Jul 082014
 

Muscle_CrampCalf cramps? Man those are just awful, aren’t they? I’ve gotten to hear some pretty choice words when one of our swimmers succumbs to a calf cramp. Let’s just say they surface and scream at the top of their lungs with phrases you might not want the young ones to hear. :-) Got some ideas for you on how to possibly prevent calf cramps and how to treat one if you are unlucky enough to have one seize you. Check out this write up on how to treat calf cramps by G. John Mullen of the Science of Performance.

I also like this article on dealing with Calf Cramps for Bodysurfers.

Common causes of leg cramps are:

  • fatigue
  • conditioning
  • hydration
  • loss of essential minerals from excess sweating
  • genetic pre-disposition
  • use of fins – especially those that keep you in a strong toe point
Jul 082014
 

Curious about the best way to fuel yourself for your swim workout? Check out this article from About.com specifically directed at swimmers and fueling for their workouts (note, not race day nutrition). Click the photo below to access the article. In essence…

These small changes in physiological parameters secondary to the GI of certain foods suggest pre-exercise intake plays a small role in performance or the physiological parameters tested in this study do not correlate with performance enhancements. The notion that the exact pre-exercise carbohydrate consumption is insignificant is rarely discussed, as the food and supplement industry spend large sums of money on marketing, but the bulk of the literature notes minimal benefits of performance, the best indicator for elite athletes. 

Whew! Guess that means I can have my banana and yogurt, or even a small bowl of oatmeal or cereal before I set off for my swim workout!

Yogurt banana

Jun 252014
 

9-7-12. Updated in 2013 and 2014 (see updates at the end of this post)

Every heard of it? Swimming Induced Pulmonary Edema – SIPE. I had not. But after reading an article written by a triathlete in this year’s NY City Ironman Triathlon (link below), I was sufficiently alarmed. This is something every open water swimmer and triathlete should learn about. This condition can affect even healthy, well-conditioned and highly trained athletes.

SIPE is a form of pulmonary edema first discovered in the mid 1990s. Athletes most affected are divers, swimmers, and triathletes. From Wikipedia:

SIPE occurs when fluids from the blood leak abnormally from the small vessels of the lung (pulmonary capillaries) into the airspaces (alveoli)…

As with other forms of pulmonary edema, the hallmark of SIPE is cough productive of pink, frothy or blood-tinged sputum. Symptoms include (from Wikipedia):

Shortness of breath out of proportion to effort being expended.
Crackles, rattling or ‘junky’ feelings deep in the chest associated with breathing effort – usually progressively worsening with increasing shortness of breath.
Cough, usually distressing and productive of copious pink, frothy or blood-tinged sputum

Contributing factors to SIPE are the temperature of the water, constriction from wetsuits, and even pre-race adrenaline. Other factors may include: direct injury to the lungs; heart problems, infection, hypertension and even fish oils.

Here are some articles I reviewed to learn more about SIPE:

  1. This is the article that initially caught my eye: Why I Also Almost Died During the 2012 New York City Ironman Triathlon
  2. Here is an article from an Endurance Triathlete website: http://www.endurancetriathletes.com/sipe.html
  3. This article is written by a triathlete who also happens to be a heart surgeon: http://athletesheart.blogspot.com/2012/04/swimming-induced-pulmonary-edema-sipe.html
  4. In this American Journal of Emergency Medicine article, the authors note potential contributing factors of hypertension and fish oils in athletes who have experienced SIPE. http://www.journals.elsevierhealth.com/periodicals/yajem/article/PIIS0735675709004021/abstract

As the first article indicates, an athlete must find that balance between pushing hard and wanting to finish a race with understanding and recognizing signs of what could be a serious problem. The triathlete in the NY marathon did not want to stop, but he did know that something wasn’t quite right. He may be alive today because he stopped. No race or event is worth dying for. There will always be another opportunity to compete. Listen to your body, and when it gives you warning signs, heed them.

_________________

Update 9-7-12. In an email today from usopenwaterswimming.org, they had a great section on S.I.P.E. I’ve copied and pasted their posting (not yet showing on their website). 

Swimming Induced Pulmonary Edema (SIPE)

This month we are going to partially reprint an article which appeared 4 years ago in our newsletter. This reprint is prompted by a recent post titled “Why I almost Died During the New York City Ironman Triathlon” at http://ht.ly/djjoE. It is written by a triathlete about her experience with SIPE.

Swimming Induced Pulmonary Edema or SIPE is a rare condition which occurs sometimes in open water swimming. The following is an e-mail interview conducted with Dr. Jolie Bookspan who has studied condition.

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 athletes to have to stop a race. Sometimes it can 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.

6. 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. There have been deaths. We wonder how many people who suddenly went under were not drowning but developed pulmonary edema? There is no way yet to tell. Drowning also produces pulmonary edema (after the fact). Repeat cases of pulmonary edema can occur in the same person.

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. If it is a person who is frothing, get help.

Although SIPE seems to be a rare condition, open water swimmers and race organizers should be aware of its existence and plan accordingly. A doctor on site will be able to hear the “rales” condition by listening to lungs/breathing with a stethoscope. Also, it is recommended to have oxygen available to administer for anyone suspected of SIPE.

The following excerpt is written by Regan Scheiber and her personal experience with the SIPE after the 40K Memphremagog Marathon swim in Canada.

“It was the summer of 2000 that I experienced my first and only episode of pulmonary edema. I don’t know exactly what combinations of events caused the edema, but I do know this: A week prior to the Magog race, I swam the Atlantic City marathon. It was a close, intense, eight hour race that tested my will to win. I was very dehydrated at the end of the race, but that was normal. That night I started to develop what I thought was a cold or allergic reaction to the water. I had a stuffy nose and felt very rundown. The next day, I drove to Maine to do some lake training in preparation for the Magog race, now less than a week away. I could not shake the sinus cold and would feel the need to cough every time I was horizontal and swimming. A little something would come up, but I thought nothing of it, and just hoped I would be 100% for the race.

I arrived in Magog, Quebec, three to four days before race day. The day before the marathon, all the swimmers participate in a short competition swim for the public, I was definitely not 100%, but my upper respiratory irritation seemed to have calmed down. On race day, the water was a cold 64-65 degrees; it was cloudy, and windy. Not good for someone like me, who was relatively thin, and, as I was about to find out, did not do well in long term cold water conditions. After the first two hours of the race, I started to feel noticeably uncomfortable. I was drinking warm feeds, but it wasn’t enough. My hip flexors cramped up and I had to drag my legs for the remainder of the race. My stroke count went from 84-86 to 76-80 and maintained that pace. I remained fully lucid. Other than a slower stroke rate, I did not show any other alarming signs of hypothermia. (I think at least 4-5 swimmers were pulled from the race that day for hypothermia.)

The last kilometer, I slipped into third place, with nothing left to give. I wasn’t in any respiratory distress, just weak. When I finished the 10 hour swim (one hour longer than the previous year), I stood up in the shallow water and felt fine, just tired. Since my hip flexors were so cramped, I had to pull myself up onto the dock. I landed on my belly. Instantly, I started coughing up fluid that came from my lungs. Within a minute I was shivering so severely, I was put on a stretcher and later sent to the hospital. It took an hour of warm I.V. fluids and a warm blanket to raise my body temperature from 88 degrees to 98 degrees. All the while, I was having trouble catching my breath and was periodically coughing to clear my lungs. Once I was comfortable, I told the doctor about my lungs and he did a chest x-ray. It showed fluid in the lungs, also known as pulmonary edema. My body had started to clear the fluid on its own, but it needed the help of Lasex, a diuretic, to speed the process along. A few hours later, I signed myself out; my only ongoing injury was now the hip flexors.

I took two weeks off to heal and do some light training. I then swam Long Island Sound, winning the women’s race in record breaking time. A year later, I swam the elusive English Channel. The water temperature was 64-66 degrees, and again, my hip flexors cramped up. I dragged my legs, shivered and swam with a slower stroke rate, all the way to France. I did not have pulmonary edema. I was fine, and so was Jane, my daughter, with whom I was three months pregnant.

Did the sinus cold and upper respiratory problem I got after Atlantic City compromise my immune system and make me more susceptible to pulmonary edema, given the right conditions? I don’t know the answer.”

Regan was swimming a very long 9 hour race, but the condition has occurred in swimmers with only 15 – 30 minutes of immersion.

The following article appeared in the American Family Physician, March 1, 2004 issue. It details an incident of SIPE and discusses proper treatment for the condition.

“A healthy 20-year-old United States Navy search and rescue swimmer trainee, who was equipped with only a mask and fins, developed hemoptysis, sharp substernal chest pain, and shortness of breath after performing a dive to a depth of 12 feet. He immediately surfaced and began to cough up pink, frothy sputum and have persistent shortness of breath. His initial oxygen saturation was 70 percent on room air and improved to 86 percent on three liters of oxygen via nasal cannula during ambulance transfer. On arrival at the emergency department, the patient had an oxygen saturation of 100 percent on three liters of oxygen with improved shortness of breath and resolved hemoptysis.

Auscultation of the lungs revealed bilateral rhonchi. The remainder of the physical examination was unremarkable with all vital signs being normal. Electrocardiogram, complete blood count, electrolytes, creatine kinase, troponin, and coagulation studies were all within normal limits. A chest radiograph showed fluffy perihilar infiltrates bilaterally. A chest radiograph taken several hours later showed resolving infiltrates. The patient was diagnosed with swimming-induced pulmonary edema (SIPE) and discharged.

While the exact pathophysiology of SIPE remains uncertain, it is believed to be related to exertion, immersion in cold water, and overhydration. The body’s normal response to exercise is to increase cardiac output to meet the increased oxygen demand. Although an increased cardiac output is known to cause pulmonary edema in racehorses, this increase is rarely enough to produce such an effect in humans.

(1) Cold-water immersion is instrumental in this process because the peripheral vasculature constricts to divert blood away from the extremities in an effort to maintain the core body temperature. This results in a central pooling of blood, leading to an increased preload, increased pulmonary artery pressure, and an increased cardiac output. The vasoconstriction also causes an increase in afterload, which leads to an increase in pulmonary vasculature resistance. The increased cardiac output from exertional activities coupled with an increased preload and afterload from immersion appear to be sufficient to rupture the pulmonary capillary membranes, thus resulting in pulmonary edema. In several documented cases of SIPE, it has been noted that the patients consumed anywhere from two to four liters of water in the hours leading up to their swim in an effort to remain well hydrated.

(2) It is believed that this degree of hydration led to a fluid overload that contributed to the onset of pulmonary edema by increasing the pulmonary capillary pressure.

(3) Patients may present with symptoms, such as cough, dyspnea, hemoptysis, tachypnea, and confusion with hypoxia, after exertional cold water activity such as swimming and scuba diving.

(4) Treatment for patients with SIPE consists primarily of supportive measures such as removing the patient from the wet and/or cold environment and providing supplemental oxygen. Although useful in treating pulmonary edema in racehorses, diuretics are typically not necessary because patients tend to show relief of symptoms soon after being placed on supplemental oxygen.

(5) Full resolution of radiographic findings typically occurs within 24 to 48 hours.”

JASON A. YODER, MS3, ENS, MC, USNR

Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd.Bethesda, MD 20814 ANTHONY J. VIERA, LCDR, MC, USNR. Naval Hospital Jacksonville. 2080 Child St. Jacksonville, FL 32214

REFERENCES

(1.) Hopkins SR, Schoene RB, Henderson WR, Spragg RG, Martin TR, West JB. Intense exercise impairs the integrity of the pulmonary blood-gas barrier in elite athletes. Am J Respir Crit Care Med 1997; 155:1090-4.

(2.) Weiler-Ravell D, Shupak A, Goldenberg I, Halpern P, Shoshani O, Hirschhorn G, et al. Pulmonary oedema and haemoptysis induced by strenuous swimming. BMJ 1995;311:361-2.

(3.) Pons M, Blickenstorfer D, Oechslin E, Hold G, Greminger P, Franzeck UK, et al. Pulmonary oedema in healthy persons during scuba-diving and swimming. Eur Respir J 1995;8:762-7.

(4.) Lund KL, Mahon RT, Tanen DA, Bakhda S. Swimming-induced pulmonary edema. Ann Emerg Med 2003; 41:251-6.

Update 6-25-14. So many have written in about seeing this blog post and sharing their own incredibly scary S.I.P.E. experiences. I received an email from Elaine Howley, Asst. Editor of the U.S. Masters Swimming publication SWIMMER Magazine this month. She wrote an article on S.I.P.E. in the March/April 2013 publication of SWIMMER.  We’ve corresponded on the topic, and she shared with me a Duke study that you might be interested in. 

Elaine spoke with Dr. Moon from Duke last spring. They had been exploring the use of Viagra as a treatment in Immersion Pulmonary Edema (also known as S.I.P.E). When Elaine spoke with Dr. Moon, they were in the study phase, so results should be out or forthcoming. According to the study’s site, however, it looks like it’s still ongoing: http://dukedivemedicine.org/?p=724.   

If you have had Immersion Pulmonary Edema and would like more information about it, or if you would like to participate in the project (Duke pays travel expenses and gives a participation stipend), please contact Dr Moon or Dr. Freiberger at 919-684-6726 or email tonya.manning@duke.edu

 

Apr 092014
 
Swimmers should definitely avoid stretch #2 and #4!

Swimmers should definitely avoid stretch #2 and #4!

I get a lot of questions about whether swimmers should stretch and which stretches they should do. I’m doing some research into this. I do know I’ve heard that “static stretching” is not beneficial in warm up and, in fact, can cause harm. I’ve also read that static stretching has a role and that would be in post workout. Here are some articles I found today while pursuing the web on this topic. Click the titles to jump to the online article. As I get more information and links, I’ll add to this posting.

General Static Stretching is a Waste of Time (a 4-part series)

Reasons Not to Stretch – NY Times

How does Static Stretching Affect an Athlete’s Performance?

 Top 5 Worst Stretching Mistakes

Jul 212013
 

We swimmers do joke that chlorine is our perfume. I mean seriously, we reek! Pool_Chlorine_OdorLg

Well, one of our swimmer friends has found a very cool and very inexpensive way to make your own product to remove that chlorine yuckiness from your hair and skin. This was posted recently by ElaineK on the USMS discussion forums. If you are a member, you can read the full discussions between Elaine and other swimmers here.

There is a product on the market to remove chlorine from hair and skin (Swim Spray) that costs $12.95 for a 4oz bottle, on their website. If you look at the ingredients of Swim Spray, there are only two: Water and ascorbic acid (vitamin C).

After doing a few minutes of research online, I learned that I could make my own spray by adding 1 tsp. of Vitamin C crystals to a pint spray bottle of water. I just purchased a bottle of Vitamin C crystals from Trader Joe’s for $11.99. I am going to use my empty 2oz. free sample of Swim Spray to refill it with my own mix for a cost of about $0.13 per bottle (there are 908- 1/8 teaspoons in the bottle of crystals)!

$0.13 vs $6.50 for 2 ounces of Swim Spray. That gives you an idea of how much $ goes into packaging, marketing, salaries, and all of the other overhead expenses to bring a product to market.

By the way, if you there is not a Trader Joe’s near you, Vitamin C crystals can be purchased online. Just use an empty travel size hairspray bottle, mix up a batch, and throw the bottle in your swim bag. After your swim, briefly rinse off in the shower, spray your hair and skin, wait a few seconds, then rinse. Now you can use your shampoo and body wash or soap as usual.

I would recommend mixing up just enough for a small (4oz or less) bottle at a time, so the Vitamin C doesn’t break down. Besides, it would be a lot easier to carry around than a big spray bottle.

Jul 142013
 

Women’s Health had an interesting article on a study done about what it takes to get us to avoid some of those tempting comfort foods. You know, those really yummy things like  pizza, donuts, milkshakes, fries, cheeseburgers, cheesecake (and let’s be honest, probably anything “cheesy”). We’ve all seen the trend for restaurants to include some basic nutritional information on their menus or websites. Apparently, that isn’t enough of a motivator for us. So based on the study, Women’s Health came up with this visual guide. You can read more from the Women’s Health post by clicking this graphic below.

Next we’ll probably find out from some study that we need giant size posters like these EVERYWHERE to really penetrate our thick skulls. Or, we just do what we do  in Masters Swimming and say, “I swim to eat”, and throw in a couple of extra sets or work a little harder. Right?!

Eat Less

Jul 092013
 

Got a small potpourri of interesting health related information for this post. Y’all know I’m a big proponent of drinking water and staying hydrated. (Hey you, yeah you – bring your dang water to practice!) Well, here is a picture that landed on my Flipboard reading this morning. Just more reasons to keep drinking water.

Water

 

FruitThen there is fruit. I have a LARGE sweet tooth and have always loved eating sweet things, including fruit. In fact, I eat several servings of fruit everyday. I used to count calories and know that some diets are big on eliminating “sugar” foods, including fruit, from your diet. Got kind of discouraging because fruit contains sugar (albeit natural sugar) and can carry a calorie count. Well let me say how heartened I was when I read this article from ABC World News. No time to read the article? Here are the main points:

  1. Fruit eaters tend to have lower BMIs – even less than pure veggie eaters. So there!
  2. Fruit is packed with water and fiber – its naturally occurring sugar is less concentrated. Hallelujah! And…if that isn’t enough, oftentimes that sugar comes with valuable protective substances (such as those you find in Mangos which can protect against breast and colon cancer cells)
  3. “Fruit has awesome antioxidants” . As they say in the article, “The smartest strategy is to not only eat fruit, but to mix it up.” Oh yeah, that I do!
  4. Fruit has beauty benefits – ok, so this is a work in progress on my part. Supposed to give you good skin – even for us with Irish heritage? Get out!
  5. Fruit provides endurance-boosting energy. Say no more, I’m hooked!

And finally, as I get older (and hopefully wiser), I’m trying to find more natural products to do some of the “jobs” at home. Check out this chart on ways to use common items in your home for cleaning, personal care/beauty, or for dietary/medicinal applications.

 

ChartPRoducts900

 

Jun 092013
 

 

Click photo for a USA Swimming article on the importance of hydration

Click photo for a USA Swimming article on the importance of hydration

I know I’m most likely “preaching to the choir” here, but I’m forging ahead anyway! I just returned from teaching a Level 3 USMS Coaches Certification course in Alexandria, Virginia. We had the incredible opportunity of having Dr. Jim Miller attend the class.  (Past President of USMS, Orthopedic Surgeon, Swim Coach, FINA-USA-USMS expert on Shoulders and Shoulder Injuries and other Sports Science topics.) We called upon him to present the last portion of the class which was on injury prevention and rehabilitation. By the way, if you haven’t heard him talk or seen his work on shoulders, you should. His knowledge is amazing! For example, did you know that 60-85% of Masters swimmers will have a shoulder injury that keeps them out of the water one week or more?

In his talk, hydration was a major focal point. Time and time again in his presentation, Dr. Miller stressed the need for staying hydrated – before practice, during practice, and after practice. It is absolutely an essential part of our overall well being. Get up in the morning and drink a full glass of water. Your system was dormant during the night and dries out. You need to replenish your cells with water. According to a Chicago Tribune story (posted June 5th), the Centers for Disease Control came out with a study saying that nearly half of Americans are not drinking enough water. Their study showed that 43% of adults drink less than 4 cups a day – not nearly enough.

And for those of you that pop Aleve, Advil or some other form of an NSAID, here is a frightening statistic from Dr. Miller. It is estimated that 40% of those on dialysis today are there because of NSAIDs. NSAIDs can be extremely hard on your kidneys. If you do take them, do so with plenty of water and don’t take them on an empty stomach. Don’t take them as preventative (oh, I’m going for my 3 mile swim, 5 mile run, or 25 mike ride and I know I’ll be sore). Wait to use them when the pain actually hits. Try for ice, heat, yoga, foam rollers, massage or other remedies to reduce your dependence on NSAIDs. Your kidneys will appreciate this.

You’ve got to bring water to practice, and you’ve got to make sure to drink it then and even after practice. No matter what time you workout, you should also give your body the fuel it needs to do the workout. We know it isn’t fun to swim on a full belly, or to even contemplate eating at 5 a.m., but you’ve got to do something. Dr. Miller’s suggestion is for a liquid meal even as simple as water mixed with some type of carbohydrate based drink along the lines of Gatorade, Powerade, or other brands you may prefer. Make it a 50-50 combination of water/drink to reduce calories and make it more palatable to your system that may not want much on board. You’ll have a better practice, and, most likely a better day if you get started by giving your body the energy it needs to work for you. (My go to pre workout is a banana topped with just a little almond butter – and, of course, a glass of water. :-) ) Click here to check out this article on What’s In Your Energy Drinks? on the USMS website. Pretty interesting!

Here are a couple of other snippets from Dr. Miller on shoulders. Our upper extremities provide up to 90% of our power and propulsion in our strokes. Because Masters swimmers often swim for decades, the chances that we will incur a serious shoulder injury are very high. Even small things, like sudden changes in our training regimen, can impact our shoulders. You are on a business trip and miss pool workouts for two weeks. On your return, you jump right in and resume at the level you left. This is pretty hard on your shoulders folks! Allow yourself to ease back that first practice or first few practices.

There are a lot of orthopedic surgeons and physical therapists who agree with Dr. Miller that it is very important for you to develop bilateral breathing to protect yourself. Bilateral breathing (breathing to both sides) is especially important if you are going to swim for decades like many masters swimmers. Why? Because over time, one sided breathing can lead to a lopsided stroke and can actually change the musculature in your back, neck and shoulders to be dominant on one side. For more reasons to adopt a breathing strategy to both sides, check out this article from Swim Smooth - http://www.swimsmooth.com/bilateral.html

Take care of your shoulders with a few simple exercises that I posted about a few months back – Shoulder Injury Prevention Exercises. See that posting for a video on some fantastic exercises that will save your shoulders while strengthening your core, improve your rotation, and stabilize your scapula (a big cause of shoulder problems).

The fact that we have so many stroke repetitions in our workout is a big contributor to shoulder injuries. Learning to swim all four strokes is very helpful as you work different areas of your musculature. Throw in kick sets and drill sets to help mix things up.

Take care of your body, its the only one you are going to get. Swim smart and give yourself a break every once in awhile.