Swimming and Pulmonary Edema Part II
Wednesday, December 12, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
1. What is pulmonary edema and why should swimmers know or be concerned about it?
Edema means too much fluid accumulation. Fluid suddenly fills the lungs. The left side of the heart is not pumping properly. It can cause you to have to stop a race. It can sometimes cause serious illness and death.
2. Is it more likely to occur in cold water?
It seems to be more likely in cold water. It has occurred in surface swimmers and scuba divers in both cold and warm water. Cold is only one of the several proposed causes.
Causes or contributors seem to be things that increase cardiac preload and afterload, including immersion in water, cold water, heavy exercise, negative pressure breathing (like breathing with a snorkel, and swimming with the chest below the surface and even the slight elevation of the head to breathe in), and drinking too much water or other fluids before swimming. Don't drink lots of water before swimming.
3. What are the signs and symptoms?
Unusually shortness of breath (not just fatigue) and coughing bloody froth. No chest pain.
With a stethoscope you can hear rales, an abnormal rattling breathing sound. Chest x-rays show the classic pattern of pulmonary edema. When blood oxygen in the arteries is checked, arterial O2 may be lowered.
4. Do wet suits provide any measure of protection against PE?
Difficult to say since it has occurred in people with and without wet suits. I haven't seen charts where the numbers of each predisposing possibility, like protective garments and temperature, were compared.
5. Can medical personnel easily detect PE?
Pulmonary edema is not subtle. The person is usually gasping and spitting pink froth, and asking for help with a worried look.
A swimmer who develops shortness of breath and cough in a race may have something else like exercise induced asthma.
6. What is the first aid if PE is suspected?
Get them out of the water. Sit them up to elevate the head, if conscious. Give them 100% oxygen by mask, and get them to the emergency facility.
7. If PE is untreated and the athlete continues to the race/swim, what could happen?
Depends how serious. Symptoms can resolve on their own or they can get worse. I wish I knew the future for them, but it's like other injuries. There have been deaths. We wonder how many people who suddenly went under were not drowning but developed pulmonary edema. We have no way yet to tell. Drowning also produces pulmonary edema (after the fact). Repeat cases of pulmonary edema can occur in the same person.Related Posts:
Interestingly, the frothing pulmonary edema occurs in racehorses after hard races. They are blowing bloody nose froth all over, but veterinarians have reassured me that the horses are fine. Any readers who are veterinarians, please tell me more. If a person is frothing, get help.
Subjects Invited for Immersion Pulmonary Edema Study
Swimming and Pulmonary Edema Part I
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Read success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, click "updates via e-mail" (under trumpet) upper right.
For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification through DrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
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Photo by Salim Virji
Labels: circulation, cold, fix pain, injury, ironman, pulmonary edema/oedema, swimming, triathlon
8 Comments:
At Tuesday, November 25, 2008 5:43:00 PM,
Anonymous said…
Julie:
I have had three episodes of SIPE: two in open cold water and once in a pool. I have been to a cardiologist and pulmonologist with lots of tests and the only abnormal finding was exercise induced hypertension. I have since improved my diet, trying to follow the DASH protocol. Six months and no episodes, but I have not had a stress test to check for the exercise induced hypertension.
My current hypothesis is overtraining. The literature shows some association of overtraining with endothelial dysfunction, which could explain the exercise induced hypertension, and with cold water immersion and stress lead to the perfect storm in our lungs.
If you think about most of the reported instances of SIPE, they involve individuals with a high likelihood of being overtrained.
At Wednesday, November 26, 2008 2:50:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Hei Peter, What I have found as the most correlated and most overlooked factor is drinking too much fluids. Tips the scales to overload.
Readers, "DASH" is Dietary Approaches to Stop Hypertension - eating fruit, vegetables, reduced total and saturated fat - confirmed to lower blood pressure. Some of the effects that lower blood pressure are thought to relate to lowering fluid balance.
To educate me, would you define what characterizes "overtraining" and what is the specific "dysfunction" in the endothelium. How do they relate?
"Overtraining" is often a vague phrase. I hear it with musculoskeletal pain too. When I look at their stroke mechanics, it often turns out to be injurious movement ergonomics, rather than overtraining. Different context, same question - what is truly causing it. Check for overhydration - don't drink lots before swimming.
I posted a call for Subjects Invited for Immersion Pulmonary Edema Study. Maybe that would be fun for you or others?
Happy swimming. Feel better. Three episodes - you're brave. Keep me posted.
At Friday, November 28, 2008 10:06:00 PM,
petergrasse said…
Julie:
You are right: Overtraining is a vague term, mostly because there are not good physiological measures. The first phase usually results in musculoskelatal injuries. But if one is careful with workouts, then you can develop some of the secondary symptoms of overtraining including fatigue. Avoiding this is the aim of periodized training.
There is some medical literature evidence that overtraining can impair the endothelial cell function. Enthothelial cells line blood vessels and they dilate in response to exercise workload to keep blood pressure down.
Hydration level may also be a factor, but so far, none of the researchers in the area have offered more than descriptions and treatment-no causes and no preventions. I will contact the folks at Duke, but I am too old for their study and live too far away.
At Thursday, February 12, 2009 8:08:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Peter, you asked for cause and prevention, writing: "none of the researchers in the area have offered more than descriptions and treatment-no causes and no preventions."
From my work so far, as stated above, "What I have found as the most correlated and most overlooked factor is drinking too much fluids." That means I identified that as a contributing cause. A preventive measure is not to drink so much before swims. There is also no one here named "Julie" :-)
At Sunday, May 24, 2009 11:17:00 AM,
Nathan said…
Today I suffered an episode of SIPE during the swim leg of a half ironman. the sea swim was not cold and i have done double the distance at race pace in the pool regularly with no side effects.
the only differing factor i can see is the (too tight?) wetsuit.
Any thoughts on this? I have had juvenile asthma so this pre existing condition may have caused some damage to my alveolar walls which is weakening the lung and increasing my chances of SIPE.
Otherwise my diet is fine, and i'm not hypertensive. I am already fit for ironman in a month's time. (I have to use a wetsuit)
Any advise, and/or views on returning to training?
Nathan
At Monday, November 30, 2009 8:53:00 PM,
Billinljtx said…
Julie,
I have experienced what I would call SIPE about a half dozen times over the past 3 years. I am 57 yrs old, but am not a triathlete. However I do swim 3 times a week at a local indoor pool, and have for many years. The usual workout is 1500 yards. I experienced it today, and the only unusual thing I did was to drink a couple of large glasses of water and a diet soda about an hour before swimming. Other times it will happen after an especially hard workout, but not always. My doctor was not familiar with the condition and I haven't received any treatment for it. It usually lasts until bedtime and it gone in the morning.
At Monday, November 30, 2009 8:57:00 PM,
Billinljtx said…
I did was to drink a couple of large glasses of water and a diet soda about an hour before swimming. Other times it will happen after an especially hard workout, but not always. My doctor was not familiar with the condition and I haven't received any treatment for it. It usually lasts until bedtime and it gone in the morning. Not sure what else to do - swimming seems to be the best thing for me at my age. Bill
At Tuesday, December 01, 2009 12:48:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
To Nathan, It isn't know what kind of asthma or lung involvement may predispose to this. Negative pressure breathing at the time of immersion seems to increase risk. That means sucking air against resistance, as during an active obstructive event at the time. It changes fluid volume at the heart. I have wondered if a way to train would be to train breathing resistance (safely out of the water), so that it is not such an effort at the time - see Respiratory Muscle Training for Swimming, Diving, and Running. How have you been and how was the Ironman? I have no cardiac lab at the moment to test this. Students - anyone want a study or thesis to do with me?
To Billinljtx, Would you describe your symptoms?
As above, from the work I have done so far, what I have found as a correlated and overlooked factor is drinking too much fluids. A preventive measure is not to drink so much before swims.
There is no one here named Julie.
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