What have I gotten myself into?

I am now in the base training phase for the Vineman 70.3 half ironman in July. So far it's not so bad. As long as I'm not on call, I can reliably get in my workouts. It's a goal I'm excited about.

But, I'm not as excited about the Ironman that I signed up for in November. Why? The marathon was tough enough. Do I really want to run that far after swimming 2.4 miles and cycling 112 miles. Do I really want to cycle 112 miles? Right now, a 24 mile bike ride is a long ride to me.

And, do I want to be out in the sun exercising for what will likely be more than sixteen hours straight?

What about the training? Can I train for it AND do my job, AND have a life?

I signed up with a friend. If I decide not to do it, will I let her down?

I think I am going to focus on my next big race, Vineman 70.3. After that race, I'll see how I feel, if I really want to do the Ironman. Because, if my heart isn't into it, I won't do it.

Not Quite Common Sense

A conversation after I perform a coronary angiogram:

Me: You have a blockage in your artery.
Patient: So you put in a stent?
Me: No.
Patient: You didn't open the blockage?
Me: No. You will do better with medicine.
Patient: The blockage is still there?
Me: Yes. But it was a complicated blockage, and putting a stent in it just wouldn't be the right thing to do. Medication is a better way to treat this.
Patient: Medicine? For a blockage?

It seems intuitive -- Find blockage, open blockage, patient all better. It doesn't quite work that way. In fact, there's a trial published last year called the COURAGE trial that found that many patients with stable coronary disease do better with medicines than with angioplasty. There are definitely situations where angioplasty is the right thing to do, but there are others where medicines or surgery are better options.

Further, any time we place wires, balloons, and stents in a coronary artery, there is a risk. We could tear the artery. We could puncture a hole in the artery, causing blood to accumulate in the pericardium, the sac around the heart. And the dye that we use can cause injury to the kidneys. These are just some of the many possible life-threatening complications.

I'm sure there may be a few unscrupulous cardiologists out there who would be willing to put a stent in just about anything. The patient knows the blockage is open and does well, perhaps just as well as if no stent had been deployed, and yet an unnecessary risk has been taken.

Maybe it's a hard sell to say that there's a blockage and it's better not to open it. But, often it's the best thing to do.

Photo from www.endovasc.com

Pictures from The Marathon

Before the race, on Ventura Blvd.

Somewhere in the middle of the marathon, chugging along.

The last mile, downtown. In pain.

Crossing the finish line!!!

The cheezy finisher's photo.

More on The Marathon

Not everything goes as planned. I couldn't find my pace group, so I prepared to run alone, aiming for 11 minute miles with one minute walks through the water stations at each mile marker. I had my trusty Garmin GPS to pace me and measure my heart rate. I'm a scientist -- I like numbers.

I wanted to make sure I didn't start too fast, and I was partially successful at that. The first mile was all uphill and the next four were all downhill. It was tempting to run full gear down the hill, but I remembered the advice from Coach Mary: In the first few miles, two types of people will pass you: People who are faster than you, and people who will be walking at mile 22. Seven years ago, at my last marathon, I was the girl walking at mile 22, and I didn't want that to happen.

The first 10K split had me at 1:08:19, a 10:59 per mile pace. And I kept going, felt good, a little aching in my knees but otherwise fine. Half marathon (13.1) split was 2:26:44, 11:11 per mile pace, a little slower, but I felt good. I felt fabulous through mile 18 or 19, not too much aching, able to run more than the people around me who were too often slowing to a walk. My 30K split was 3:27:41, a 11:08 per mile average.

Hit the wall? Is there a wall? I don't see it.

And there it was at Mile 22. The bottoms of my feet ached, but mostly, I just felt tired out. There was a hill, and I took an extra minute and a half walk break to get up the hill rather than run it. And I started running again, slowly, like a 12 minute mile pace. I changed my rhythm to five minutes running, one minute walking. Those five minutes were the longest five minutes ever.

At mile 24, there was a photographer, and I was the only runner in his view. I put on my best smile to hide how miserable I felt. I wonder how that came out.

And then at mile 25, I found some steam. The end was in sight. In fifteen minutes, or sooner, I'd be done, so now was the time to give it everything. We headed through downtown, past mile 26, turned right on Flower Street, and through the finish.

My time: 4 hours, 57 minutes, 35 seconds. An average of 11:21 per mile.

I wanted to run faster, to finish in 4:45. But I'm still proud of myself. This was 18 minutes faster than my marathon seven years ago, and a more consistent running effort. To put it into perspective, my place was:

5,767 out of 17,011 finishers

1,390 out of 6,520 women

217 out of 778 women in my age group.

All in all, not too bad.

Photo courtesy of www.answers.com

4:57

Not as fast as I wanted, but my fastest marathon yet, and a fairly consistent pace. Hit the wall at mile 22.

Tlred, sore. More tomorrrow.

Race Day Strategery

I'm ready. But a few things I'm not sure of:

Who do I run with? My run group has a 4:30 pace group and a 5:00 pace group. I don't know that I can keep up with a 4:30 group for the entire race, and I think 5:00 would be too slow for me. Should I suck it up and go with the 4:30's and drop back if they're too fast for me, or go it alone and time myself doing 11 minute miles, and if I feel good at the halfway point, picking up the pace? Or, maybe I'll find a 4:45 group from another running club and join them.

Do I wear a hat? It will keep me cool, but will it feel funny since I haven't run with one recently? Will I look good for pictures in a hat? :)

And how about the fuel belt? Do I run with my trusty two 10-ounce bottles of PowerBar Endurance Fruit Punch drink and two 10-ounce bottles of water, or will I run faster with eight fewer pounds around my waist? And then where do I put my Clif Shots and Gu? Maybe I'll safety pin them to my body.

I am leaning toward the following:
-Joining onto a 4:45 group and if there is none then going it alone.
-No hat. Headband and sunglasses, with pony tail.
-No fuel belt to weigh me down. Drink at all water/Gatorade stations. Safety pinning Clif Shots and Gu to my shorts.

Regardless of these little details, I've made it this far without any significant injuries. I am ready!!!

Getting Psyched for the Marathon!

"Go Heather!" will appear on the front of my shirt.

The elephant's rear will be on the back.

I think this will help me get some crowd support. I'll definitely need it.

Shirt courtesy of Running Banana.

Burnout

I'm finding it hard to stick to my workout schedule. First off, I'm still getting over this upper respiratory infection, which while I'm feeling better, is sapping me of my energy. And I just don't feel like working out.

It will be a relief for the marathon to be over. I'm ready to change up my routine. It's been two days weights, five days running, and three days cycling for weeks on end. I haven't been in a pool for months!

One big change is that I'm changing my coach. Mary, my current coach, is fabulous, but she is in Rochester, NY -- if I still lived there, I'd definitely stick with her. But, I need to be better connected to the local tri community. More than just being a member of the LA Tri Club, I need to know which of the many workouts in a week are suited to my goals.

I've chosen to work with Triathletix, a local triathlete coaching company. Tonight I had the opportunity to speak to Jamie, my new coach, and I'm confident that he's going to put together a great program for me.

Sick :(

I hate slowing down. It makes me feel like I'm lazy.

I've come down with a sore throat and feel exhausted. Maybe I'm a little better this evening. I haven't exercised in two days, which feels really strange.

Many people around me have been sick with a similar illness, and I took pride in the fact that I haven't been ill in over a year. Maybe I brag about it a bit -- I attribute it to a healthy vegan diet and being a triathlete.

The marathon is in sixteen days. Tomorrow is supposed to be a ten mile run. I really want to do it. I am not terribly close to anyone in the group, but I just like running with other people. Right now I don't feel up to it. Maybe I will in the morning? I hope I do. Maybe I'll run with the 11:30's instead of the 10:30 per mile pace group that I usually run with.

Or maybe I should just skip it. That's going to feel really weird. I'm going to see what I feel like when I wake up tomorrow morning.

Update, Saturday February 16: I did not run. Instead I walked a couple miles, to and from Trader Joe's. Getting outside, I realized that running just wasn't a good idea today.

Image from www.luckyoliver.com

I'm a cardiologist, not a pastry chef!

In honor of my parents' visit, I made carrot cake. Normally it's a two-tiered cake, and normally, the frosting goes on nice and smoothly. However, I covered it shortly after baking, and it absorbed a lot of water, making it a bit flat and far too moist, which made frosting the cake a challenge. But it does taste good, even if it looks a little funny.


The recipe is from Dr. Pete's Eating For a Healthy Heart. He's a cardiology fellow at U of Washington. He's a vegan, a fabulous cook, and wrote this cookbook while in medical school.

One slice has 375 calories, 8 grams of fat, and 3 grams of protein.

My Valentine

This valentine is from my two and a half year-old niece, and is the first piece of mail that I've received addressed to "Aunt Heather". If this is the only valentine I get this year, that's all I need.

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.