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Dr. Rosenthal's Blog



Healthy Snacks

April 2017

I'm always on the lookout for healthier snacks. I did not have to look far for these two great ideas from Veronica Garcia, our medical assistant in Terrell. Peel and slice a cucumber or jicama and sprinkle with Tajin seasoning. Squirt some lime juice on the cucumber. You have a pick-me-up snack with a lot fewer calories than potato chips, cookies or candy. You could actually eat a whole pound of jicama for less than 250 calories - not that I am recommending you do that.

Tajin seasoning is made of chili peppers, sea salt, and dehydrated lime juice. I was not familiar with it or with jicama either but together it really does make a good crunchy, salty snack.​

A one-cup serving of sliced raw jicama has about:

  • 49 calories
  • 0 fat
  • 6 grams fiber
  • 1 grams protein
  • 11 grams carbs
  • 2 grams sugar

A one-cup serving of cucumber has about:

  • 16 calories
  • 0 fat
  • 3 grams of sugar

Both are great to have on a hot day. These have become our go to snacks in the Terrell office.



Any Medical Answers You Might Need

February 2017

I get questions from patients who might have medical conditions that are not related to my field. I might have questions myself about certain conditions. The first place I turn for an answer is PubMed. This is a free service that catalogs all medical publications and allows you to search by topic, author, or even very advanced searches. For example, if you have been diagnosed with a certain type of cancer or arthritis, you can search for all the articles that have been published about it. You may end up with a huge list of articles but at least you can look through them and get an idea of what people are writing about and what is new. Some things even your doctor might not know about yet. I actually like it when a patient brings me something I might not have seen. More often than not, I can find a promising clue or expert that can help the patient who asked me the question. If you type my name in as 'Rosenthal RL' you will see my publications including the most recent description of "Inhaler Syncope".


Answer to Photo Challenge

I did not get any correct answers to the photo challenge, so here it is.

The bench where President Obama and Chancellor Merkel met during the G7 summit in Elmau, Germany was on the front page of newspapers when it happened in 2015. We couldn't resist duplicating the pose when we were there a few months ago.





Here is another picture from that trip.




Photo Challenge

December 2016

Here is a challenge for my patients from a recent trip. Identify the location where this photo was taken and the individuals the "actors" are mimicking. No hints except that correct identification does not imply endorsement of the views of either of the individuals identified or of the actors for that matter. The winner will be acknowledged in a future blog.

rosenthanl photo challenge.jpg

In addition, I am very proud to announce that I have been recently been named an Associate Editor of The American Journal of Cardiology. In that role, I will be responsible for reviewing submitted manuscripts for possible publication. The Editor is Dr. William C. Roberts who is the recipient of a Lifetime Achievement Award from the American College of Cardiology. He is widely acknowledged as the greatest living cardiac pathologist in the world. We are incredibly fortunate to have him as a very important part of our daily activities at Baylor Heart and Vascular Hospital.



Healthy Tex-Mex Recipes. Really!

September 2016

I'm always on the hunt for healthy diet recipes and weight loss suggestions. A couple of my patients came in recently and I could not recognize them because they had lost so much weight- between 50 and 60 pounds each. The diet plan followed by one can be found at engine2diet.com, and the other was trimhealthymama.com. Both websites look great. My patients said they loved their diets: they were easy, filling and enjoyable. The Engine #2 diet is actually designed by a firefighter in Austin, Texas- hence the Engine #2. Healthy vegetarian Tex-Mex recipes are hard to come by and they have a bunch. Below is one they have posted on their website for free. However, if interested, I would encourage you to buy their cookbooks; and if really serious, attend their workshops (some held in Dallas). The Trim Healthy Mama diet also looks really good. If you will commit and stick to a plan, you can lose weight. These both look like plans that would not be too painful to follow.

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Jane’s Jammin Burritos
burrito.jpg​​​​
• Prep Time 15 minutes 
• Cook Tim e 20 minutes
• Serves 6 
INGREDIENTS:
1 large onion
2 cloves garlic
2 zucchini, chopped
2 yellow squash, chopped
1 red bell pepper, chopped
3 cups shredded Napa cabbage
2 cans fat-free vegetarian refried beans
2 cans black beans, drained and rinsed
1 cup cooked brown rice
2 teaspoons cumin
1/8 teaspoon cayenne pepper
6 large Ezekiel sprouted grain wraps
Salsa and guacamole, to taste
INSTRUCTIONS:
Sauté onion and garlic in large skillet with a little water or low sodium vegetable broth on high heat for 3 minutes. Add zucchini, yellow squash, red pepper, and cabbage to the skillet. Cook for 4 to 5 minutes, until vegetables are al dente (soft but firm) and cabbage is wilting. Add the black beans, refried beans, and rice to the skillet. Stir ingredients together on low temperature until it is thick and mortar-like. Season with cumin and cayenne. Slap a large spoonful of veggie mortar onto the center of the Ezekiel wrap and spread it from top to bottom along the center line. Fold the sides over using a bit of the veggie mortar as adhesive for the top flap. Rest the burritos next to each other and place them seam-side down on a parchment lined baking sheet. Bake for 20 minutes or until the wraps are crisp. Serve with salsa and guacamole on top.


Our Last Trip

June 2016

We took our dog Moose on a bucket list trip. We promised him a trip to the beach to swim in the ocean before he got too old to enjoy it. So we packed up the car and headed to Carmel, California. They have a famous, giant, dog-friendly beach right in town. You see it featured whenever there is a tournament on Pebble Beach. 

The 8th hole is on a cliffside next to the beach. In tournaments, some players will miss hit their shots onto the beach and have to climb down the cliff and try to hit their ball back onto the course. Seeing it first hand, that is not an easy task at all. Needless to say, our dog loved the beach and the ocean. I wish it wasn’t a 2-day drive to get there. 

Since I just wrote about walking the golf course when playing, I recommend walking the Black Mesa course north of Santa Fe if you are near there. It is not only beautiful; the added excitement comes from trying to not encounter a rattlesnake in the rough. Actually, the smartest thing to do is to sacrifice any balls you hit off the fairway to the rattlesnake gods and not tempt their fate. 

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Go Walk the Golf Course

May 2016​​​​

Mark Twain said, “Golf is a good walk spoiled”. Not much of a golf fan apparently. He didn’t want his peaceful stroll interrupted by ducking hooks and shanks. His loss. You actually can enjoy your golf more by walking the course, enjoying the scenery and get a good exercise workout at the same time. Even if you walk the par 5's on a typical course, about 500 yards each, you will put in a mile. Walk an entire course and, depending upon how straight you hit it, you will travel about 5 miles. Besides, walking gives you more time to mutter things under your breath about your last shot before your next shot. 


Up at 5 a.m.? Here is something you can do to start your day

April 11, 2016

​​​If you happen to be up at 5 a.m. there is a good exercise show called “Sit and Be Fit” on PBS, Channel 13. It is designed primarily for senior citizens who may feel too weak or unsteady to go to the gym or who are getting over surgery or an illness and want to get back to being in shape.  They show you exercises that can either be done while sitting in a chair or while standing. The “sit and be fit” part I think is really good because the exercises are safe to perform even if you are at home by yourself, kind of like home physical therapy. One of the big benefits is a focus on balance which these exercises emphasize. You need to practice balance as you get older- I am going to write some more about that in the future. I don’t know a single one of my patients who would not be able to do these exercises and should benefit from them. 


What to do When Your Doctor Tells You to Cut Down on Salt

March 14, 2016

You have swelling in your legs or high blood pressure and your doctor has told you to limit the amount of salt you eat. This is not the end of the world, although many patients react to this advice like it will be. There are rows and rows of spices in the grocery store that can be used as tasty substitutes and they all can be used as long as they don’t say “salt” on the bottle. Garlic = yes. Garlic salt = no. Here are some combinations of spices you might enjoy mixing up and using. You can find others by searching “Herb Shaker Recipes” on Google. Fortunately, since we live in Texas we like hot and spicy so you can load up on diced jalapenos,  Tabasco Pepper Sauce, and Cholula Hot Sauce. A lot of my patients can’t give up putting salt on their watermelon -  I can’t help them -  they have lived in Texas too long! 

Savory Shaker
6 teaspoons thyme
3 teaspoons sage
6 teaspoons savory
5 teaspoons rosemary
Spicy Shaker
½  teaspoon cayenne pepper
1 tablespoon garlic powder
1 teaspoon onion powder
1 teaspoon black pepper
1 teaspoon basil
1 teaspoon cumin
Zesty Shaker
2 teaspoons onion powder
2 teaspoons paprika
1 teaspoon white pepper
1 teaspoon celery seed
1 teaspoon mace
2 teaspoons dry mustard

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Grapefruit and Your Heart

February 15, 2016

A lot of people love grapefruit. I'm not a fan, but many people enjoy eating grapefruit for breakfast or having a glass of grapefruit juice every day. And grapefruit is certainly healthy. However, grapefruit has potential interactions with some medications you also may be given. If you are big on grapefruit that fact may be worth talking over with your doctor because it can impact some medications that you might be prescribed. The interaction is especially true for statin medications, such as Lipitor or Zocor, which many of my patients take for high cholesterol.

The components of grapefruit juice inactivate a very common enzyme (CYP3A4) which metabolizes or degrades many medications including certain statins. So if you eat grapefruit and then take certain statins then the statin will not be broken down or metabolized as quickly and it will have a higher concentration. In other words, if you eat a grapefruit and then take a Zocor pill the concentration of Zocor will be about 3 times higher. That can be looked at as a beneficial effect because the higher concentration will reduce the cholesterol more, however, the negative effect or risk is that side effects will also be more likely. The side effect patients complain about the most from statins is muscle pain.

My practical advice if you are a grapefruit lover is to switch to a statin that is metabolized by an enzyme that is not CYP3A4 and that has no interaction with grapefruit. Choices are:

  • Pravastatin (Pravachol)
  • Rosuvastatin (Crestor)
  • Pitavastatin (Livalo)

Another practical point if you are taking Zocor or Lipitor and getting muscle pain is to make sure you quit eating grapefruit!  I also ask my patients who take a statin to buy Coenzyme Q10 100 mg to take every day because this reduces the chance of muscle pain.  There was just a good review of this topic entitled "Grapefruit Juice and Statins" in the American Journal of Medicine 2016; 129:26-29 for those who want to learn more.


I Take it Back 

December 14, 2015

I will take back what I said in an earlier blog about the limited value of the Fitbit and other step counters.   I changed my mind.  10,000 steps a day equals the 150 minutes a week of moderate exercise recommended by the American Heart Association.  So if the Fitbit helps you accomplish that goal, go for it.  The problem is that step counters only count steps, so it will not count your calories or fitness from riding a bike or, what we have found, walking on a treadmill while holding the rail.  My patients are disappointed to find they come for a treadmill stress test on which I have them hold the rail for balance and not get any credit for steps.

As an alternative to 150 minutes of exercise a week, 75 minutes of vigorous exercise can be substituted.  So depending upon how hard you exercise, that is 10 or 20 minutes a day.  I think you can do it. 

​​Examples of moderate exercise are:
  •  Walking 3-4 miles per hour
  •  Bicycling less than 10 miles per hour
  •  Iyengar Yoga
  •  Tennis double
  •  Gardening at a constant pace
  •  Mowing with a self-propelled mower
​​​​Examples of vigorous exercise are:
  •  Jogging, running, spin class
  •  Swimming laps
  •  Tennis squash, racquetball singles
  •  Jumping rope
  •  Hiking uphill
  •  Vinyasa Yoga
  •  Mowing with a push mower


I encourage you to go to myfitnesspal.com to find their great exercise calorie counter and food calorie counter.  You can get these apps on your phone and computer.  They have a huge database of types of exercise for you to keep track of how many calories you burn and a massive database of calories from foods even from restaurant menus, grocery stores, etc.  You can keep an instantaneous count of how many calories you are taking in.

I will have more tips on how much exercise you should do to stay fit, and more importantly, live longer on future blogs. 


The Mediterranean Diet 

September 25, 2015

In the late 1950's, researchers identified that the population of the island of Crete, off Greece, had the lowest cardiac mortality and greatest longevity on earth.  Heart disease was so rare on the island than doctors had to look it up in textbooks.  They commented that it was not unusual to see 80, 90, and 100 year old men going off to work in the fields every day.  They suspected and demonstrated the cause of this remarkable longevity was due to diet.  


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When in Rome  

June 15, 2015

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We just got back from Italy.  If you should go, Italy is one of the places where you are allowed to suspend any calorie or food restrictions.  Pictures are a sampling of some of the memorable pasta dishes.  If you go to Rome, try to find Bonci Pizzarium on Via Della Meloria - best pizza I have ever encountered.

Ninette Mouser has kindly provided me with a number of recipes which she prepares to keep her husband doing so well now more than 20 years since he first needed our services.  People are always asking what they should eat. This is what you should eat.  Thank you, Ninette.

Here is a visual sampling of some of the culinary temptations that Italy has to offer.  Buon appetito!

 

 


Eating Healthy at Restaurants 

May 16, 2015

There was a very good article in the May 12th New  York Times with advice on how to eat healthy at restaurants.  I learned recently that Dallas is such a big test market for restaurants because our citizens eat out 80% more of the time than the average of the rest of the country. 

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Your Heart Equipment Shopping List 

January 6, 2015

Depending upon the specific heart condition in question such as heart rhythm problems or high blood pressure, there are several types of devices available that are worth investing in to help monitor your cardiac status. 


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The Air is Thinner Up There 

October 16, 2014


Every year, I see patients just back from Colorado who are concerned because they experienced shortness of breath or palpitations while they're on vacation.  We go there as well on vacation with our Labrador dog, Moose.  I will try to explain why many of these symptoms are in fact predictable and a result simply of the physics of going to altitude.


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Advice for Eating Healthier 

October 16, 2014

A patient gave me his rules for eating healthier

  1. Don't buy your meals any place where they also sell gasoline
  2. Don't eat at any restaurant that also has a take-out window - To which I add
  3. Don't eat sitting in your car, especially if you are driving
Follow these 3 simple rules and you are already on your way to healthier eating. You are what you eat. 


​​​​Science and the Mediterranean Diet 

August 4, 2014

Healthy Diet Guidelines
Here is a link to a recent review by Dalen and Devries in the American Journal of Medicine entitled "Diets to Prevent Coronary Heart Disease 1957-2013: What Have We Learned"; which focuses on the scientific evidence behind specific diet advice for cardiac patients.

They review the results of some well conducted scientific trials on the effects of diet on cardiovascular morbidity and mortality and confirm that the Mediterranean style diet is particularly cardio-protective.  They indicate "Mediterranean-style diets are effective in preventing coronary heart disease even though they do not decrease total serum cholesterol or low-density lipoprotein cholesterol."  As they conclude, this form of diet is more effective than the standard low-fat, low cholesterol diet which has been taught for decades and which has a modest if any effect on lowering cardiac risk.

They include a table of food groups shown to decrease risk of coronary heart disease in prospective studies with references and the food groups are:

  • Nuts
  • Fruits
  • Vegetables
  • Green leafy vegetables
  • Legumes (beans)
  • Whole grain
  • Fish 
  • Moderate alcohol
  • Fiber
  • Poultry
  • Olive Oil

I would endorse including these items as the bulk of your daily food intake. You are what you eat.​​​


Dr. Rosenthal's Daily Diet  

August 4, 2014

Patients frequently ask me what I eat to try to stay thin and hopefully healthy so I am going to share some specific menu items.  Calories are per serving on the container - I generally have 2 serving sizes.  Please note that what I do for me many not work or be healthy for your particular medical condition, but since I am asked this question so often, I am letting the secrets out. 

For Breakfast  
 Abbotsford Farm Egg Whites (scrambled) 25 calories with  Sanderson Specialty Farms "Texas-Texas Premium Select Salsa" (Medium spicy) 5 calories.  I don't add anything else, but you can add tomatoes, cheese, peppers, etc. and make an egg white omelet which fills you up and has very low calories.  Notice no toast, no bacon, no sausage, and no biscuits and gravy. 

Alternative choice for breakfast 
Quaker Oats Old Fashioned Oatmeal (not instant) or McCann's Irish Oatmeal, steel cut, 150 calories, with dried cranberries or raisins, slivered almonds and brown sugar.  This will fill you up until lunch.  

For Lunch
I eat the same lunch every workday.

Dannon Oikos Nonfat Yogurt (Peach) 130 calories.  It tastes like ice cream!  If I get tired of this after a couple of years, I will switch to low-fat 2% cottage cheese with sliced peaches (from Ham's Orchard in Terrell) 90 calories.  Of course, you can put any fresh fruit you like in this.  Low calories but salt content are relatively high as is the case with almost all cheeses.

For Snacks
I eat a lot of almonds from Whole Foods.  At work when I can't help myself, I eat an occasional granola snack bar.  This is about 200 calories.  This is for when you are starving, and you can't control yourself; once a week at most.
If you want to lose weight, have a bunch of carrots, celery and radishes cut up for snacks, and you can dip them into whatever salsa you like.  Just about every salsa is low calorie - I told you the one I like, but you get what you prefer.

For Dinner
My wife is a great cook, so we have a very varied menu selection for dinner but we try to eat a vegetarian menu for 3 or more days a week.  I have included a recipe for Salmon Croquettes I like and will add more in the future.

We usually have a simple salad, and our salad dressing is Newman's Own Caesar Dressing, 150 calories.  Again watch for salt content on the labels as dressing can have a lot of salt, but this one tastes much better than simple oil and vinegar.  This has 380 mg sodium per serving.  I tell patients to find products with less than 400 mg sodium per serving, ideally less than 200 mg sodium per serving.  I tell patients "you can have any salad dressing you like as long as you can see through it" which knocks out Blue Cheese and Ranch dressings.  Patients don't seem to get upset until I tell them the Ranch is out.