Three weeks ago I had a pretty scary experience in Connecticut. I was there for the Quassy Rev3 Triathlon, a half-iron distance race on a hilly course in warm weather. After finishing 3rd at CapTex in Austin the week before I felt a bit out of shape and had only decided to race the Rev3 as a way to test out a new half-iron nutrition plan. I was hoping to finish the race feeling good, and avoid heat exhaustion and the medical tent.
When I came out of the water way behind the leaders I wasn’t surprised, and when I was unable to ride away from the large pack of cyclists (okay I was barely able to hold on) it didn’t seem like an implausible performance given how I felt prior to the race. Around mile 20, however, I noticed that there was more going wrong with my body than some tired muscles.
As we started a 7 mile long climb, which summits around mile 30 of the 56 mile course, I lost contact with the group. It was then I realized that I was struggling to breath, and coughing up fluid. It seemed to get worse unless I backed off, and being in my aerobars was worse than sitting up. Fluid in the lungs is a pretty obvious abnormality that makes it easy to decided to quit. I waved to the ref as I pulled to the side of the road to call it a day, but he simply nodded at me and zipped off. After my experiences in San Juan and Saint Croix I was well aware that the fastest way to the med tent, if you can move at all, is on your own two feet (or wheels). I sat up and pedaled slowly through the remainder of the 56 miles, coughing the entire way and feeling like I was drowning on dry land.
Back at transition we noted a pink tint to the fluid I was coughing up, and the med staff sent me to the hospital. I was really lucky to have Abby’s parent’s at the race spectating, so when I was admitted to the hospital for tests and overnight monitoring I at least had family to keep me company.
After initial testing showed that I was unlikely to have heart or lung failure I was released, but told not to fly until further testing had been done at home. I spent a day in New York with Abby’s family, then took a train back to Chicago (20hrs, it’s not worth the views).
Last week I went through further testing, an MRI, a stress test, and a couple hours with one of the area’s top cardiologists. And in the 12 days between the race and the results of my tests I spent most of my time trying to figure out where my life was heading. I was terrified, but interestingly it wasn’t the prospect of no longer being able to compete in athletics that scared me. I’m pretty good at coming up with creative ways to enjoy my life, and I know that the next part of my life, post-triathlon, will be just as exciting and fun. No, I found myself more concerned with my family. This is the third race this year where I’ve had problems, and I’m at a point where I know that when I race my family and friends are praying for the next update to come across twitter so they know I’m okay. I want to them to be excited to watch me race, not fearful.
By the time I arrived to my final doctor’s appointment to review my test results I was almost hoping for there to be something wrong with me that would explain every problem – from heat exhaustion to edema. Fixable or not, end of my career or not, I wanted a way to tell everyone who cares about me that I’ll be okay, that I know what to do, and they can stop worrying. But that’s not what the tests said.
It was good news. They found nothing wrong with my heart. In fact, my heart looks really healthy, as one would expect from a professional endurance athlete. My heart even got more efficient under stress. The doctor sees no correlation between my heat exhaustion in San Juan and St Croix and what he has diagnosed as “swimming induced pulmonary edema” (SIPE).
According to one study, a questionnaire sent to the USAT membership in 2009, SIPE has been experienced by at least 1.4% of triathletes, and is caused by vasoconstriction around the lungs when entering cold water. This short blog entry, and an article about SIPE on Slowtwitch are much better explanations. There’s also some evidence that heavy sodium loading (overhydrating pre-race) can exacerbate the condition, which it appears was the case with me.
This is the type of diagnosis I wanted (a confident doctor with an acute and hopefully avoidable episode), but as I get back to training I can’t forget the soul searching I did over the last few weeks. I’m in this sport because it’s fun, I love the people I meet and the thrill of testing my physical limits. Triathlon is a wonderful adventure, but it won’t be my last. I wouldn’t bet my life for it.
I have learned a lot about myself this year, and I can use it to improve. SIPE is avoidable, and I just need to find the line between over and under hydrating prior to a race. I’m ready to be a better triathlete.