gives me a sense of accomplishment. With what other sport can you tell people, "I did 50 miles today"?

Yet another reason why exercise and triathlon are such a big part of my life.

Injury

If I've learned anything in my 30's as an athlete, it is to take injuries seriously. If you push through an injury now, it'll only make the recovery and time off from running longer.

A couple of weeks ago at my track workout, I tripped on a shoelace and fell flat on my face. I brushed myself off, tried not to look completely embarrassed, and kept running. My hands were a bit raw from scraping the track, but otherwise I felt great.

When I got home, my left adductor thigh muscles were sore. I iced them, and the soreness went away.

Four days later, I ran my marathon. Around mile six, I started feeling that soreness again. It was a mild nagging pain that went away by mile 10, and caused me no trouble thereafter.

Then, with each successive run, it's nagging me even more. I ran 8 miles on Sunday with it sore most of the run, then took three days off and on Wednesday it was back again with a vengeance.

Now I am taking a week off. I'll be doing lots of biking and swimming, and maybe a couple of power hill walks (though I'll be tempted to run... but I won't). I'll also be icing twice a day and taking my ibuprofen.

Image from marathonracerunning.com

Comeback Marathon

It probably wasn't the most sane idea to sign up to run another marathon two weeks after dropping out of a marathon. But, I wanted to see how my training would stack up and I hoped my nerves wouldn't get the best of me.

I ran the IMS Arizona Marathon this weekend. This time I finished, though I still landed at the port-o-potties three times and had stomach cramps that caused me to walk intermittently, especially at the end.

It was a somewhat tough, point-to-point, mostly uphill course with a net elevation gain of just under 400 feet. And it was the smallest race that I've ever run, with only 99 marathon finishers.

I am so grateful for my friend who ran with me. He hadn't run in over a month, yet braved the race with me. For the 15 miles that we ran together, he kept me entertained and motivated, though I wasn't the greatest most friendly running partner that day.

My time was 4:34:09. That's third place in my age group (out of five -- yes that's intentionally in small print). That's a personal record by over 23 minutes. Minus the gastrointestinal issues, I could have easily taken ten minutes off that time.

Now I just need to figure out what to eat and what not to eat. Pre-race dinner was pasta with marinara and some faux burger crumbles. Perhaps it was the soy? Or maybe I'll just pop some Immodium before my longer runs??

Losing Weight

Obesity contributes greatly to heart disease. When people don't exercise and carry too much weight, they put themselves at risk of diabetes, high blood pressure, and elevated cholesterol.

I tell a lot of people to lose weight in order to reduce their risk. Here are some weight loss tips that I've seen work:

- Use a nutritionist. That's someone who can tell you exactly how many calories your body needs and what foods you should and should not be eating with any particular medical problem.

- Write down everything you eat and the approximate number of calories. Share that diet diary with someone, such as a nutritionist, your doctor, or a personal trainer. It keeps you accountable. If you have to write down that handful of M&M's that you're thinking of eating, are you really going to eat them?

- Weigh yourself daily. That way you see trends of weight gain before your weight gets out of control.

- Follow a vegan diet, or at the very least, cut back on the quantity of animal products that you consume. Vegan diets have been shown to aid in weight loss, help control blood sugar in diabetics, and lower cholesterol.

- Do some form of exercise most days of the week. Long-term registries of people who have lost weight and kept it off for several years show that the vast majority of successful "losers" excercise almost every day.

- Remember that weight loss and weight maintenance is about lifestyle change. These are not changes that you are to make for a couple of weeks and then revert to previous poor habits.

Getting Ready for a Comeback

It's been a tough week emotionally. I keep thinking back to my marathon mishap from last Sunday, and I think it all comes down to my chronic stomach issues.

I do fine on any workout under two hours. However, anything longer than that, and I've had stomach issues. First I chalked it up to the protein in the Clif Bars that I would consume during a race. Then, one particularly bad day occurred the day after chewing four pieces of sugarless gum (sorbitol increases intestinal motility). I think I just have a sensitive stomach and need to stick to basic pasta and marinara the night before a long workout.

I felt sick all day on Sunday and much of Monday. But, I forced myself to drink water and juice to rehydrate. And, I wasn't sore, at all! I think that's because while I dropped out around mile 21, I had been essentially walking from mile 15. On Tuesday, I did a relatively easy workout at the gym, and on Wednesday I was back to my usual workout with my personal trainer in the morning and a track workout in the evening.

Since I can't have a DNF hanging over my head, I've decided to race the Arizona Marathon on Sunday, February 15. My coach had me ramp up this week, run 9 miles today, and then next week I'll taper my exercise in preparation for the marathon.

Having to drop out of the marathon last weekend was a tough blow, but I'm learning from the experience and moving on.

DNF

DNF stands for "Did Not Finish". Today is my first DNF, at the Surf City Marathon. Marathoners like Paula Radcliffe and Deena Kastor, and triathletes Chris "Macca"McCormack and Norman Stadtler have DNF'ed at big races. So I suppose that middle-of-the-pack athlete me can have a bad day too.

I've done marathons and half-ironman distance races. I trained harder for this marathon than for any other marathon that I've done. I did a 22-miler with solid 10-minute splits. I ran an 18-miler in negative splits just three weeks ago. And, two weeks ago, I finished a half marathon in 2:03. I was hoping to not only do well, but to have a personal record by several minutes. So what happened today? I'm not sure.

Dinner last night was at a Mexican restaurant, with pinto beans, rice, and some veggies and fried bananas. It wasn't anything too unusual, other than that I probably ate more than I usually do. But my stomach was fine in the morning. My pre-race fuel was my usual raisin bran with soy milk, yogurt, and a piece of fruit. I felt strong at the start. My strategy was 9:45/mile splits. I was hitting those consistently, maybe a little faster on a couple miles with a downhill. I was fueling with Gu, and with the Sharkies on the course which I specifically tried out on my own last weekend because I knew they'd be at the race and wanted to make sure I'd digest them okay. And I felt great -- that is, until about mile 13, when I slowed down a bit. I had a little bit of stomach cramping. Maybe I was dehydrated, I thought, so at the mile 14 water station, I walked through, drinking a cup of electrolyte drink plus two cups of water. I felt better for a little bit.

Then came worse stomach cramping and the urgent need to stop at a port-o-potty. And again, I felt a little better after that. I passed another water stop, but took nothing because I just felt I couldn't keep it down. At the next water stop I grabbed a Larabar, which I knew from past experience that I could digest while working out. But again the Larabar sat in my stomach like a rock. I had to walk a lot because running would induce cramping. Then I became lightheaded. I walked through several water stops without taking any drink or food because I couldn't keep them down. I passed the first aid tent at mile 18, thinking about stopping, but still, I wanted to see if I could feel better. I knew my goal time of 4:15 was in the toilet, but maybe 4:30? 4:40?

No such luck. I just felt worse and worse. A lot of people that I knew passed me, asked if I was okay. I appreciated their enthusiasm, but I was so embarrassed. Here I am, having trained so hard for this race, and I'm walking the last half of a marathon.

By mile 19, I resigned myself to the fact that I would not be finishing. Running just wasn't a possibility at this point, because I was even more lightheaded. I hadn't had any fluid since mile 14, which was well over an hour ago and I had no way of keeping any fluid or nutrition down. I had yet another emergent port-o-potty stop at mile 20. I couldn't feel my radial pulse, which is an indication of hypotension or low blood pressure. And finally I saw the first aid tent at mile 21.

I stumbled over and as tears streamed down my face, I stammered out.... "lightheaded.... cramps...." Next thing I knew I was lying down in the first aid tent, in tears, covered in blankets. I'm not one to cry at the drop of a hat, but I felt sick, but worse yet I was ashamed of myself having worked so hard for months for this marathon to land on a cot in a first aid tent. There, I was able to sip a bit of water, about an ounce, but not more than that. After resting for what felt like an eternity, shivering under countless blankets, I could sit up and not feel like I was going to fall over. I rode back to the start in the "sag wagon". I could have stopped at the first aid tent to get some IV fluids, but I didn't want to be in the happy race environment any more, so again stopping at a port-o-potty twice on the way, I stumbled to my car and drove home.

On the way home, I was able to keep a fruit smoothie down, though that wasn't pleasant. I weighed myself at home and found that I'm six pounds less than when I started this morning -- clearly dehydrated. And even now, hours later, I'm not feeling that great, though I'm sitting here sipping orange juice and oatmeal.

I'm mad, but it happens. Now, I need to move on. I want to prove I can run a marathon in 4:15-4:20. Based on my previous times I can do it. I'm going to find a marathon in the next couple of months and I will do it.

The Perfect Banana Mango Smoothie

I had an awesome banana mango smoothie at a restaurant recently, and asked for the secret to how it was made. They said that the secret was frozen bananas, a little orange juice, and a little soy milk.

Here's what I came up with: 1/2 cup frozen banana, softened in the microwave, 1/2 cup frozen mango, 2 oz soy milk and 2 oz orange juice. Throw it all in the blender, and yum! 160 calories.