The Twenty Miler

In marathon training, our training peaks at a certain mileage. The group that I run with chooses to run twenty-six. However, at the urging of my trainer, and with a little bit of common sense, I ran twenty miles, as those extra six miles run during training can lead to injuries. And, bottom line, if you can run twenty miles, you can definitely run twenty-six on race day.

My run was good, with the exception of this nagging pain in my left foot. It starts at the base of my big toe and runs about halfway down my arch, mostly a dull pain. It was much better with running on dirt as opposed to pavement. And, after running, it doesn't even hurt. I'm not sure what it is.

During the run I felt like I could definitely run faster. And, at the end of the twenty miles, I felt like I could have run another six, were it not for my aching foot.

I think I've conquered my upset stomach issues. Whenever I do a distance event, triathlon, or run longer than ten miles, I'm sick to my stomach toward the end and for the rest of the day. I've found that for me, I need to keep drinking, even if I'm not thirsty, not just water but also an electrolyte fluid. I need solid food for carbs on my run too. Oreo cookies work very well -- it's not like I eat them any other time of the week. And yes, they are vegan.

I think I'm ready for the marathon. From here, I will be tapering my running distances to get ready for marathon day on March 2.

The Suit Experiment

I'm a young woman and I don't look like the stereotypical cardiologist. So, I've become accustomed to the confused stares that I get when I introduce myself as a cardiologist. Often I suspect that my young looks give me less credibility than if I was a man and had some grey hair.

Normally, I wear pants and a shirt or sweater or a dress under my lab coat. I've never been one to wear a suit to work. But today, I put on my black pant suit and blue button down shirt, without the lab coat, to see if there's a difference.

One of my colleagues who noticed said, "I'll vote for you!" suggesting that I look like a candidate for office. Others complimented me on how nice I looked today. And I had a few questions of what the special occasion is.

There definitely is a difference in how patients react. Today, I felt like I got fewer of those looks of astonishment from new patients. And, patients seemed to take what I had to say more at face value.

Maybe I should wear a suit more often.

Image from www.designerexposure.com

The Zetia Scandal

Schering-Plough, the company that makes Zetia and Vytorin (simvastatin combined with Zetia), released the results of the ENHANCE trial. The trial looked at simvastatin 80 mg versus simvastatin 80 mg plus Zetia 10 mg and the effects on carotid intima medial thickening, in other words, the lining of the carotid artery. The addition of Zetia had no beneficial effect.

I think that the intent of Schering-Plough was to demonstrate that not only is Zetia good at lowering LDL cholesterol, but that it also has a beneficial effect on the lining of the arteries, and therefore can protect against cardiovascular events. Clearly, the study fell short.

I've gotten phone calls and e-mails from patients on Zetia asking, should I stop taking Zetia? Does it matter if my cholesterol is lowered?

The bottom line is this: There is great data for statins, particularly simvastatin (Zocor) and atorvastatin (Lipitor) for lowering cholesterol and reducing event rates. With these medications, we know that lower cholesterol is better, with an optimal LDL goal of 60-70. And, I think that this new study lends credibility to the theory that it does matter what class of drugs are used to lower cholesterol, that it's not just the cholesterol lowering effect of the statins that make them so effective, it's also the effect on the arteries' lining.

However, some people cannot tolerate statin medications due to muscle aches or liver function problems. For these patients, Zetia might be an appropriate alternative.

If you're taking Zetia or Vytorin, please do not stop your medicine. Talk to your doctor. If you are on Zetia alone, you may ask if you should be on a statin instead. There may be good reason why you are on Zetia.

The Training

My week's schedule for training looks like this:

Monday -- 1 hour weight training and 30 minutes running
Tuesday -- 1 hour spinning (indoor cycling)
Wednesday -- 1 hour weight training and 40 minutes speed work
Thursday -- 50 minutes running
Friday -- 1 hour spinning
Saturday -- Long run. 20 miles.
Sunday -- 1 hour spinning and 30 minutes running.

Spirit of the Marathon

I went with several members of my running club to a screening of the movie Spirit of the Marathon. It detailed the training and obstacles faced by a few first time marathoners and two world-class runners, and the reason why they choose to run a marathon. It was really well done.

The timing of the movie was great. For me, I'm running my first marathon in almost seven years. It got me thinking about why I train to race in endurance events.

I run to prove that I am strong, that I am capable of finishing a marathon, and hopefully by the end of the year, a half and full ironman. I run to destress from life. And, I run to set an example for my patients.

If you can, see this movie. It is absolutely inspiring.

Image from www.marathonmovie.com

Lentil Pilaf with Bulgur

This recipe is from one of my practice's office managers. She is an amazing cook, brings in home-cooked food for us all the time, and when she brought this in, it was so amazing I *had* to have the recipe. And finally I got around to making it.

Put lentils in pot, cover with water, and boil. Then add bulgur and a cup of water, and simmer until water evaporates. Meanwhile, saute some chopped onion in olive oil. Then mix it all together.

With a salad and some sweet potato soup from Trader Joe's, this was a filling dinner.

Ironman Heather???

I think I've lost my marbles.

Ellen, a sorority sister from college, called me today. She's signed up for an ironman in November in North Carolina and since she knows I "do this crazy stuff" wanted to know if I wanted to join her. There was only one spot available, and I pondered it..... and now........

I am signed up for the Beach 2 Battleship Ironman on November 1!!!

Running Smarter

I have vowed to be a smarter runner. That means I take better care of myself so that I don't get injured. It also means being prepared in the case of an emergency.

The metal tag on my shoe is a Road ID. It is engraved with my name, date of birth, and emergency contact numbers. A good idea to have just in case something bad happens.

Athlete Physicians

Saoirse pointed out this New York Times article that describes how athletes often seek out physicians who are athletic.

Knowing this, how can I put it to work for me? Hmmm....
Photo from New York Times, Jan 3, 2008.

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.