Interview with Ironman, Dr Brian O'Donnell on his experience of swimming induced pulmonary Oedema, the signs and the symptoms and some tips on how to avoid it.
I’ve had SIPE twice now, Dec 21 and 3 weeks ago. Lifelong endurance athlete, 55 yo woman, 5’5” 64kg, was training for tri half & IM this year, new to OWS 7/21, swam through winter down to 4 degrees, twice weekly, variously in shortie, skins, occasionally full wetsuit. 70 OWS now - back out there, at perimeter or in my depth just now. Plan to tow a small paddleboard to self rescue at first sign in the future - which for me is crackles/emphysema at deep inspiration, though identify with feeling that unable to hold breath quite long enough to freestyle properly - but I find this normal in first part of a cold water swim - sometimes for 10 or 25 m, sometimes for 400, to really settle in - yet 68/70 swims have been fine, over 400 m to 2 km, max 600 m in winter. I have only felt unease just before the crackles. First time I was at 450 m on 800m loop. Was last out of water, so had to swim on, climbed out at pontoon with difficulty 35m short of slipway. Might not have made slipway. Kept calm, swam HUBS, but the 315 m went like 3k, increasingly gasping to breathe, fluidy coughing. I’m a Vet Surgeon, have treated plenty of pulmonary oedema, and knew was SIPE. I had worn my wetsuit in truck for an hour to drive to lake, had drank 600 ml electrolytes from a bidon in car en route. Was wearing a tight full wetsuit, had gained weight in Pandemic. Bought a new more flexible suit, used it a couple times no problem- still tight round neck though. I only put suit on upper body now as get in water, and don’t take in fluid before swimming. Second time had flown home from a week’s hard riding with plenty of climbing, in Mallorca! Sound familiar?! I had swam in the sea in skins at about 13 degrees daily for 20-40 minutes. Pool swim immediately after flight, lake SIPE swim next morning. Didn’t feel tired, but have history of misdiagnosed iron deficiency anaemia for a decade, 8 years ago. That was fully worked up by cardiology after, As was a cardiology misdiagnosis. Was still competing racing bike, with lots of ectopics and no power. Recovered over 5 years, had fatigue and micro vascular angina symptoms after iron replete ( oral iron, still need to take a maintenance dose). I tested and found high homocysteine, lowered that and gradually returned to sports over last 8 years, and this has been first problem. This time, got to 175m before becoming really annoyed by the tightness around my neck of full wetsuit - using as had a planned tri requiring it the next weekend. Turned onto shorter 400m loop, at this point no crackles. 25 m later, could hear emphysema. SIPE again. Turned around, about 125 m from slipway. After 50 m, realised was in a bad way. Tried floating on back, but doesn’t help, as body still immersed. Other swimmers in lake, so called for help, whilst continuing to feebly swim, making hardly any progress. Towed in last 50 m. Both times recovered once out of water and removed suit. I have developed increased BP during Pandemic, which is likely cause. ECG normal, except athletic bradycardia. Seeing my good cardiologist on Tuesday to rule out anything concerning. My BP goes right down after hard exercise, but I think I need to shed Pandemic weight down to my old 57 kg to restore properly low bp. In meantime, as a paddleboarder, I’ve just bought a kid’s board, and am going to see if towing it swimming works for me, as can mount easily from stern using a krab and sling, at first sign of SIPE. Am receiving mixed response to SIPE. It’s dangerous and I don’t want to drown, but don’t want to give up OWS either - want support for a safe way forward - surprised to find support not a given, within the sport. We’re not invalids, the vast majority of the time! Agree cardiovascular full assessment required by an empathic sports cardiologist capable of understanding swimming and SIPE, however. Would be good to have a swimmer/tri self support group for this, but a constructive positive one - not dwelling on the negatives, as important to stay calm in water throughout. Useful to learn triggering circumstances and avoid them, sharing these is great - like a hard week on the bike then a flight. Tight wetsuit. Fluid intake etc. Also a concern that most swimmers/tri people and medics don’t know what SIPE is, nor how to treat, same goes for some committees/organisers. Vital people realise need total rapid removal from water and to peel off suit straightaway is main need, then to rest and recover. Sorry for long reply, but interesting to swap accounts of this in interest of not drowning and continued swimming, where can be arranged safely. Great to hear from another clinician sufferer, as well. Let me know if there’s a way we can collate people’s experiences for common good!
Thanks for sharing. I had a very similar experience 2-weeks ago in a triathlon. First time in 20 years I didn't finish a tri. I wish I would have seen this earlier. This needs to be shared more broadly so triathletes and medics can be prepared.
Thank you. Very important to tell the story. I had it severe recently with significant fluid buildup and came close to drowning. ER and hospital overnight, then I’m on the mend. Was freaky terrifying though to be unable to lift myself out of the water and grabbed by someone in the nick of time. And then to feel like suffocating while sitting on shore coughing up so much bloody sputum. I feel for anyone who deals with this. It can feel like drowning on dry land for a bit afterward - til the fluid clears enough to get SAT back up. O2 really helped, comforted me.
Thanks for the vid. I get this nearly everytime I swim unless it's warm water. I thought it was pollen affecting my asthma, but it's not I'm going to try the less hydration method & Sydenafil also
I went open water swimming for the first time the other day and had a lot of these symptoms. It was absolutely bizarre and quite scary. Calm water, only swam out 10 metres before I felt like my lungs were working at half capacity and they were getting more and more painful. Distance back to the shore felt further than it should have, I felt desperate to get back to land. Even floating or holding onto a rock didn't relieve me much. I was coughing a lot and felt a really strong urge to burp. My partner helped me back to shore and I felt better but didn't feel much better until I unzipped my wetsuit to below my chest. The uneasiness is a really weird sensation, like the environment is closing in on you. I was absolutely fine 20 minutes after coming out of the water and getting my suit off. No continued symptoms. Absolutely bizarre. I tried going in the water again a few times and each time was better but still had to come out after a few minutes. I seemed to be able to burp before each new swim as well which helped. I spoke to my doctor and they instantly dismissed it, tellong me it's impossible to get SIPE without accidentally swallowing a large amount of seawater (which I hadn't) which seemed off to me. I had drunk quite a lot of water immediately before getting in the water, so I had wondered if it was that.
I would suggest that your Doctor doesnt know anything about SIPE. I was a cardiac physiologist in a past career and hubby is an anaesthetist - so this topic was well researched by us both. However, the burping sounds more like a function of your breathing. It may be that you are not exhaling sufficiently while you are swimming. This isnt unusual for someone swimming in the OW for the first time. The burping can just mean that you are swallowing air - it doesnt necessarily mean you are swallowing water. My advice would be to ask an OW swim coach to go with you for the next few sessions - sometimes it only takes one time for you to correct it. 1. make sure you are exhaling completely, if you are taking a massive breath in and overfilling, you will feel like your lungs are already full and like you cant get in any more air. Focus on the out breath!
@@FionaODonnellperformance Yeah I got that impression hehe. Ok that makes sense. Thing is I swam in the adjascent cove just half an hour before this, with just swim trunks and no wetsuit, to three times the distance to a buoy and back and had absolutely no issues whatsoever. I was the one helping my partner improve his swimming. As soon as I even got 10 seconds into the water at durdle door with the wetsuit on it started, sometimes just standing on underwater rocks without even having to swim.
Hi there - I've been researching SIPE today - as I've had a very mild version of this -I had no pink froth - but shortness of breath - a little wheezing and a slightly productive cough - which lasted for a few hours - and over hydration definitely is a factor - along with high salt intake pre swim - the wetsuit squeezes fluid up to your torso and thorax - so increases blood volume in your heart and lungs - and then the cold water increases this pressure by vasoconstricting your periphery - then strenuous swimming increases the pressure even more - so removing your wetsuit makes sense - it relieves the pressure - nothing I have read mentions swallowing water being a problem with SIPE - I agree with you - it is off advice-
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I’ve had SIPE twice now, Dec 21 and 3 weeks ago. Lifelong endurance athlete, 55 yo woman, 5’5” 64kg, was training for tri half & IM this year, new to OWS 7/21, swam through winter down to 4 degrees, twice weekly, variously in shortie, skins, occasionally full wetsuit. 70 OWS now - back out there, at perimeter or in my depth just now. Plan to tow a small paddleboard to self rescue at first sign in the future - which for me is crackles/emphysema at deep inspiration, though identify with feeling that unable to hold breath quite long enough to freestyle properly - but I find this normal in first part of a cold water swim - sometimes for 10 or 25 m, sometimes for 400, to really settle in - yet 68/70 swims have been fine, over 400 m to 2 km, max 600 m in winter. I have only felt unease just before the crackles.
First time I was at 450 m on 800m loop. Was last out of water, so had to swim on, climbed out at pontoon with difficulty 35m short of slipway. Might not have made slipway. Kept calm, swam HUBS, but the 315 m went like 3k, increasingly gasping to breathe, fluidy coughing. I’m a Vet Surgeon, have treated plenty of pulmonary oedema, and knew was SIPE.
I had worn my wetsuit in truck for an hour to drive to lake, had drank 600 ml electrolytes from a bidon in car en route. Was wearing a tight full wetsuit, had gained weight in Pandemic.
Bought a new more flexible suit, used it a couple times no problem- still tight round neck though. I only put suit on upper body now as get in water, and don’t take in fluid before swimming.
Second time had flown home from a week’s hard riding with plenty of climbing, in Mallorca! Sound familiar?! I had swam in the sea in skins at about 13 degrees daily for 20-40 minutes. Pool swim immediately after flight, lake SIPE swim next morning.
Didn’t feel tired, but have history of misdiagnosed iron deficiency anaemia for a decade, 8 years ago. That was fully worked up by cardiology after, As was a cardiology misdiagnosis. Was still competing racing bike, with lots of ectopics and no power. Recovered over 5 years, had fatigue and micro vascular angina symptoms after iron replete ( oral iron, still need to take a maintenance dose). I tested and found high homocysteine, lowered that and gradually returned to sports over last 8 years, and this has been first problem.
This time, got to 175m before becoming really annoyed by the tightness around my neck of full wetsuit - using as had a planned tri requiring it the next weekend. Turned onto shorter 400m loop, at this point no crackles. 25 m later, could hear emphysema. SIPE again. Turned around, about 125 m from slipway. After 50 m, realised was in a bad way. Tried floating on back, but doesn’t help, as body still immersed. Other swimmers in lake, so called for help, whilst continuing to feebly swim, making hardly any progress. Towed in last 50 m.
Both times recovered once out of water and removed suit.
I have developed increased BP during Pandemic, which is likely cause. ECG normal, except athletic bradycardia. Seeing my good cardiologist on Tuesday to rule out anything concerning. My BP goes right down after hard exercise, but I think I need to shed Pandemic weight down to my old 57 kg to restore properly low bp.
In meantime, as a paddleboarder, I’ve just bought a kid’s board, and am going to see if towing it swimming works for me, as can mount easily from stern using a krab and sling, at first sign of SIPE.
Am receiving mixed response to SIPE. It’s dangerous and I don’t want to drown, but don’t want to give up OWS either - want support for a safe way forward - surprised to find support not a given, within the sport. We’re not invalids, the vast majority of the time! Agree cardiovascular full assessment required by an empathic sports cardiologist capable of understanding swimming and SIPE, however.
Would be good to have a swimmer/tri self support group for this, but a constructive positive one - not dwelling on the negatives, as important to stay calm in water throughout.
Useful to learn triggering circumstances and avoid them, sharing these is great - like a hard week on the bike then a flight. Tight wetsuit. Fluid intake etc.
Also a concern that most swimmers/tri people and medics don’t know what SIPE is, nor how to treat, same goes for some committees/organisers.
Vital people realise need total rapid removal from water and to peel off suit straightaway is main need, then to rest and recover. Sorry for long reply, but interesting to swap accounts of this in interest of not drowning and continued swimming, where can be arranged safely.
Great to hear from another clinician sufferer, as well. Let me know if there’s a way we can collate people’s experiences for common good!
Many thanks for this really useful video and the detailed, calm and measured description of the symptoms.
I came across this term SIPE for the first time today when googling understanding water for swimming. Thanks for producing this helpful video.
Thanks for sharing. I had a very similar experience 2-weeks ago in a triathlon. First time in 20 years I didn't finish a tri. I wish I would have seen this earlier. This needs to be shared more broadly so triathletes and medics can be prepared.
Thanks, a great description of the symptoms, especially from someone who is super-fit.
Thank you. Very important to tell the story. I had it severe recently with significant fluid buildup and came close to drowning. ER and hospital overnight, then I’m on the mend. Was freaky terrifying though to be unable to lift myself out of the water and grabbed by someone in the nick of time. And then to feel like suffocating while sitting on shore coughing up so much bloody sputum. I feel for anyone who deals with this. It can feel like drowning on dry land for a bit afterward - til the fluid clears enough to get SAT back up. O2 really helped, comforted me.
Thank you for sharing your experiences. I wish you well!
Thanks for the vid. I get this nearly everytime I swim unless it's warm water. I thought it was pollen affecting my asthma, but it's not I'm going to try the less hydration method & Sydenafil also
I went open water swimming for the first time the other day and had a lot of these symptoms. It was absolutely bizarre and quite scary. Calm water, only swam out 10 metres before I felt like my lungs were working at half capacity and they were getting more and more painful. Distance back to the shore felt further than it should have, I felt desperate to get back to land. Even floating or holding onto a rock didn't relieve me much. I was coughing a lot and felt a really strong urge to burp. My partner helped me back to shore and I felt better but didn't feel much better until I unzipped my wetsuit to below my chest. The uneasiness is a really weird sensation, like the environment is closing in on you. I was absolutely fine 20 minutes after coming out of the water and getting my suit off. No continued symptoms.
Absolutely bizarre. I tried going in the water again a few times and each time was better but still had to come out after a few minutes. I seemed to be able to burp before each new swim as well which helped. I spoke to my doctor and they instantly dismissed it, tellong me it's impossible to get SIPE without accidentally swallowing a large amount of seawater (which I hadn't) which seemed off to me.
I had drunk quite a lot of water immediately before getting in the water, so I had wondered if it was that.
I would suggest that your Doctor doesnt know anything about SIPE. I was a cardiac physiologist in a past career and hubby is an anaesthetist - so this topic was well researched by us both. However, the burping sounds more like a function of your breathing. It may be that you are not exhaling sufficiently while you are swimming. This isnt unusual for someone swimming in the OW for the first time. The burping can just mean that you are swallowing air - it doesnt necessarily mean you are swallowing water. My advice would be to ask an OW swim coach to go with you for the next few sessions - sometimes it only takes one time for you to correct it. 1. make sure you are exhaling completely, if you are taking a massive breath in and overfilling, you will feel like your lungs are already full and like you cant get in any more air. Focus on the out breath!
@@FionaODonnellperformance Yeah I got that impression hehe. Ok that makes sense. Thing is I swam in the adjascent cove just half an hour before this, with just swim trunks and no wetsuit, to three times the distance to a buoy and back and had absolutely no issues whatsoever. I was the one helping my partner improve his swimming. As soon as I even got 10 seconds into the water at durdle door with the wetsuit on it started, sometimes just standing on underwater rocks without even having to swim.
Hi there - I've been researching SIPE today - as I've had a very mild version of this -I had no pink froth - but shortness of breath - a little wheezing and a slightly productive cough - which lasted for a few hours - and over hydration definitely is a factor - along with high salt intake pre swim - the wetsuit squeezes fluid up to your torso and thorax - so increases blood volume in your heart and lungs - and then the cold water increases this pressure by vasoconstricting your periphery - then strenuous swimming increases the pressure even more - so removing your wetsuit makes sense - it relieves the pressure - nothing I have read mentions swallowing water being a problem with SIPE - I agree with you - it is off advice-