Grand Rapids Tri 70.3 - SIPE and the Weirdest of Days Ends Up In the Hospital
OK, so I'm a repeat offender who never writes race reports or plans (not much anyway). But there was too much to learn from this one so I want to share with the team.
This was the first real race for me after being off in all of 2015 with hamstring tendonitis that had me completely on the sideline for 9 months, till about August 2015 when I began to (successfully) build run miles to run a 200 mile relay in October in the Northwest Arkansas hills. After that I started and had a successful November out season, essentially restarting my bike from almost nothing up to an FTP of 236.
Both race rehearsals were solid for me with the second building on the first. I focused on execution and was very satisfied with the effort, particularly with the second...probably the best I can recall since I hit my numbers all around to meet my (mental/sticky note) plan. So going into this race I was particularly confident, after looking at the competition, of being on the podium in my 61-65 male age group.
The race venue is in Michigan, far from my Arkansas home. This was home for Virginia and I, moving away for work in 1983. So I knew that all the heat and humidity would likely be far away, and even if it was here that day, I trained in it for some time now in Arkansas so I was well prepared for heat. I'm sweat heavily in warm weather with high dew points, so the Michigan weather would likely bring fluid relief, and that was the case on Sunday. It was a picture perfect day.
The day opened for me just after 3am. I woke and planned to get up anyway at 3:30, so I was up with a solid breakfast of loosely cooked oatmeal, brown sugar and other carbs, and plenty of fluids. All Saturday and through this morning to the race site I was hydrating (not sure if I would put the pre-race beer from Saturday night in that category, but I digress). The race venue was about 50 miles from my sister-in-law's but it was an easy drive on the interstate, so that part of the plan went well. We miscalculated however with the GPS and driving in. We found ourselves being brought in via roads that were closed when we got close to the race venue so that had us confused. Virginia figured it out but that probably cost us 15 minutes and that cost us later as we had to hurry more in transition setup. The parking was about half a mile off so that too was a miscalculation on time needed. Normally we are very close to the race site, so this is a learning experience. I had transition setup all prepackaged so that went well.
We made it to the swim start with about 10 minutes to spare. Not enough time for a warmup. I normally much prefer a warmup, but was not worried (more on this later). The start was an in-water gun (horn) start at 7:05 and all was fine at the start. I know I went out too fast and had to back off some. The sun was to our backs, swimming to the west so sighting was very good as evidenced by the GPS track. The we were full on into the sun on the way back so sighting was impossible, and the GPS track shows that too. I'm not fast in the water finishing in 45:15 (watch time...DNF's not showing on the results). Not my best result.
But now the fun starts. The end of this (I'll cut to the chase) was that I was coughing up blood at the very start of the run, so within 1/4 of a mile I turned off the watch and walked back to the medical tent.
My experience that led to the DNF did not materially manifest itself till the bike. On the swim I do remember that my breathing was off though not to the point of panic as I remember. I was late to the start so I did not get a warmup and probably went out faster than normal. The water was in the upper 60's to low 70's and not uncomfortably cold. The wetsuit was no more constricting than usual...not a problem. All in all the swim was a little slow but nothing that stands out. If my lungs were filling with fluid then I did not realize it yet. I did not hear the lung gurgling that others who have experienced this (SIPE) have experienced.
My transition execution was ok except for one rookie move in forgetting to take the second safety seal off my two Gatorade bottles (dual seals). Once I was out on the bike things felt good for the first 10-15 miles and I was hitting my power targets. All felt well and the numbers bore that out.
But then something was wrong. The first warning I remember was recognizing that my power was falling and I just did not know why. My right hamstring was becoming increasingly angry (the 2015 hamstring issue never manifested itself during HIM training) so I attributed the power drop to that soreness. I clearly remember trying to pick it up but it just did not happen no matter how hard I tried. My two rehearsal rides were right on, and that on a harder course so something was off but I just blew it off to the angry hamstring. The power drop continued and worsened, being able to pick up the power with about 15 miles left but still not near my targets. Later on the bike a cough developed but if I did spit I couldn't see it due to the bike movement. But this was the first place where I knew my breathing was labored.
In T2 my wife noticed how slowly I moved. That's probably the first time I remember wheezing while I tried to clear my breathing. But out of T2 I was wheezing so much that I could not go 6 steps without wheezing and coughing up to spit. When I spit what was coming up from my lungs, that was the first time I saw blood, and almost every few steps was the same. I tried to continue but only got a quarter of a mile before I turned around to headed to the medical tent.
The medical tent was the first place I received confirmation that bleeding during exercise could occur for both breathing or gastric reasons. But they were not equipped for this. The coughing continued but with time slowed down and I left the tent feeling overall ok to walk. My marathon running partner is a head of surgery at the local VA hospital in Little Rock, so Alison was my first call (between wheezes, I could barely whisper words on the phone). She did her Q&A and said send me a picture. I told her that would be gross ("welcome to my world" was the response). But up came a wad of blood into a tissue. The order was "get to the ER", confirmed later by one of my daughters who is a nurse.
I was released from this first-in-my-life hospital stay at about 4pm on Monday. Through that time we began to learn of SIPE -- Swim Induced Pulmonary Edema. Turns out that this somewhat rare issue is dead on for Long Course triathletes and divers. It was not hard to find write ups, both personal and medical once you knew what to look for. Even found one of our members who had a bad experience with this once on a long swim. Normally the lungs fill up with fluid, due to what is believed to be contributing factors such as over-hydration, the cold of the water causing the body to concentrate blood in the core to keep core temperature up (raising core blood pressure), constriction of the wetsuit (raising core blood pressure), the lack of warm up, the intensity of a swim on raising blood pressure in the lungs, etc. I have heard recordings of swimmers coming out with VERY obvious gurgling in their breathing and constant stories from just not being able to swim their normal pace to being in breathing distress to the point of near panic. Sometimes it manifests itself with bleeding but not always. What I did learn in the hospital was that the interface between the lung air space and the capillaries is VERY thin, so the increased blood pressure can burst blood vessels in the lungs. On some occurrences the experience does allow the triathletes to continue through the bike (the stories were similar to mine on the bike having to just push through an off effort), but almost always end up on the run where aerobic needs are usually much higher and getting stopped on the run due to lack of breathing capacity, or worse (bleeding).
In the end after just over 24 hours in the hospital the pulmonary specialist and I agreed based on the facts: We decided that (a) since there were no indications before the half Ironman, (b) other than a "small" amount of blood on the CT in the upper part of my lungs no test has shown anything medically wrong, and that (c) I felt fine other than feeling just like I came off a bad cold with my breathing, that he is going to do a few more blood tests and see how I am with a couple of low stress weeks. He also spoke of doing another CT then. I can't tell you how many times I heard that I was an anomaly being in exceptional health at 61.
Thanks for listening, but here is what I want you to hear. I learned from Alison (my running partner, and surgeon), and from all the doctors at the hospital, that doctors don't fool around with breathing issues where fluid is in the lungs. Continued fluid production, or bleeding can quickly turn pulse O2 level into dangerous territory and if the bleeding continues it will coat more-and-more of the lung tissue lowering the ability of the lungs to supply needed oxygen for life, let alone strenuous exercise. For me, the learning experience is that nothing good could have happened from just pushing through the run, and in fact it could have been very dangerous. So to all of you my friends and teammates, if you experience similar symptoms be very careful. Trying to be an Ironman hero could have very dangerous consequences. If I learned one thing from this half it is not what I expected. It was that being a typical type A has to be tempered with an acute awareness of what my body was telling me, and by coughing up blood to the point of having to walk just to continue to wheeze and gasp for air, that was enough and it was time to bag the run.
Three days out I still found my breathing constricting but each day seems to be little better. On Tuesday a walk with family it was clear that my breathing was labored and I was not comfortable. As I write this it is day 4 and and finally feel like I can get back on the bike trainer for an easy to moderate ride and will do so today. At 61 I find that I heal much slower than when I was younger. I planned on taking a down week this week and the getting back on track to train for IM Chattanooga. Although I wanted a good learning experience from the half IM this past weekend, this wasn't quite what I had in mind and of course it is doing some mind games on me. It will take a little bit to get my confidence back.
Thanks for listening. Certainly your input is welcome. And I want to thank all of you who reached out on the dashboard and via email with the love and concern you extended. That means a lot and was a source of encouragement.
Comments
Patt, Thanks for the update. It was great meeting you and Virginia at the race expo. I am glad to hear that you are out of the hospital and feeling better. It looks like you made made the smartest move of the day by bagging the run and getting to the emergency room.
Also really glad that nothing dangerous happened to you.. rest well
Damn bro, tough day out there and a bit scary.
Glad you are recovering and want to thank you for sharing these happenings/findings and educating the rest of us. Very valuable information for myself and the team.
SS
That is very scary indeed and I am happy to hear you are now doing better.
It sounds like you have read quite a bit on SIPE so you may already know how to keep it at bay. I have had several incidents of SIPE. For me a good 15 minute running warmup, a swim warmup if possible and a moderate start to the swim has kept my SIPE away for several years now. I run before every open water swim and even prior to my IM races. I'm still nervous every time I go into open water but so far, so good for me. Hopefully, the same will hold true for you!
Again, thanks for posting and best to you on a speedy recovery and outstanding IM Chattanooga!
I'm glad all is well and it wasn't worse. You were in tune with your body enough to know something wasn't right and made smart decision to stop. This is a very educational post on a couple levels. Not many triathletes know about SIPE or the warning signs.
Thanks for posting!
SIPE - not something to scoff @ for us OFs. We may be mentally tougher, but we are becoming physically more fragile, and need to take seriously - as you did - any warning signs of impending doom, like coughing up blood. I'm glad you had the wisdom to stop and get help.
It's good to be reminded of the risks of: no warm-up, excessive pre-race hydration, too tight wet suit, sudden immersion in cold water, sudden high exertion @ start of swim, etc.
I'm not 100% yet. But easing back in.