Why am I awake this early?

Lately I'm awake by 5 am, sometimes a little earlier, sometimes a little later. The morning is the only time I can reliably get my workouts in, and that way I don't have anything hanging over my head that I *have* to do later in the day.

It hasn't been a good running week for me. My iliotibial band (that's the band of connective tissue that runs along the outside of the thigh) has been very inflamed. I've felt tired. My running has been slower. My worst run was on Thursday, when I got on a treadmill in our hospital's cardiac rehab center in the afternoon, and even at 5.3 miles per hour, I felt completely wiped. Maybe it's because it was so warm in the room, but I've just felt so discouraged this week.

With the LA Marathon only 8 weeks away, I'm worried that I'm not getting in the miles that I need. And I'm afraid of any injuries that could sabotage my running the marathon.

So, this morning when my alarm went off at 5:15 am, I was not thrilled at all to roll out of bed and run an hour and a half on my apartment's treadmill. I'd rather run outside with the LA Leggers, but since I'm on call, I can't be that far away from the hospital.

Today ended up being my best run in the past two weeks. I did a walk/run workout, run for 9 minutes, walk for 1 minute. It averaged out to a 10:33/mile pace, which felt good, and I finished eight and a half miles in an hour and a half. My iliotibial band (ITB) only hurt a little bit.


This is a foam roller. It has been the savior for my ITB woes. By rolling on it with body weight, it helps dissipate scar tissue, and makes running much easier.

I'm very grateful for today's run. Had it not been so good, I really would have been discouraged.

Happy New Year!

My Resolutions:
1) Complete my first half ironman distance triathlon -- Vineman 70.3 in July.
2) Run the LA Marathon in 4:30-4:45.
3) Help my 53 year-old father complete his first triathlon.
4) Learn Spanish. Es mui importante en California.
5) Keep up with the cardiology literature.

I think that's enough.
Happy New Year everyone!

Passed!

I just found out that I passed my interventional cardiology board exam!!!

It was a lot of studying, and such a relief.

Training Update

I'm training for the Los Angeles Marathon, my first marathon in six and a half years. Even though I'm a few years older, I'm going to finish faster by training smarter. My goal is to run the marathon in 4:30-4:45. If I can maintain the 10:30 per mile pace from the City of Angels Half Marathon, then I can do it.

Part of my training is running with others, which is something I've never really done before. I've joined the Los Feliz Flyers, a group that does weekly track workouts. The group has all sorts. There are some rather hardcore members, and then there are the "TOG's" -- The Other Group. The TOGs are a little slower than the hardcore group, and we run a total of three miles for a workout. Last week, we did 800 m at 5k pace, then 1200 m at 10k pace, 800, 1200, and 800. It's a good group, not competitive, and I find myself somewhere in the middle of the TOGs pack.

Next, I'm joining a group for my longer runs, the LA Leggers. They have several pace groups and meet early on Saturday mornings. This morning I tried them out for the first time, joining the twenty or so members of the 10:30/mile pace group -- I wasn't sure whether to run with the 11 minute/mile group or the 10:30's, but I think I chose well.

Where Does Cholesterol Come From?

Of course it's not real shrimp. But it's tasty and nutritious -- VegeUSA's Vegan Shrimp with Sweet Chili Sauce. This whole plate of "shrimp" is 140 calories, 4 grams of fat, and zero cholesterol.

Did you know that "real" shrimp has twice the cholesterol as the same quantity of beef?

Lately, I've tried an experiment -- I've asked my patients with elevated cholesterol, "Do you know what foods have cholesterol in them?" The answers are interesting. Many patients just don't know. Sweets, oily foods, fat, they say.

The answer is simple: Animals make cholesterol. So anything that was an animal, or came from an animal, has cholesterol in it. Beef, chicken, pork, fish, seafood, dairy, and eggs are full of cholesterol.

A vegan diet, which is a without animal products, is cholesterol-free. And cutting back on animal product consumption, or better yet, following a vegan diet, will lower cholesterol.

Giving Back

Volunteering has always been something that is important to me. I feel very lucky to be where I am in life, to have had great family and mentors to guide me toward my career in cardiology. Because of this, I decided to put my talents to use, and I am the cardiologist of the Los Angeles Free Clinic. I volunteer one evening a month to see uninsured patients who need a cardiologist.

Tonight was my first shift. It was an interesting and rewarding experience. It's very different to think about practicing medicine in a situation where we can't order the tests we take for granted. Echocardiograms, stress tests, and cardiac catheterizations take months to obtain. So I have to rely on my clinical judgement and physical examination skills.

Easy Meal

A quck, easy, and healthy dinner from Trader Joe's:Sweet Potato Bisque soup, straight from the carton to the microwave. On the plate, lentils (ready to eat right from the bag) on leftover whole wheat couscous. And, a salad with baby beets and black berries, with ginger sesame dressing.

Thoughts from a Weekend On Call

It's been a busy weekend. I didn't get a chance to work out, which makes me feel like a complete sloth.

I do love my job. I save lives. Honestly. And it's a great feeling when I do get the chance to help someone.

Other times, I'm asked to see patients who are critically ill, who have already something very bad happen to them. Often it's like being asked to see Humpty Dumpty after he's fallen off the wall, and being asked to do what all the king's horses and all the king's men can't do.
This weekend has had elements of both, and I am emotionally exhausted.
Image from www.alphabet-soup.net

Rave Run

This might have been the coolest run ever.

Griffith Park has a holiday light display every year. You can idle through in your car after waiting in a long line.... I chose to run!

Ella Corre -- City of Angels Half Marathon Race Report

"Ella corre" is "She runs" in Spanish. I'm learning Spanish. It's a good skill for a physician in Southern California to have. So to practice, I may throw a little Espanol into my posts.

It was cccccooooolllllld this morning! As we waited for the start, it was about 41 degrees. If this were any other city I've lived in (Detroit, Rochester NY, Boston), it would be expected to be this cold in December. Not in Los Angeles. We huddled in Griffith Park by the heat lamps, then shivered in the porta-potty lines before the race started.

The first five miles were in Griffith Park, which is where I've done my training runs. My goal was to run 10:30 mile splits, and at the halfway mark to pick up the pace if I felt good.. My first four were about 10:00-10:15. Part of me was excited, and the other part of me was worried that I'd lose steam.

I lost a little bit of steam, and my splits slowed down, but not too much. The scenery was nice -- Griffith Park, Silver Lake, Echo Park reservoir, and then into downtown LA.

My main issue was gastrointestinal. My stomach felt heavy, like I would throw up, or worse. And while a well-timed Gu packet gave me more energy, five or ten minutes later my stomach was getting angry at me. This is an issue I need to figure out well before Vineman 70.3 in July 2008.

Even now my stomach is screwed up. I planned to have a Tofurky sandwich on whole wheat with lettuce, tomato, and guacamole. Instead I had a banana, sweet potato soup, and two slices of whole wheat toast with Earth Balance and strawberry jam, and my stomach didn't really like that either.

So, anyway, my lackluster time: 2:17:47. I ran two half marathons last year on 2:11 and 2:12. I've slowed down this year, probably because I've cut back to running 4 times a week, maxed out at 24 miles in a week, and I'm a year older. On the flip side, I have added a spinning class each week to cross train, and unlike last season, I haven't been significantly injured. Maybe for me slower is smarter.

Biggest Loser and Why Can't Everyone be So Successful

The reason I really like this show is that it demonstrates that people can become healthier by losing weight, exercising, and eating healthfully.

On the most recent episode, the remaining seven contestants met with the show's doctor. One contestant's cholesterol dropped by 100 points. Another who was pre-diabetic no longer was glucose intolerant. And, one contestant who had hypertension no longer needed to take blood pressure medication after his large weight loss.

These feats were all accomplished by a change in lifestyle -- not with medications.

Why can't I get my patients to do the same? Many of my patients are overweight, eating terribly, with risk factors for heart disease -- diabetes, high blood pressure, abnormal cholesterol. They're often fortunate that they have not had a heart attack or stroke YET.

I try to give them the knowledge to eat well and exercise on their own. Most are receptive to my advice and willing to make changes. But invariably, they come back a few months later.... HEAVIER!!!

Sometimes, I liken it to my high school cheerleading coach, who when she would get annoyed at us not listening to her, would turn around, face the wall, and continue to talk, until we all noticed and started giggling. I feel the same way -- I might as well be talking to a wall.

But, I think a lot of it is our society. Sedentary is acceptable. Restaurants serve non-healthful foods -- they really don't care how healthy their food is for the most part, as long as it tastes good. And when you're hungry on the run, what do vending machines have? Junk.

The Biggest Loser contestants are sequestered on "The Biggest Loser Campus". They aren't exposed to negative influences of society. They have personal trainers. They have healthy food.

I have had one successful patient who I cared for during cardiology fellowship. He was hospitalized with a heart attack. He was a smoker, overweight, with a history of high blood pressure and high cholesterol. I gave him my usual talk -- quit smoking, eat better, consume more fruits and vegetables and less meat (most doctors won't say this, but it's true, meat is not good for you), exercise and lose weight. He quit smoking, lost 50 pounds, and as a result, dropped his cholesterol and blood pressure. In the two years that I cared for him after his heart attack, he did really well, without any angina (heart-related chest pain), and lower blood pressure and cholesterol levels.

Lifestyle change is possible. It takes a motivated person. When successful, these people can live longer, healthier lives.

I Want to Swim!!!

Those are words you'll rarely hear me say.

In my two full triathlon summer seasons, here's how it works: I burn out toward September, and get sick of biking and swimming. Then I start running more and train for a half marathon. And then I do whatever on earth I feel like to stay in shape, treadmill, kickboxing, spinning classes, until March, when it's time to get back in the pool and dust off the road bike for another season.

But I have more ambitious goals now...... I'm training for a Half Ironman!!!!!



Yes, that's 1.2 miles of swimming, 56 miles of biking, and a 13.1 mile run.

This past season, I had no coach. But to do a half ironman, I definitely need one. So, I'm going back to my coach from Rochester, Mary Eggers of Train-This. She is a triathlete superstar and will be my online coach.

I've found a local masters swim group. And I want to swim! After the City of Angels half marathon on Sunday, I'm ready to start training for my first half ironman!!

Vegan Thanksgiving 2007

Tofurky

Stuffing, gravy, cranberry sauce, sweet potatoes

My plate!!!! Gone in no time. Clockwise from upper left: Corn muffin, tofurky with gravy, stuffing, cranberry sauce, sweet potatoes, green bean casserole, squash, and a generous helping of mashed potatoes and gravy in the middle.

Staying on Track During the Holidays

Sometimes we fall off the wagon and a few pounds creep on. We ease up from our good habits, cut out a day or two of exercise, slip up on the diet with a few extra cocktails or chips and dip at a few social gatherings. Over the course of a few weeks, they may lead to a few extra pounds.

Now, we don't just gain weight for no reason. Our weight reflects a balance of what we take in, food and beverages, and what energy we expend by exercising or through our daily activities. A gain in weight means we're either moving less or eating more, or both.

The first thing to do is to take a step back and analyze what it is we're doing wrong. Next we have to decide how to correct that.

For watching what we eat, one of the most effective strategies I've found is a food diary. Write down everything you eat, the quantities of each food, and the number of calories. Share the list with your doctor. Or, use it to be accountable to yourself. That way, if you're tempted to have another four cookies, you know you'll have to write it down, and will be less likely to splurge.

And, even if everything you eat is vegan, that doesn't automatically mean it's healthy. I'm a big fan of Turtle Mountain Purely Decadent vegan chocolate almond fudge brownie ice cream, but even vegan treats need to be consumed in moderation.

Exercise time is one of the first things to disappear at this time of year too. But, make a commitment to stay in shape. Write in exercise "appointments" on your calendar, just like any other appointment that you would make. Or, if your exercise routine is getting stale, try something new.

I find the show The Biggest Loser to be really inspiring. If you've "fallen off the wagon", I find it helpful to see people who are even farther off from their goals reach them through hard work.

Have a great Thanksgiving!

Back on the Bike

After my Long Beach Triathlon disaster, my bike has been sitting in my living room unused. I've been doing a lot of running to get ready for the City of Angels Half Marathon on December 2. My cycling has been limited to a weekly spinning class at Bally Fitness to keep my quads strong and avoid muscle imbalance issues that led me to major iliotibial band problems last year.


But, as I plan on finishing a half-ironman this coming year (1.2 mile swim, 56 mile bike, 13.1 mile run), I need to be riding on the roads. The LA Tri Club had a (mostly) women's beginner ride, 32 miles up the Pacific Coast Highway from Malibu. More experienced riders called the route "mostly flat". For me, not so much.

The first sixteen miles were okay. On the last sixteen, my legs felt like jello toward the end. Which tells me, I need to ride more.

Next: getting back to swimming. I haven't swam since my last triathlon either.

Veggie Stew

Sautee vegetables in oil for five minutes. I used potatoes, cabbage, carrots, cauliflower, and celery. You could easily use any other vegetables. Peas, corn, or sweet potatoes work well here. Then add broth. Simmer for 25 minutes. Then add soy sauce and flour. Cook another 10 minutes. Season to taste and serve over rice or pasta.

Creamy Corn Chowder

I have never made a soup that I thought was fabulous... until now. This is from the Blossoming Lotus 7 Minute Chef, an online book put together by the chefs of the Blossoming Lotus restaurant, who are the ones who catered my brother and Mary Ruth's wedding in Hawaii.

The soup is not hard to make. I started by sauteeing an onion with garlic, salt, and pepper. Then I added some potato, and then water, corn, carrot, and a little soy milk. After simmering, I added roasted cashews, blended half of the soup, mixed it back together, and added some more corn. This made for a very delicious and filling soup.

It's done!

The interventional cardiology board exam is done!!!!! Did I pass? I think so, but I won't know for a few months.

And now it's back to living normally. It felt good to go back to work today, to get out of my apartment where I've been studying for hours on end.

I accumulated a to-do list while studying. It includes baking cookies, getting an oil change, framing my diplomas from the past few years, and buying an ipod. And, losing the two pounds I gained while studying -- sadly, even with running 23 miles, a spinning class, and two days of weight training in a week, while sitting on my rear end the rest of the time a couple pounds crept on.

So back to life. And the picture? Yes that's me. I've decided I need a picture of my face on the blog, instead of the back of my head running past a bunch of port-o-potties.

Interventional Cardiology Board Exam Tomorrow

I've been studying for months. Hopefully, it will all pay off.

Those of us who became board certified after 1990 have to re-certify every ten years. It's a nuisance to study and take exams, but I suppose there's some merit to it -- medicine changes so much in just a few years. In my specialty, interventional cardiology, in ten years alone there have been revolutionary changes to how we perform angioplasty, the medicines we use, and the stents that were just beginning to come into use ten years ago.

One of my mentors, who certified years ago, likes to gloat to me about how he never has to take an internal medicine or cardiology board exam ever again. I jokingly remind him that that's because he's old.

So here goes nothing tomorrow. If I pass, then no more exams until 2012, when I have to re-certify in internal medicine.

More Eat Your Veggies Meals

Peanuty noodles, greens medley, and baby carrots.


Tofu scramble, yucca fries, and strawberries.

Eat Your Veggies Delivery Service. They've even fed Alicia Silverstone. And these two weeks before my interventional cardiology boards, they're making my life much easier.