Al - I hadn't seen this before. I think the good Dr. is well intentioned, but there was a deep study of tri-deaths from 2006-2008 (or abouts). I think there were 14 fatalities in this period and 13 occurred in the swim (1 on the bike). Most had autopsies and the lion's share of those revealed a heart problem. But the cause and effect that Dr. Mandrola is inferring seems to be reversed. The conclusion of these studies was that the individuals had pre-existing conditions; and that the unique combination of an IM start + anxiety + (typically) cooler water, can lead to hyperventialiting that triggers the heart attack. That's a completely different conclusion than IM training scars the heart and kills people. And I believe most of these deaths are from BOP (and sometimes MOP) athletes (e.g., the 2 at this year's Nautica tri).
I won't argue with the Dr that some exercise can scar the heart but someone needs to explain to me how low intensity exercise harms the heart as opposed to the lung busting, heart-about-to-jump-out-of-your-chest short distance stuff. I can assure that - at least for me - IM is a leg/arm muscle fatigue challenge, and that my heart feels like it's on a cake walk. I've always thought that if I had heart problems, I would have keeled over in my 20's while doing a hard interval set on the track.
Again, not to discount what the Dr says, I think the real lesson of triathlon swim deaths is this; if you are relatively new to endurance sports, and you are over the age of 35, you should strongly consider getting a full medical check up including EKG under stress before you RACE. It will be a waste of time and money for most people, but it could very well save your life if you have an undetected pre-existing condition.
OK, I read the post. Behind the author's obvious difficulty understanding why "ordinary" people (meaning those who aren't superior athletes competing at an elite level) would train for and complete the Ironman event, there is actually some truth to concerns about risks to the heart.
And yes, Paul is correct that almost all deaths in IM occur in the swim (a glaring exception was the IM California I participated in in 2001, when someone about my then-age took the downhill/left turn on the back side way to fast and crashed). But there are medical studies which show an alarmingly high percentage of middle aged men (50s/60s) who have elevated cardiac enzymes after running a marathon. That is, someting like 30-40% will show blood test results similar to those found after a heart attack.
And there are other instances of damage people do to themselves in an IM: bowel ischemia resulting in loss of most of the colon (Chris Legh, Julianne White), kidney stone (Tim DeBoom), hyponatremia, heat exhaustion. I myself had signs of rhabdomyolysis (traumatic muscle destruction) after a particularly hot and humid IM in Madison, Sept 11, 2005.
Downhill skiing is dangerous, too, and so is mountain biking, but I still do those things as well. My point is, just because something poses a health risk is not a sufficient reason to cagtegorically avoid it. I think it was riskier to drive my car to Seattle daily for seven years, than it is to train for and compete in IMs.
I am 60, and had my first episod of afib in 2005. It was near the top of the first hill at vineman, and my hr went up to 250+. I made it to to the bottom of chalk hill on the first lap before I finally gave up. It took a while for the doctors to figure it out. My cardiologist is fine with me doing triathlon (with the caveat that if I have an episode, I take my medication and wait for someone to drive me to medical attention - no more 40 miles+ of seeing if I'll feel better). He says there is no research to indicate that I am any more likely to have a heart problem doing IM than anywhere else. But - he says that at my age it is imperative that I be prepared if I'm going to do long course triathlon. If I'm prepared, I'm OK. If not, then it could be risky. That makes sense to me, and that's what I never see in the articles. For instance, this year I was training for an IM. 6 weeks before my race, I had to go help a family member for 3 weeks - absolutely not exercise. When I got back, my fittness was signficantly reduced. Maybe i could have finished my IM, but I chose to withdraw - 15 hours is a long time if you're ready - a very long time if you're not. Are the people that have problems fully prepared? Have they been doing long course for 10 years? Are they well rested, overwegiht, etc.? Not much of this information is ever given - my guess is they don't really have it. I think that the EN method of preparation is especially good for "older athletes" - if you can get through the OS and the normal intensity of EN training, the race is easier, just longer. I'm obvviously not a doctor, but I do have a good cardiologist, and I've thought about it a lot.
As I've told multiple people over the years after they've said "you're crazy", "all that running and you'll ruin your knees", etc, etc, the one response I have is: I'd rather live doing something that gives me the opportunity to be healthy, and enjoy, than face life sitting on a couch worried about how I'll die.
Having survived the Widow maker two years ago (coronary artery rupture) which occured during an olympic distance race, i can say my doctors and myself believe my long time commitment to triathlon,(ironman for 12 years), likely saved my life, we also believed it likely enabled me to fully recover from the heart attack with no permanent heart damage. Won't go into any more details, but in my case, i'm very thankful i found the sport(and so is my family).
@ Todd - reminds me of Jim Fixx. Most people that aren't very knowledgeable think he was a great runner and that running killed him. In reality, he was an author who took up running at age 35 when he weighed 240. He died of a heart attack at age 52, but his father passed at age 43. Fixx had taken some time off running and regained weight when he started back and had his heart attack. He was predisposed to heart disease and Ken Cooper concluded that running had extended his life. Unfortunately, consistency is important and his break may have cost him his life.
Paul, re: Jim Fixx. Ken Cooper and Dr. George Sheehan had been bugging Fixx for sometime to come into Cooper's testing facilities and get a full workup done and he always made excuses and avoided the tests. They were (Dr. Sheehan has since passed on) and are convinced that if Fixx had had the tests they offered performed, they would have discovered Fixx's heart problems and the issues could have been repaired.
@ Al - yep, well aware of that. Lots of people mistakenly thought Fixx was a world class runner. I think it was John Parker (author of Once a Runner) who said that a 12 year old in flip-flops could outrun Jim Fixx. The point was that for many, Fixx was the face of running, and his death served as an excuse to avoid the sport. The real story leads to a completely different conclusion.
There is NO doubt that heart arryhthmias are rampant in endurance athletes. (Search atrial fibrillation on ST ) If you don't have an arrythmia, it's easy to dismiss. Mine began in the middle of IMWI training last year--and came out of NOWHERE. The stress and anxiety of my huband's near-death crash was likely a contributor as it began a few weeks after that. One day you are fine, the next day you have Afib. Running in Acadia in Maine I felt weird and started walking. Saw my HR go from 150 to 180, 187, 194, 200, 212, 224 before self-converting. I had no idea what it was.
My Afib did not resolve, and I have been on drug therapy since Feb for paroxysmal or "lone" Afib. The meds are terrible. I can't get my HR up, and the meds have an inotropic effect on the heart too, i.e. it decreases the contractility of the heart muscles and therefore decreases the cardiac output per heartbeat. This has impcted my life and training greatly.
On Thursday of this week I am having a cardiac ablation at MGH. Since I have ZERO other risk factors--no ischemic heart disease, no HBP, no deformities--they feel I am a perfect candidate. The hope is for the ablation to fix the problem and, within a few months, get me off the meds completely and back to normal.
FWIW, I read Dr. John's posts and what he described feels like my story to a T. Every single word he wrote resonates, and the questions he asks about upper limits of exercise I believe have merit. You can explain it away if you have not experienced heart arrythmias, but those of us athletes who have do not dismiss that the endurance stuff plays a role.
I will also admit to you that I (beyond) stupidly ignored it for far too long. Everyone has "palps," right? (wrong.) I am as guilty as ANYONE of being so in love and committed to the IM game that I brushed it aside to wait until WI was over. My aerobar collapse and crash that ended my day in WI at mile 85 on the bike...I sometimes wonder if the universe interceded to save my life. Who knows, but the fact that I didn't go through with the marathon was probably a very, very good idea.
Like Bob, I have no limits on what I can undertake as an athlete, but I am pondering the future.
I will find out hopefully what is going on with my heart thursday when I do an imaging stress test. I have BP issues and it was nicely controlled with meds and exercise. About 3 months ago now I guess my BP starting going crazy and in the end stuffed in the back of an ambulance for possible heart attack (44 years old). I am training for IMAZ so I wonder if my body is revolting from the training or something else.
I find this very interesting and scary at the same time.
@Linda - don't know what kind of medication you use, but I started with beta blockers to control the high heart rate if I had an afib episode. I felt awful, and couldn't really exercise because I couldn't get my heart rate over about 120. My doctor switched me to calcium channel blockers. They work a lot better. Seem to let my heart rate rise pretty normally - but controls the very high herat rate (220+) I get when I have an episode. I normally take a time release medication, but my cardiologist has OK's me to stop the CCB a couple of days before a race, and carry a fast acting version of the same medication if I need it during a race. I have an antiarythmic, but rarely need to take - although I do carry it during races.
@Steven - Good luck with your testing - but don't be discouraged if they don't figure it out this time. It took me a couple of years, multiple stress tests, holter tests, etc. before they figured it out. If they don't figure it our - keep after them.
My brother in the A-fib struggle! I am on a CCB (diltiazem) since I can't take a beta blocker--BP too low and I have Raynaud's. My sensitivity to the CCB is pretty extreme. Can't explain it, it just is.
I'll let you know how the ablation goes. It's tomorrow. I have to give it 3 months before I know how well it worked--or not. Below are the reasons, expressed in layman's terms, why they think I am the "perfect cadidate" to fix it and get me off the meds.
* Ablation tends to work best on the following and it's me to a T:
1. paroxysmal (“lone”) a-fib
2. people who have infrequent episodes
3. people who self-convert quickly to normal sinus rhythm
4. people who have had a-fib for a relatively short period of time
5. Are young (relatively :-) ) as my heart is not effected by stiffening as happens in the elderly
6. have ZERO other risk factors (Luckily, I have NONE)
7. am not fat (can't believe how many times they bring that up)
Comments
I won't argue with the Dr that some exercise can scar the heart but someone needs to explain to me how low intensity exercise harms the heart as opposed to the lung busting, heart-about-to-jump-out-of-your-chest short distance stuff. I can assure that - at least for me - IM is a leg/arm muscle fatigue challenge, and that my heart feels like it's on a cake walk. I've always thought that if I had heart problems, I would have keeled over in my 20's while doing a hard interval set on the track.
Again, not to discount what the Dr says, I think the real lesson of triathlon swim deaths is this; if you are relatively new to endurance sports, and you are over the age of 35, you should strongly consider getting a full medical check up including EKG under stress before you RACE. It will be a waste of time and money for most people, but it could very well save your life if you have an undetected pre-existing condition.
OK, I read the post. Behind the author's obvious difficulty understanding why "ordinary" people (meaning those who aren't superior athletes competing at an elite level) would train for and complete the Ironman event, there is actually some truth to concerns about risks to the heart.
And yes, Paul is correct that almost all deaths in IM occur in the swim (a glaring exception was the IM California I participated in in 2001, when someone about my then-age took the downhill/left turn on the back side way to fast and crashed). But there are medical studies which show an alarmingly high percentage of middle aged men (50s/60s) who have elevated cardiac enzymes after running a marathon. That is, someting like 30-40% will show blood test results similar to those found after a heart attack.
And there are other instances of damage people do to themselves in an IM: bowel ischemia resulting in loss of most of the colon (Chris Legh, Julianne White), kidney stone (Tim DeBoom), hyponatremia, heat exhaustion. I myself had signs of rhabdomyolysis (traumatic muscle destruction) after a particularly hot and humid IM in Madison, Sept 11, 2005.
Downhill skiing is dangerous, too, and so is mountain biking, but I still do those things as well. My point is, just because something poses a health risk is not a sufficient reason to cagtegorically avoid it. I think it was riskier to drive my car to Seattle daily for seven years, than it is to train for and compete in IMs.
Keep pressing!!
There is NO doubt that heart arryhthmias are rampant in endurance athletes. (Search atrial fibrillation on ST
) If you don't have an arrythmia, it's easy to dismiss. Mine began in the middle of IMWI training last year--and came out of NOWHERE. The stress and anxiety of my huband's near-death crash was likely a contributor as it began a few weeks after that. One day you are fine, the next day you have Afib. Running in Acadia in Maine I felt weird and started walking. Saw my HR go from 150 to 180, 187, 194, 200, 212, 224 before self-converting. I had no idea what it was.
My Afib did not resolve, and I have been on drug therapy since Feb for paroxysmal or "lone" Afib. The meds are terrible. I can't get my HR up, and the meds have an inotropic effect on the heart too, i.e. it decreases the contractility of the heart muscles and therefore decreases the cardiac output per heartbeat. This has impcted my life and training greatly.
On Thursday of this week I am having a cardiac ablation at MGH. Since I have ZERO other risk factors--no ischemic heart disease, no HBP, no deformities--they feel I am a perfect candidate. The hope is for the ablation to fix the problem and, within a few months, get me off the meds completely and back to normal.
FWIW, I read Dr. John's posts and what he described feels like my story to a T. Every single word he wrote resonates, and the questions he asks about upper limits of exercise I believe have merit. You can explain it away if you have not experienced heart arrythmias, but those of us athletes who have do not dismiss that the endurance stuff plays a role.
I will also admit to you that I (beyond) stupidly ignored it for far too long. Everyone has "palps," right? (wrong.) I am as guilty as ANYONE of being so in love and committed to the IM game that I brushed it aside to wait until WI was over. My aerobar collapse and crash that ended my day in WI at mile 85 on the bike...I sometimes wonder if the universe interceded to save my life. Who knows, but the fact that I didn't go through with the marathon was probably a very, very good idea.
Like Bob, I have no limits on what I can undertake as an athlete, but I am pondering the future.
I will find out hopefully what is going on with my heart thursday when I do an imaging stress test. I have BP issues and it was nicely controlled with meds and exercise. About 3 months ago now I guess my BP starting going crazy and in the end stuffed in the back of an ambulance for possible heart attack (44 years old). I am training for IMAZ so I wonder if my body is revolting from the training or something else.
I find this very interesting and scary at the same time.
@Steven - Good luck with your testing - but don't be discouraged if they don't figure it out this time. It took me a couple of years, multiple stress tests, holter tests, etc. before they figured it out. If they don't figure it our - keep after them.
Looks like a non-swim death at DC/Nations tri, suspected cardiac arrest.
www.washingtonpost.com/local/cyclis...story.html
Hi Bob!
I am on a CCB (diltiazem) since I can't take a beta blocker--BP too low and I have Raynaud's. My sensitivity to the CCB is pretty extreme. Can't explain it, it just is.
My brother in the A-fib struggle!
I'll let you know how the ablation goes. It's tomorrow. I have to give it 3 months before I know how well it worked--or not. Below are the reasons, expressed in layman's terms, why they think I am the "perfect cadidate" to fix it and get me off the meds.
* Ablation tends to work best on the following and it's me to a T:
1. paroxysmal (“lone”) a-fib
2. people who have infrequent episodes
3. people who self-convert quickly to normal sinus rhythm
4. people who have had a-fib for a relatively short period of time
5. Are young (relatively :-) ) as my heart is not effected by stiffening as happens in the elderly
6. have ZERO other risk factors (Luckily, I have NONE)
7. am not fat (can't believe how many times they bring that up)
Here's hopin'.
@steven, how did your stress test go??
@bob, have you had an episode during a race, that seems a bit scary.
I went off my beta-blockers and plavix last week, good riddens. Hope i never have to take those again, i feel your pain.