Lili Barouch, Sports Cardiologist and Triathlete

 

92-137. Lili Barouch

Fri, Jun 20, 2025 4:33PM • 44:15

SPEAKERS

Will Bachman, Lili Barouch

 

Will Bachman  00:02

Hello and welcome to the 92 report conversations with members of the Harvard and Radcliffe class of 1992 I’m your host. Will Bachman with a reminder, if you go to 92 reportdotcom that’s 92 reportdotcom you can sign up for the newsletter for this show, and then I’ll send you an email every week with the show notes of who’s on the show. Case you can’t listen to every single episode, you’ll get informed at least of who’s been on the show. Now today, I am excited to welcome Dr Lily Baruch, Lily, welcome to the show.

 

Lili Barouch  00:37

Thanks for having me. I’m excited to do this interview. So

 

Will Bachman  00:41

Lily, tell us about your journey since graduating from Harvard.

 

Lili Barouch  00:47

Well, let’s see, mostly, I left Boston and came to Maryland, and I’m still here. So that’s the short version. The slightly longer version is that after I graduated from Harvard, I went to medical school at Johns Hopkins. There’s, oh, there’s a funny story about that, actually, which is that I was wait listed at Harvard, where I had originally planned to go, and I got into Johns Hopkins. And once I got into Hopkins, I called up Harvard and I said, Well, I was insulted that I was wait listed, so I called him up and I said, well, take once i i said, Take me off the wait list. And she said, Wait, well, don’t you want to find out if you got in? I said, No, I’m going to Baltimore. And she was flabbergasted. She had no idea what to do or how to do. I said, No, give my spot to someone else who deserves that. I’m moving. And they figured it out somehow. And I came to Baltimore. So I stayed in Baltimore at Johns Hopkins for medical school and all of my post graduate training. After that, I became a cardiologist, and I specialized initially in heart failure and transplant. And then I stayed at Hopkins on the faculty. So I joined the faculty in 2003 So while most people were at our 10th anniversary, I was still on call and training, because it’s a long time, but I joined the faculty in 2003 and doing a combination of of basic science research, I had a research lab and inpatient and outpatient care for heart failure and heart transplant patients, so kind of the sickest of the sick cardiology patients, which is very rewarding, but also very, very intense, I guess I would say so after in the meantime. So from a professional standpoint, I stayed in that role for about 10 years, and then I tell people I’m a recovering basic scientist, because around that time, I decided that that whole, it was too much of everything all at once, and I kind of shifted to doing more outpatient, outpatient cardiology at that point, still heart failure patients, but more in the outpatient setting. In the meantime, I had gotten married and had two kids who were young at the time, so another reason for the outpatient role the kids were so I now live in Howard County, Maryland, which is where my office is. So my commute went from 45 minutes to nine minutes with, I think, three traffic lights total, which was fantastic. From so and that’s what I’ve continued to do now, and I have a pretty exciting new program that i’ll tell you about in a few minutes. On the personal side, one of the reasons I came to Baltimore was that I was in a relationship with someone whom I subsequently married during medical school, and that’s who I had my two kids with, and when we moved to we moved to Howard County, where my kids have grown up. They’re now in the so it’s pretty tough to have kids during cardiology fellowship. That’s when they were both born, but I didn’t want to be one of those physicians that waited until she was 45 to start having kids, which is common, actually, but I can’t imagine that. Now I’m about to turn 54 and to have kids that were like still in school. Now they’re both in their 20s, and one’s going to graduate from college in a few months, and the other one is out in the world and working. So then let’s see on the personal side. So I eventually divorced my first husband and was remarried. I had, I have some pretty significant hobbies that sort of led into my new professional venture that I’ll also tell you about so around 20 years ago, I started becoming more athletic. I became a runner first, and then a triathlete, and that’s been about 18 years now that I’ve been doing a few races per year, doing first, primarily running, but also biking and swimming, and we can talk about that more a little bit later. As well. In that led to an interest as sort of initially started out as a side interest in cardiology, a new field called sports cardiology, which is cardiology specifically geared towards athletes. And I always had a few athlete patients as part of my overall clinic practice, because of people that I knew, or friends of friends and things like that, who needed to see someone. But it gradually grew into more than just a sort of a side gig. And a few years ago, I founded the program for sports cardiology at Johns Hopkins. And after that, we also founded a training program to train future sports cardiologists as well. So that’s been actually really fun. So building a new program from scratch over the last three to four years has been really pretty exciting, and it’s really gained a lot of national attention. The field of sports cardiology overall has grown a lot, and we just got back from the national national meeting in sports cardiology, where I was able to participate, and it’s just been a very exciting and fun thing to do. It’s kind of a merger of some of my personal interest in athletics as well as as well as my cardiology practice.

 

Will Bachman  06:14

That’s very cool. Well, let’s see. I mean, there’s a lot of things to explore here. Let’s hear more about sports, cardiology and as a lay person, I’m even a little surprised that it’s kind of a new field. I would have thought, well, you know, athletes, they need a cardiologist probably, but tell us about the evolution this field and the role that you’ve been playing in it.

 

Lili Barouch  06:35

So sports cardiology, so there’s a few different parts to sports cardiology. So there’s some of it is involved, sort of screening athletes. So that’s mostly younger athletes, like college athletes, professional athletes, things like that. Most people don’t that’s interesting that you would say that athletes need a cardiologist, because most of them actually don’t need a cardiologist, especially if they’re younger. But but in terms of screening, there have been a few. So there were always cardiologists who took care of athletes. But as a field, it’s sort of grown into some of the specifics that are particular to what it means to take care of high level athletes, both younger or professional athletes, as well as what is affectionately called masters athletes. So athletes over age 35, or 40, of which we would all be considered, if we consider ourselves athletes, better than calling us older athletes, I guess. So there’s some of it is screening, you know, looking for evaluating athletes that might have a risk factor, or something like that, to see if they’re at risk for having cardiac problems while they’re competing or doing very high levels of training. Some of it is taking care of athletes who have a symptom, so somebody who passed out while they were running, or who had chest pain while they were playing soccer or something like that, or people who have known cardiac disease, so someone who had congenital heart defect that they were born with, or an older athlete who knows that they have coronary disease or a valve problem, something like that, who needs ongoing care in order to make sure it’s safe for them to participate. And then there also are some and then the final area is there are some significant changes in the heart that happen with high level exertion. So the heart undergoes some remodeling. So it gets a little bit bigger, the walls get a little thicker, just like if you go to the gym a lot your you know, your muscles that you can see get visibly larger and stronger the same Not, not exactly the same way. But there are some changes that happen to the heart and your overall cardiovascular system when you do a lot of exercise, and the type of exercise matters, right? So if it’s a lot of strength training, certain things happen. If it’s a lot of endurance training, different things happen. But in extreme cases, that can sometimes lead to cardiac testing looking abnormal. And so if someone is not used to seeing athletes, they might misinterpret some of those test results as being abnormal when it’s actually normal for an athlete of that level of training.

 

Will Bachman  09:02

Oh, wow. Okay, so a lot of interesting things here. I want to ask about. So screening athletes. You said this is younger athletes, maybe who are about to embark on some college level athletics or even high school athletics. What are some things that you might discover that the person didn’t know about? I mean, probably, if it was a congenital heart defect, they probably would have known that, I would imagine, but maybe not. But what are some of the things that you find that the person is surprised by?

 

Lili Barouch  09:32

So sometimes they don’t know, actually, if it was something major. They usually do know because maybe they had surgery or something like that. But sometimes it’s just, sometimes it’s just a risk factor, like, they had a family history of someone who died of a cardiac cause at a young age, but they didn’t have, like, the whole family wasn’t screened for that particular thing. Sometimes, like, a murmur is picked up. A murmur is a sound that you hear with a stethoscope when you listen to somebody’s heart is picked up on a physical exam, and that. Leads to cardiac ultrasound imaging that might discover like a more minor heart condition, that wouldn’t have necessarily been evident in childhood, but could be picked up on screen that could increase their cardiac risk, or there, I guess, or they have an abnormal ECG. So an ECG is an electrical tracing that we take of the heart’s electrical activity that different screening programs require different amounts of either testing or history and physical. So in the most basic form of screening, is just like a history and physical from your regular doctor. For most like regular like high school sports, that’s all you need for, like sports clearance to make sure you don’t have some kind of uncontrolled condition that you didn’t know about. For for like college athletics, there are each it’s not, there’s not a single standard throughout the country of what type of screening is. So, for example, I participate in screening for Hopkins college athletes now, and there’s like the general screening, where the general Sports Med and the team physician sort of screen everybody to a certain extent. And then if there’s some kind of if they pick up a risk factor or pick up something that needs cardiac screening, then I see those patients that in, like, second level screening, high blood pressure is another one. There’s a not nearly as much in younger athletes as older athletes, but sometimes we pick up high blood pressure, which is usually asymptomatic in a younger athlete that needs to be addressed, like, why do they have high blood pressure if they’re only 18 or 19, and if so, then do they need to be on medications? Or is there some other reason for it? As

 

Will Bachman  11:38

part of that screening? Do you put people on one of those treadmills that gets angled up and angled up and goes faster and faster that thing

 

Lili Barouch  11:46

stress test, yeah, sometimes we do, actually, it depends on what is, what is picked up. So some types of ECG abnormalities or if, or if they have a symptom. You know? Another thing is that athletes, often, they tend to be symptom minimizers, partly, I think, because, you know, from my perspective, from my athlete perspective, you know, exercising at a very high rate of exertion is uncomfortable, right? It’s never going to be, you know, it’s right. That’s why it’s called vigorous, right? It’s never going to just feel like you’re walking in the park. So it’s sometimes it hurts, right? If you’re running all out, things are strenuous. So we tend to ignore minor symptoms that don’t seem like they’re affecting anything at the time. But of of athletes who subsequently developed, you know, the most serious thing that we worry about, of course, is a cardiac arrest. Many of them actually, more than half, actually had some kind of symptom beforehand. You know, assuming that they survive, which we hope that they do, well, sort of report later, like, well, then they had some kind of chest discomfort or some kind of shortness of breath or something. And then, if you ask them, Well, why didn’t you tell somebody? Many of them will say, well, it didn’t seem that serious, right? So, you know, if your leg hurts a little bit, or your arm hurts a little bit, or your chest feels tight because you’re running really hard, you might hard. You might not really think that was something serious, but it actually could have been. So we have to find a balance between not wanting to have anxious people become super alarmist every time they feel the little bit little less twinge, but also to not have people ignore potentially serious symptoms.

 

Will Bachman  13:17

What happens when you find a risk factor and you tell the person. Does that mean you should just be, well, I’m still going to, you know, go do this sport. But like, Thanks for telling me. Or should just people be they’ll be more mindful or report certain things. Like, what do you do with that information? Oh, you have this risk factor

 

Lili Barouch  13:35

so well, that really depends on, depends a lot on what it is. You know, if it’s something like high blood pressure, then they need to be mindful of it. They need to keep track of their blood pressure, get it treated if it’s too high, things like that, but wouldn’t necessarily make them stop playing. But if it was something very serious, like they had a murmur, but that turned out to be a serious valve problem, they might need surgery. Or if they had a abnormal EKG that put them at risk for an abnormal heart rhythm, that might be more serious. So it depends on what it is they’re actually so another thing I should say is that this is part of why sports Cardiology is its own field. I think because there’s a lot of nuance to this there. We just had new guidelines come out this year, actually, about what we the way that we help athletes decide these things is called shared decision making. So previous in the previous guidelines, that was much more paternalistic, which was more like, Well, the doctor says if you can play or if you’re not allowed to play, and then you just have to go by that. I mean, that was kind of old school thinking, but until relatively recently, that’s pretty much how it was. And so another reason why athletes might not report symptoms is that they might be afraid that if they report a symptom, they would be told that they can no longer play, or they might be kicked off the team, things like that. And so that obviously led to a lot of bad things happening, because then people would sometimes not all some athletes would then either hide their. Symptoms or not report them, or because they were afraid they would become disqualified, which is bad on both sides, right, because then people aren’t getting their symptom taken care of, and they’re also not. They’re also, they’re also, might be playing when it’s not safe, and that’s just not a good way to go. So the newer guideline, but we also though many of those sort of restrictions were based on very little data. So, so people just assumed that I can give you an example. So there’s a heart condition called hypertrophic cardiomyopathy, in which the heart it’s a genetic condition, where the heart becomes like way too thick, and that can it increases the risk of abnormal rhythms. And people assumed and so people who have that condition have an increased rate of cardiac arrest. So people assumed that, well, if you let them exercise vigorously, that would be bad, and they would have an even higher rate of cardiac arrest. So maybe they shouldn’t exercise at all, or hardly at all. And it turns out that after a generation of telling people this, their rates of cardiac arrest didn’t really change a whole lot, and now they also have diseases of being sedentary, so now like high blood pressure and diabetes and coronary disease and so subsequent studies have shown that that’s not helpful for most cases and people that are have severe symptoms, obviously they’re not going to be exercising vigorously. So the newer guidelines have looked at more recent research studies to look at actual data, like, does restricting these people actually help them or not? And in many places, the answer was no, it’s actually okay for them to participate in ways that we didn’t think was possible even 10 or 15 years ago, but also that it affects athletes like, you know, psychological state very severely if they get disqualified from the sport they’ve been playing their whole life and things like that. And that’s not a small thing. So we have these sort of shared decision making conversations in which we sort of talk about the risks and benefits and look at, you know, and share enough information with the athlete that they can make an informed decision, together with their physician and their, you know, other, whoever else is involved, if it’s a teenager, their parents, things like that, to to decide. And so we want to make sure that we’re doing something, making recommendations that are as safe as possible for them, but also not restricting them more than necessary, because it might not make them safer, and it also might cause damage in other ways that we wouldn’t think about.

 

Will Bachman  17:25

So we’ve talked about screening of your kind of ordinary if I can say that, like college athletes, let’s talk to us a bit about what you’re alluding to earlier, truly, like elite athletes, professional athletes, on the major sports leagues, or Olympic athletes. And the changes to your heart when you’re at that extreme of an elite level of are most of those athletes? Do they, in addition to a regular physician, do they have a cardiologist that they’re consulting? What sorts of changes to the heart do they need to be aware of, and are you know how to How do things change for someone who’s kind of at that elite level of performance and training?

 

Lili Barouch  18:07

So that’s a great question. So I think that the higher level up somebody is, the more likely they are to have more people involved in their care. In general, there have been some studies on sort of elite like Tour de France cyclists or like Olympic athletes, things like that. And so they do track and study these things too, because otherwise, you know, we don’t other that’s how we learned what happens to people’s bodies in, you know, their hearts, but also other parts of their bodies. And it’s sort of the extremes of of physical performance. So it’s pretty interesting, actually. So people who do very high levels of endurance exercise. So endurance exercise are things like elite level cycling, long distance running, long distance swimming, cross country skiing, mostly aerobic type exercise at like extreme levels mostly have an increase in size of the heart, like the Chamber sizes get larger is kind of like the most noticeable thing that we see people who do primarily strength based exercise, such as weightlifting, bodybuilding, but also things like gymnastics that are primarily strength sports as opposed to endurance sports, get more increase in the thickness of the muscle wall of the heart, as opposed to an increase in the chamber size. And then there are lots of mixed sports, of course, also like something like rowing or triathlon that has a high level of both that you get kind of a little bit of both of those things, and they can even so they, in the most extreme cases, can fall significantly out of what’s considered the normal range for a non athlete. And so we have additional guidelines in sports cardiology for what we consider. Or different ways of of assessing whether that heart is still normal. It also depends on who’s in front of you, right? If it’s an elite Olympic level athlete who’s at their peak performance and their heart looks dilated, you’re not going to say that person has like dilated cardiomyopathy, which is a pretty serious disease of the heart muscle. Um, just because their heart is bigger than the normal range. So, you know. But if it’s someone who’s coming in to My Heart Failure clinic, shorter breath and their heart looks that size, then that’s a completely different picture. So you have to kind of look at it all in context. And then there’s some, you know, if we you asked about the treadmill that goes up and up and up, so the stress so stress testing is one way to test that. Or if you have someone that has an enlarged heart, you enlarged heart, you know, if they perform amazingly well on the stress test, then that’s different from if they’re having trouble or shortness of breath.

 

Will Bachman  20:51

So normally, you get told, Hey, go do some exercise. Everybody should exercise. You go out four or five times a week. Do some exercise. It makes you healthier, right? But I’m curious, is there sort of, at this extreme elite and that we’re talking about, is there some point where, when you’re at that level, it could start, you know, potentially causing some kind of, you know, negative potential impacts, either in the short term or maybe longer term, like 10 years after you you know, an Olympic level cyclist, is there, you know, potential issues you need to be worried about. So there

 

Lili Barouch  21:25

actually are, and that’s a really good point. So for keep in mind that, as you said, for most of the population, as a cardiologist, most of the people that come to me that are not athletes, we’re begging them to do more exercise. We’re trying to get them off the couch for like, 30 to 40 minutes, you know, three or four times per week as like a minimum. And so from going from zero exercise up to like the recommended amount of exercise, which the American Heart Association guidelines say, 230 minute strength training workouts, and three, at least 30 to 45 minute aerobic exercise workouts of at least moderate intensity is kind of like the American Heart Association guideline for the minimal recommended exercise. So going from like zero to that amount is like the greatest amount of benefit, and then you get continued benefit up to three or four times that amount. So the minimum recommended amount of exercise in kind of like hours per is like two and a half hours per week, like spread out throughout the week. And if it’s vigorous exercise, it’s less. It’s like half of that. I think So for people that are doing no exercise, two and a half hours a week might sound like a lot, but for someone who’s an endurance athlete, you know, people would do that in a day, or even, you know, more than that in one day. So before

 

Will Bachman  22:43

we move on, this was an important point. This was interesting, that you continue to get marginal additional gains up to three to four times that minimum recommended,

 

Lili Barouch  22:54

yes, oh yeah, that’s true. So above that, so double so up to like, three or four times that amount, so, which is about, I guess, like six to eight hours per week, you get additional benefits. So the most gain is to go from, like, zero hours per week to two or three hours per week of total exercise, up to about eight hours. Because that would be about, you know, an hour a day or so, maybe two hours on the weekend. You can get more you get greater fitness, greater benefits in blood pressure, cholesterol, reducing risk of diabetes, those types of things, longevity, but beyond that, once you’re above eight or 10 hours per week of exercise, first of all, there’s no additional benefit. So someone who is running marathons is not really getting more specific health benefits than someone who is like, training for and running, you know, like five KS or 10 Ks, necessarily, or who’s doing Ironman triathlons versus, you know, regular running and biking, so beyond eight or 10 hours a week, it’s because they want to do that, because they’re a competitive athlete, or because they just enjoy it, or for whatever other reason.

 

Will Bachman  24:01

So you might get stronger or you might get faster, but you won’t actually get like health benefits. It’s, you won’t get sort of a lower risk of cardiovascular disease beyond that kind of, there’s sort of no increasing marginal returns at that.

 

Lili Barouch  24:18

That’s exactly right. So once you’re above that amount, it’s, it’s because it’s something that you want to do, and then something that’s making you healthier. Okay, with that in mind, I mean, I do those things even though, because I like it, but it’s but, that’s but, but you’re but the other question you asked is very important, which is that, is there such a thing as too much? And the answer is, maybe for certain things, probably yes. So once you’re above kind of about maybe more than like 10 times, well, let’s say more than like 10 or 12 hours per week, over long periods of time, you do start to see some potential issues. Shoes cropping up, especially if it’s over like many years. So someone who’s college athletes typically are exercising 1015, 20 hours per week. They have like, two or three hours of practice, and they have games on the weekends. And so, you know, we typically see about 20 hours per week, but in college, that’s like a relatively limited duration. The problems come more in our masters athletes that have been doing that amount of extra like more than 1012, hours a week for decades of vigorous exercise. And the things that changes we start to see are there’s a few specific things that stand out. One is that there seems to be an increased rate of atrial fibrillation, which is an irregular heart rhythm that can lead to the biggest complication from that is they lead to an increased risk of stroke, and just the rhythm itself usually makes people feel badly. And the other one is that there seems to be an increased rate of coronary artery calcification, which is kind of a marker for coronary artery disease. We don’t really know if that’s correlated so much with heart attacks later in life, not specifically, but we see coronary artery calcium that we have a scan that we often do to to see if someone has some evidence of hardening of the coronary arteries early on. And some athletes that you would expect would be completely healthy, have a pretty high rate of coronary calcium, and there’s several theories as to why that is. We do know that someone who has a coronary calcium score at a certain level, who’s an athlete, is still better off than someone who has that score who’s not an athlete, but it’s still better not to have any coronary calcium, if you can help it. So there’s we don’t really know exactly what is causing that. Yet, there’s some theories about, like, micro damage to blood vessels, things like that. But it definitely is something that can happen in older athletes who have been doing very high levels of exercise for many, many years. So you know, there’s, I think there is probably a point at which there is something that’s too much, but it’s the jury’s still out. Whether that really like changes mortality or not. We don’t know, but it can lead to some issues, you know, in older athletes.

 

Will Bachman  27:12

Okay, I wanted to get to another topic that you raised. We’ve alluded to it, your own performance as an athlete, your training and your competitions. Tell us about what draws you to the sport of being a triathlete and or maybe tell us about a a high point that that stands out for you in in your competitions, in your training.

 

Lili Barouch  27:33

So so I started doing, I started running in 2006 Well, actually, we’ll back up a little bit. So I started, I tried to start running in 2005 and before that, I was never, I was never, like, a big athlete in like, high school or college. I did some martial arts in college. I did some sort of general fitness exercise, you know, I would like jog a couple miles, things like that. I was in the Shotokan Karate Club in college, but I was never really, you know, I did some other things. I was generally active, but not really any kind of athlete. Turns out that I found out that I’m very bad at sports involving any ball, sticks or projectiles. So that’s probably why I thought I was not athletic, because I kept trying to do these sports here and there, and I was never very good at them, until I discovered running, which I was actually pretty decent, and I wasn’t like super fast, but, but I enjoyed it. I i started in 2005 and unfortunately, during that year, I found out that I have an autoimmune disease, rheumatoid arthritis, that sidelined me for for quite a while, for most of the rest of that year, as I got on medications and but it turned out that exercise really helped my symptoms, in addition to just wanting to be more fit and not knowing if that condition was going to lead to my being unable to exercise later. Fortunately, there are a lot of really good medications for rheumatoid arthritis now, and it’s mostly under good control, and it hasn’t limited me nearly as much as I thought it would when I was first diagnosed, but I did start exercising, and I felt better and enjoyed it. And so I started running first, you know, I just was running for fitness, and then my neighbor challenged me to do a 5k and then he stopped running, actually, because he just wanted to be better at playing soccer with his like rec league soccer. But then I kept going, and I met more running friends, and I joined the running club, and then one of my running friends challenged me to do a triathlon. So I did a little mini one first, and that was pretty fun, and it was hard because I wasn’t a very good swimmer, like I could run and bike, okay, but Swimming was not something that came very naturally to mine. I knew how to swim, but, you know, swimming that kind of distance, especially in open water, was what was? It took some time. So, oh, I should, I should pause and say, so a triathlon, there are many different. Distances of triathlons. Just like there are different distances about running races, not all triathlons are an Ironman. So a sprint triathlon is what usually sounds to most people that are generally athletic, like a manageable distance. It’s, you know, a quarter or a half a mile swim, 10 to 15 mile bike ride and a three mile run, and then you have several distances in between there, all the way up until a full Ironman, which is when most people think of when they hear the word triathlon, which is a 2.4 mile swim, 112 mile bike and 26.2 mile run. Yes, you have to do all of that in one day. You have 17 hours to finish an Ironman. If you don’t finish by the stroke of midnight, then no metal for you, basically. So, so I went along doing, you know, I did a few marathons in there, and I did mostly short and medium distance triathlons. I’m especially proud of. I’ve run six marathons total. The first one I did just to see if I could finish one the next four, I was trying to qualify for the Boston Marathon, and I finally did. And then the final one that I did was I ran the Boston Marathon in 2018 for marathons, you have to get a qualifying time at another marathon that is based on your age and gender. There are different levels of qualifying time, but it’s fairly difficult. You have to actually be pretty fast to be able to get into the Boston Marathon using a qualifying time. So so that was a pretty significant accomplishment. And then the other one was so and but then I, you know, I because I have rheumatoid arthritis, I have some joint issues. My knee is not great, my other ankles not great, things like that. So I decided to focus more on long distance triathlons. After that, I had a pretty significant medical problem in the water at another race. So the same year later, the year I guess it was in 2018 when that first happened. I had a problem when I was in a half Ironman race in the water called swimming induced pulmonary edema, which is pretty serious, and it was my first DNF did not finish the race, episode where I had to be like, taken out of the water and brought to the hospital. Basically, your lungs fill up with flu, not fluid that you inhale, but to see your your lungs, like, fill up with fluid and you can’t breathe. So that was pretty scary. And then, you know, you can kind of go one of two ways with that. So like the the doctor part of my brain says, you know, maybe that’s not such a great idea to keep doing these races after this happened. But then the athlete part of my brain said, Are you going to really let that beat you really? So I went with that side, and I decided I would continue on. And I saw, I saw my I saw a sports cardiologist at that time for myself as the patient, and got some guidelines as to how to prevent that from happening again. And I decided to just keep, keep going for it, and I was able to continue training with the sort of guidelines that I got and worked up to i and then I finally did a full Iron Man in 2021 wow. So you have to train for about a year to do one of those things. Unfortunately, I had to train twice because I was going to do it in 2020 and then we all know what happened in 2020 is that everything got canceled. You can’t like for training for an athletic event. You can’t just keep that in the bank. You got to start over again to do it the next year. So it was, that was my 50th birthday present to myself was to do the Iron Man. So that was in 2021 that was kind of the that’s like the big goal of doing triathlons for a lot of long distance triathletes, and to be able to do it at age 50. I’m very I feel very fortunate that I was able to do that. But it was my own medical problem, actually, from 2018 that really kind of led me to want to found a sports cardiology program here in Baltimore, because at the time, there wasn’t I ended up going to Boston. The Mass General has the original the OG sports cardiology program, where most sports cardiologists have been trained, not all, but so I went there to see someone in that program where I got my initial evaluation, because there wasn’t anybody in Baltimore. So I thought, hey, you know what? I see athlete patients too. I can, I can actually learn from them. And I started taking educational courses and seeing more athlete patients, and founded the program here.

 

Will Bachman  34:33

Tell us about that. Tell us about this program that you founded. So

 

Lili Barouch  34:37

the program is based on, see my part of my clinic now is comprised of athlete patients. So I have, like, two, two, part of two days a week where I see primarily athlete patients and take care of them. Some of them, I have problems. Like, for example, I had that problem. And so I had, actually, I knew when I was in the race, where that happened. I knew what it was. Because I had seen a previous patient the same problem, and I thought, Oh, crap. Really happening to me was but So partly it was that so my my particular interest in our sports program, from a clinical standpoint, is to is in masters athlete, Masters endurance athletes, and because I’m so involved in the community here in both running and triathlon. A lot of a lot of the patients that see, or a lot of the athletes who need to see a cardiologist come to me on that basis, but, but the program is, you know, it’s primarily a clinical program initially, but we also have a research aspect to it. So I have a registry of athletes. We’re about to start a National Registry of math masters athletes to look at some particular risk factors or conditions to see if they cause problems down the road. You know, you asked if we know whether you know many years of high levels of exercise cause problems? Well, in some cases, we just don’t know. And so that’s part of why we’re starting this research project to to discover that it’s only been relatively recently that there’s been an interest in following sort of what otherwise are relatively healthy athletes over the long term. Because generally, they are healthy and they do better than non athletes. But in some extreme cases, we see some issues. And also, just to find out, you know, just you know, I have some athletes that are still in their 80s, that are still doing pretty high levels of exercise, which I think is pretty amazing, pretty awesome. And then the other, the other final aspect of the sports program is training. So several of our cardiology fellows in training are interested in sports cardiology as well, and they so a couple of years ago, one of the a fellow that had been working with me in my clinic already, and I decided we were going to develop a training program and a fellowship curriculum for for him, for himself, and also for future fellows. So that was approved a year ago, and so we had the first formal graduates of the fellowship program this past month, and we’ll have a couple fellows per year that are training to be future sports cardiologists.

 

Will Bachman  37:06

And so tell us a little bit about just sort of administratively or bureaucratically, what’s involved in founding a program like you’ve done, as opposed to, I do, you know, I see sports athletes, you know, I serve as their cardiologist. Like, what’s, you know, it kind of formalizes it with Johns Hopkins, and then you have fellows assigned to it. Or, like, is there certification, or what’s involved in, kind of saying, Oh, now we have a formal program in this.

 

Lili Barouch  37:39

So, the so it’s there’s no certification yet, actually, yet. And I say yet because part of the other other programs of sports, cardiology, and in our program as well, we’re working towards more formalized curriculum. And I think someday, within the next few years, maybe a decade, there will be like, formal certification, both for programs and for fellowship. I don’t know. I mean, that’s the administrative I don’t want to get too far into the weeds about administrative details, but it’s a lot of meetings with people and things like that to get a program recognized. You know, we don’t have, you know, until we have, like, a multi million dollar donor. We’re not going to have, like, our own building. It’s, you know, I see patients in the same place where I normally see patients. So in terms of, like calling it a center or a program, it’s sort of like a virtual center, I guess. I mean, you know, there’s not like a building for sports cardiology someday, maybe

 

Will Bachman  38:34

listeners naming opportunity, if you’re so inclined,

 

Lili Barouch  38:39

yeah, absolutely. You know, be happy to name the program after anyone who wants it named after them. But some of it is just kind of getting the word out there. So I give talks to our primary care doctors, to our own division around the country, and things like that, to to get the word out and so that people know that the program is here. We taught we take care of athletes for Hopkins, like I said, there are there’s the American College of Cardiology as a sports and exercise Council, which I’m a member of, and a lot of the leaders in the field are members of this council or have leadership positions in the council. There’s an annual meeting, which we just had last weekend actually called the care of the athletic heart, which is in Washington, DC every year, where we all get together, and there are formal talks and educational symposia, case presentations, things like that, that sort of help other people get into the field, or allow us to kind of get together and network. So it’s a lot of different things like that. I think that’s, you know, working at an academic medical center. Resources, financial resources are not unlimited. So, you know, you can’t just go say, oh, I need a million dollars to start this program. So a lot of, a lot of the program was initially founded based on existing resources. So, you know, of course, you. We already have cardiac imaging, stress testing, things like that, as part of our normal division. And it’s more a matter of kind of bringing people together who are interested to have it be a program. One feature of seeing athletes, whether it’s in that Hopkins or anywhere else, is that they need to be seen relatively quick. Somebody collapses while they’re playing. They can’t wait for, like, a routine appointment that’s two months from now. You know, they need to be right away. So some of it’s just sort of being willing to bend over backwards, to get people in quickly, and to get testing done and things like that. So it’s more a matter of of, you know, people’s sort of personal dedication to making it happen, rather than like a physical structure or administrative structure. You know, the administrative structure that was already in place is kind of what I utilized to get things started at the beginning, before we had much of a budget. We’re under the umbrella of preventive cardiology, and we have some funding to get research projects and get clinical programs underway.

 

Will Bachman  41:01

Let’s turn back the clock. I want to ask you to tell us about any courses or professors that you had at Harvard that continue to resonate with you.

 

Lili Barouch  41:10

Hmm, you know, that’s interesting. Actually, the most memorable courses that I had were probably no offense to my like pre med courses and but it was not necessarily organic chemistry or biochemistry. I think some of the electives that I took are the ones that kind of stick with me the most, and not necessarily because of professional reasons. So some of the most memorable ones were the I took a course on nuclear history, and it was a, it was nuclear from 1945 to 1972 so that was from the end of World War Two until the salt two treaty. And I always remember that, and I’m not sure why that really sticks in my mind as being so relevant. But it was a, really, it was a very detailed look at that part of a difficult time in world history that kind of always resonated with me. And I never was that, you know, I was really, I mean, I was, I was a science nerd basically throughout school, and so, you know, I’d never really had a really in depth look at history like that. And it kind of stuck with me. And another one was, another one was calligraphy class, where I still have one of my final project up on the wall in our house, actually, from that so, you know, it was just, that was just a very it was nice to be able to do something completely different from all of the nerdy science stuff for a while.

 

Will Bachman  42:39

That’s so cool. And with the calligraphy, have you ever, you know had occasion to do some calligraphy for an invitation or some kind of thing like that?

 

Lili Barouch  42:50

Oh, this was, it’s, this was, it was Japanese calligraphy, not,

 

Will Bachman  42:56

not in English, all right. So, okay, so, and were you studying Japanese or

 

Lili Barouch  43:03

No, I just took the calligraphy class. I lived in I lived in Japan for a year when I was 10, so I had kind of a connection to Japan, and the calligraphy are the same characters in that overlap with Chinese as well. And my mother’s Chinese, so I’m half Chinese, and so that was kind of how I decided to take that class, but it was just, it was a lot of

 

Will Bachman  43:25

fun. Wow. Okay, amazing. So Lily, where can people find out online more about you or about your program, about your sports, cardiology program? Where would you point them?

 

Lili Barouch  43:38

So we have a website. It’s the Hopkins websites are, unfortunately a little bit canned looking websites because they have to follow the Hopkins approved format. But there is a website for our sports cardiology program, and there’s also another page that’s linked from that for the sports cardiology fellowship program that has a lot more detail about what we’ve been able to put together,

 

Will Bachman  44:00

amazing. And if you send those to me, we’ll include those links in the show notes. Great Lily, thank you so much for joining today. This is a lot of fun to speak with

 

Lili Barouch  44:10

you. Absolutely thank you so much for having me.