SIPE… My Perfect Storm.

Sunday, July 24, 2016.  Ironman Lake Placid 2016.

I was pulled out of the water, on the 2nd loop.  I’ve written a separate post recounting my experience.  This is a continuation of that post.

I was taken to the medical tent first where the initial checks came back Ok.  When I left the medical tent, I coughed up blood.  I walked back to the medical tent and was then transported to the Adirondacks Hospital ER @ Lake Placid. X-Ray was taken, blood samples were taken, wires were attached to my body for monitoring.

X-Ray came back with fluid in the lungs, which was explained to me as Pulmonary Edema.  Blood tests came back with elevated Troponin Level. ECG was erratic.  All signs leading to a heart failure.  I was given Lasix, a diuretic, to help clear out the fluid.  All these times, I was fine and feeling Ok, except for the shortness of breath.  The attending Dr advised that I’d be taken to the hospital in Saranac Lake for further testing and monitoring.  While waiting for the ambulance, I got the chance to do some google searching and discovered that it is possible to have an elevated Troponin level not caused by a heart failure.  Again, I was feeling Ok. I spoke with the Dr and said that I didn’t want to be transferred to the Saranac Lake hospital.  I wanted to leave.  The ambulance came and waited while the Dr and I had the discussion.  I asked for options if I didn’t go.  The decision was to take another blood sample (this was about 3+ hours after the first samples were taken).  The ambulance left without me.  Another set of blood samples was taken.  ECG test was also performed.  And we waited for the results.

Angelina, a friend whose husband was doing the Ironman event with other friends, stayed with me the whole time.  I’ve made my decision to leave and we were just waiting for the results of the 2nd test.  The Dr came back with bad news – the Troponin level did not stabilize, it was even higher.  Now, instead of being transferred to Saranac Lake for monitoring, I needed to be transferred to a different hospital to be checked by a cardiologist.  Again, I was feeling Ok, but the tests were not in-sync with how I feel.  I still asked for options.  The Dr said that I’d be beyond stupid and foolish if I didn’t go.  I finally agreed to be transferred to the 2nd hospital.

The (2nd) ambulance came and I was transported to CVPH Medical Center in Plattsburgh. Another set of X-Ray was taken, more blood samples were taken, and a heart ultrasound was performed in the ER.  Again, all these times, I was feeling fine.  I was brought to the Cardiac Short Stay Unit for overnight monitoring.  An IV of Heparin, beta blocker pills, plus more Lasix, were given.  More wires were attached to my body, both left and right arms with needles for either IV or blood tests.  Blood samples were taken every about 4 hours.  This was Ironman Sunday, and instead, I was in the hospital with very little sleep.

Monday Morning.  An Echocardiogram test was performed.  And then waited for the Dr to discuss the results.  All results came back Ok.  I was antsy to leave.  The Dr wanted to do another test – a cardiac catheterization, to check for any blockage which may have caused the Pulmonary Edema.  I said no because I did not want anything invasive. Besides, all test results came back Ok.  I was given another option – Nuclear Stress Test – not invasive and almost as accurate as a cardiac catheterization.  I chose to this test.  AND, while waiting, the PA came and said that a CT-Scan was needed (which seemed unrelated to all of these) because some nodules appeared on the X-Ray.  The wait was agonizing.  I was hungry and restless.  I asked the nurse to ask the Dr if I could just skip the test, and she said that I would not be given a proper discharge if I didn’t do this.  About 4PM, I went for the Nuclear Stress Test – some dye was injected and an image was taken while the heart was at rest stage, a treadmill run was performed, and another set of image was taken after the activity.  I was starving, and the nurse had a meal waiting for me when I was brought back to my room.

Finally, the nurse came with my discharge papers.  The Dr was not there to discuss my discharge.  But it didn’t matter – I was just happy to finally leave.  Once again, I was feeling Ok.

Why SIPE as the title of this post?  PE (Pulmonary Edema) was the cause of the shortness of breath, blood in the cough.  PE is caused by a heart failure, a malfunction, a valve blockage.  And the only way to find out is to undergo the tests I’ve undergone.  In my case, all tests came back Ok.  With the help of Dr Google, I found out about SIPE – Swimming-Induced Pulmonary Edema.  I strongly believe this is what I have experienced.  What caused it?  Overly hydrated before the start of the swim?  Probably.  No warm up?  Probably.  Wetsuit tightness?  Probably.  Excitement and anxiety?  Probably.  Combine all these?  A Perfect Storm.

Below are some of the links I’ve found about SIPE.   I hope my experience, as well as the articles and same experiences from the links below will provide useful in understanding this medical occurrence.

Endurance Athletes – SIPE Article

Slowtwitch – SIPE Article

Update.  Aug 2, 2016.  Cold Wet Bloke – SIPE Article

 

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I Failed.

Sunday, July 24, 2016.  IMLP.

I Failed.  The two words I uttered when they pulled me out of the water.  The same two words I said when I was consoled by friends while shaking and shivering uncontrollably.

I was pulled out of the water on the IMLP swim part, on the second loop about 4 buoys to the finish.  I wouldn’t have made it to the swim cut-off no matter how hard I tried to push.  I couldn’t breathe.  I couldn’t swim.  Not even from 1 buoy to another.  I had to hold on to every kayak I could hold on to.  Every kayak.  I knew I was the only one left in the water because all the kayaks were around me, trying to help me continue and finish.  Every kayak.  And still, I could not swim from 1 kayak to another.  Every stroke was like drowning, gasping for air.  I Failed.

I felt fine before and right on the start of the IMLP swim part.  I started at back, between the 1:30-1:45 predicted finish sign. I positioned myself on the outside part to avoid the crowd aiming for the ‘line’ on the inside part of the course.  It was foggy and sighting was limited.  After 2 or 3 buoys, I had trouble breathing.  I thought it was a panic attack.  But I was calm.  I paused.  I was still ok, passing some swimmers and some passing me.  But the shortness of breath never went away.  I kept on tugging and adjusting my wetsuit, thinking that it was restricting my air intake.  After the 2 red turn-around buoys, I held onto a kayak.  And from there on, it was either from buoy to kayak, kayak to buoy, or kayak to kayak, stopping to breathe and adjusting my wetsuit.  Before finishing the first loop, I made the decision to remove the top of my wetsuit.  I didn’t have a watch, but I believe I finished the 1st loop in over an hour.

I took off the wetsuit top before entering the water for the 2nd loop.  I asked the first kayak how much time I had for the 2nd loop.  He said plenty of time, more than 1 hour.  Ok, I thought and tried to swim.  Right on the first stroke, I gasped for air.  The kayak asked me if I wanted him to go with me.  I said yes, stay with me.  Then another kayak came.  I used them as guides.  But the shortness of breath worsened.  I was calling for the kayak every few strokes.  More kayaks came, and started talking to me, coaxing me, telling me to just relax and slowly continue.  Breast stroke would still take me to the finish.  I still had time.  I think I had about 30 minutes left after the last turn-around buoy.  And I think, by this time, all the kayaks were around me, plus the official boat to take me back to shore in case I decided to quit.  And I think even the kayak volunteers were getting exasperated with me because I was not making any progress no matter how much encouragement they do.  “Timmy, you can still make it, but you have to go now.  No more stopping.  You have to go now.”.  I tried.  I really tried.  How can you swim without air?  With about 4 buoys left, they finally said “You’re not going to make it.”.  They said “You can stop now and quit, or continue and we pull you out.”.  I think what they meant on the 2nd one was I did not quit.  Seems pointless, I continued and they pulled me out.  On the boat, I uttered, I Failed.