Take your meds, please

One last important word on how to be a good patient: If you can't afford the medications precribed for you, please tell your doctor before you are discharged from the hospital. Especially if one of those medications is Plavix. And ESPECIALLY if you just had a coronary stent placed.

What are you dressing up as for Halloween?

I'm told that my office staff dress up for Halloween. It's festive, it's fun.

I'm not dressing up. Here's why -- I don't look like a cardiologist. As a young woman, I look nothing like your stereotypical, gray-haired cardiolgist. I'm mistaken as the nurse, the physical therapist, the nutritionist, the social worker -- you name it. And not just by patients, but by health care workers as well.

Some patients have even told me that because my last name ends in "-man" that they assume I'm -- a man!

In a world of stereotypes and preconceived notions, I need all the credibility I can get. Hence no costume.

Photo from paranormalworld.net

Curried chickenless wrap, Jicama slaw, and Banana

Here's day #1 from Eat Your Veggies vegan food delivery service.

What is jicama anyway? I don't know, but jicama slaw is tasty. With a side of cold lentils and watermelon for dessert, this was dinner. And it was delicious!

Now back to studying.....

Blog Slowdown

That's my niece. Aunt Heather buys her cool shirts.

The blog has been slow, and until after my interventional cardiology board exam on November 8, there won't be too many posts here.

For now, life is work, studying, and working out. I simply can't get by without my morning run or workout, so even if that means missing an hour or two of sleep, I'm better off for it.

In fact, to avoid grocery shopping and cooking, I'm trying out Christy Morgan's vegan meal delivery service, Eat Your Veggies. I'll post a few pictures and let you know how it is, but the meals she's dropped off look scrumptious.

How to be a Better Patient

Here are a few suggestions for how to get the best health care from your doctor that you possibly can:

1) Know your medical history and what medications you take.

Some patients have no knowledge of what medications they are taking, what their medical history is, or what medical procedures they've had.

Yes your information may be "in the chart", but sometimes that chart isn't readily available. You may have another doctor prescribing medications, and you may not be taking the medicines listed in the chart. For example, if your blood pressure is high it's important for me to know that the rheumatologist started you on prednisone two weeks ago, or that your primary care doctor stopped your lisinopril because of that pesky cough.

Also, it is very helpful to carry a current list of all of your medications and doses.

2) Describe your symptoms in simple terms.

We learn in medical school that 90% of medical diagnosis is taken from the history that we are given by the patient. The best descriptions are the simplest: "I have crushing chest pain that started two hours ago and radiated to my left arm." "I have angina" is not a description of your pain. As a doctor, I need to know your exact symptoms.

You do not need to describe to me the workup you've had since walking into the clinic or hospital. "My blood pressure is high and they did an EKG and drew blood from me" is not the information I want. I know this already. Tell me what symptoms brought you here.

3) Take your medicines as prescribed. This is especially true with hypertension (high blood pressure).

Blood pressure medications are not to be taken on an as-needed basis. You need them every day. Some patients tell me that they can "feel" when their blood pressure is high -- this is not true. That's why hypertension is called The Silent Killer.

If you have any doubts as to whether you should take a medication, ask me. I'd be glad to explain the benefits of the medications that I've prescribed you.

4) If you do not speak English well, please allow me to use a translator to converse with you. That way, we will understand each other better, I will know what your concerns are, and you will understand what your plan of care is.

Image from http://www.arealahec.dst.nc.us/medical.jpg

Vegetarian Wedding

My brother, Kevin, and his fiancee Mary Ruth tied the knot last weekend in Hawaii. The wedding ceremony, as you can see, took place on the beach.

Blossoming Lotus, a vegan restaurant, catered the event. The food was nothing short of amazing!!!

Noodles and edamame, spring rolls, and Migthy Aphrodite's Greek Salad (with "Feta" cheeze).

Senorita Bombia's Enchilada Casserole, with mole sauce and sour cream.

And, last but definitely not least, the cake. Ahhh... a vegan cake. I can't remember the last time I ate cake at a wedding. This was delicous and pretty!

I had hoped to submit this to VegNews magazine for their vegan wedding issue, but sadly it's too late this year. But here it is, an awesome vegetarian wedding.

How the Mighty Have Fallen

I used to cook a lot. In fact, my initial intent of having this blog was to show how easy it is to cook healthy vegan meals. But lately, I've done so little cooking. Almost none, in fact. Much of the reason is, ironically, time -- balancing a new job as a cardiology attending, working out, studying for my interventional boards, and occasionally spending time with family and friends. On top of that, it's so easy to call up Green Leaves for a seitan wrap and a miso soup to go.

Tonight, for the first time in a while, I cooked. I sauteed broccoli and onion in my wok with General Tso's sauce and paired it with some pre-cooked wild rice from Trader Joe's.

Once the boards are over, I'm going to cook more. I miss it.

Here is a nice positive article about vegetarianism, entitled "Protein a key concern for vegetarians"

It's very positive about vegetarianism. It talks about a restaurant in Atlanta called Cafe Sunflower -- I've been there and it's delicious.

But, I disagree that protein is a "key concern" for vegetarians. Anyone who consumes a balanced vegetarian diet will get plenty of protein. We only need 10% of our calories from protein. Most Americans are well in excess of that.

And why don't we talk about the "key concerns" of the standard American diet -- obesity, diabetes, heart attacks, stroke, osteoarthritis, hypertension, high cholesterol........ ???

Adventures in Raw

Leaf is a raw vegan restaurant with two locations in LA. My omnivorous friend Jodi absolutely raves about this place, so when I met up with her for dinner tonight, we headed to Leaf in Culver City.

We had the mock salmon nori rolls as an appetizer, which was really delicious! For a main course, we split a Bombay Burrito Wrap and a Rawzagna (that is, lasagna but made raw!). Both were pretty good. And, for dessert, we had apple pie. I was pretty skeptical about raw dessert -- last time I had a raw dessert item, a raw chocolate brownie, it did awful things to my gastrointestinal system. But, the apple pie was amazing, and there were none of the previously experienced after-effects.

I'll admit, I haven't had a lot of experience with raw cuisine. I've heard talks on the subject and how food is not heated above a certain temperature to preserve the enzymes in the food, and how the enzymes are beneficial to our bodies. I don't buy into this theory and there's really no science to back it up. But, what I can say, is that raw is healthy in that the food isn't processed, has no animal products or cholesterol, is full of fruits, vegetables, and fiber.

Is Bigger Better? Maybe not.

Here's a great piece on why height matters in sports.

Now it makes more sense to me why, at 5'10", I do well in the swim portion of the triathlon, but not as well on the bike or run.

One of Many Reasons I Love LA

This restaurant is on the way between the two hospitals I work at. I tried it out for the first time tonight for a Seitan wrap as dinner on the go. The wrap was delicious and the folks behind the counter were really nice people. They're going to be seeing a lot more of me.

I can't get over how easy it is to be vegan in LA!

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 :)