Another Vegan Passover

I was far more inspired to cook last Passover, but this time around I made my veggie loaf, which came out far better this year:

This is my vegan Passover dinner. Accompanied by the Passover Frog, my niece Samantha's new toy, starting from upper left and going clockwise: Vegan kishke, veggie loaf, pasta with mushrooms (unleavened pasta of course), sweet potatoes in brown sugar, sauteed broccoli and asparagus.

Shark Attack Kills Triathlete

Dave Martin, a member of the Triathlon Club of San Diego, was killed on Friday while swimming at Solano Beach near San Diego. He was out for a training swim with eight other tri club members. Apparently, sharks can mistake a person in a wet suit for a seal.

The last shark attack in San Diego was in 1994, and the last one in the Los Angeles area was near Malibu in 1995.

It all gives me pause before I head to Manhattan Beach tomorrow morning to swim.

Training Progress

I'm feeling pretty good about my first race, the Wildflower Olympic Course on May 4.

I've been biking longer, consistently doing a weekend long ride up to 35 miles and two spin classes during the week. Today we climbed one of the canyons on our bike ride. Now, the last time I climbed with a triathlon club group, I was dead last up the hill. Totally different story today. I was toward the front of our group on our twenty minute climb!

One month ago, I ran hard for one mile and finished in 8 minutes 38 seconds. This week, I completed the distance in 8:21

Master Swim Experience

I've done Master Swim, an organized swim program for adults, in many places. I'm always one of the slower swimmers, but in my current Master Swim, these folks absolutely blow me out of the water (ok, perhaps not literally).

Amongst triathletes, I'm an okay swimmer. I'm somewhere in the middle of the pack. And of the three sports, it's the one that I place best in at any triathlon that I've done. But in Master Swim, I'm in the slow lane.... oh no, I stand corrected, it's the "development lane". And I'm the slowest person in that lane!

The workouts are written for elite swimmers. For an hour workout, we may have 700 m to warm up, then 6 x 150, then 10 x 50's and then something else, oh I don't know, maybe 4x10000m. I lose track after a while, so it doesn't really matter to me, because were I to complete all that we are supposed to do for that workout, I'd be in the pool until midnight. I get through maybe two thirds of the warm-up and then we move on. The 150's are supposed to be on 2:45. Are you kidding me? My 100's are on 2:30!!! And if we're doing this in the big 50 meter pool, then you can bet I'm missing that nice wall that I expect to find at 25 meters across so that I can jet myself to the other side.

They expect us to do backstroke and butterfly. While attempting to do the backstroke, you can call me Crash. I'm weaving back and forth in the lane just trying to propel myself forward. And as for the butterfly, I think I can flail my arms up and down once or twice to look like I'm attempting the stroke.

Now I do understand, I'm one of those triathletes who "crawls out of the woodwork" sometime in March or April to get back into the pool. I was a little bit busy training for a marathon during the winter, and I'll admit, I don't love to swim. I like it, but give me a chance to go run an hour, I'd take that any day over swimming laps in the pool.

The coaches are welcoming and encouraging and give some good tips on technique. But a part of me feels out of place amongst these swimming all-stars.

Photo courtesy of http://www.ci.san-marcos.tx.us

Balancing Act

Being a cardiologist and a triathlete don't always go together so well.

My job is unpredictable, because my first priority is always an ill patient. When I'm on call, which is about every three days, I have to answer my pager when it rings. That means that my pager is in a plastic ziplock bag at the edge of a pool when I'm swimming laps. Or it's sitting on my shoulder while I'm in a spinning class because the music is so loud that I wouldn't hear it otherwise. Or, it's on my fuel belt, along with my cell phone, when I'm out for a long run.

On occasion, I actually have to rush to the hospital to take care of an acutely ill patient, and that can mean dropping a workout completely at the spur of a moment. If a patient is having an acute heart attack I need to be at the hospital within thirty minutes. I've adapted my workouts during times when that is an issue. I have a run that I call the "MI Shuffle" -- MI for myocardial infarction, or heart attack. I start the run at my apartment, and I run the 2 miles to my hospital and back. From any point on that run, I can either sprint to the hospital or back home to get my car to drive to the hospital. If I have a bike ride to do, then I ride laps around the local park, because from any point in the park I can ride to the hospital in a timely manner.

And then there's the issue of time. My average work week is about 60 hours, which for a physician isn't that horribly busy. I know busier doctors. And I do about 10 hours of training each week right now. I wake up every weekday between 4:15 and 5:15 am to get to the gym, the pool, or onto the streets for a run. Mornings are the most reliable part of the day with the fewest disruptions and hence the best time to work out.

Weekends aren't always open either. For triathletes, the long workouts are done on the weekends, and those are the core of training for those of us gearing up for a half ironman. But, I'm rounding at the hospital every third weekend, which can mean up to 16 hours of running around the hospital seeing up to thirty patients in a day. So, if I'm on call on the weekend, I'll move my weekend workouts to the middle of the week so that in case I get very busy I don't miss out on too much.

As I advance from base training and put in even more hours of training, it's going to be very interesting.

Base Training

I'm a few weeks into the base phase of Half Ironman training. I've also chosen my first triathlon of the season -- Wildflower Olympic distance on May 4. It's a challenging, hilly course. Further, it's known as the "Woodstock of Triathlons" since most people camp near the course the weekend of the event. Now, I've never been one to camp as I have a great appreciation for mattresses and indoor plumbing, but for a good event, I'll suck it up for one weekend and sleep in a tent.

I've started swimming again, and I think I'm going to join up with a master swim group soon.

And finally, because the bike is my achilles heel, I'm going to set up a private session with my coach to help out with my bike form. I know I'm very inefficient on my bike, and with fixing those problems, hopefully I'll move faster than my usual 14-15 mph on long rides.

Tomorrow I run hills. On Saturday I bike hills. My life is going to be full of hills for the next several weeks.

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.