2016 Ironman training update, accident report and public service announcement

I’m 13 weeks into my 24 weeks of Ironman Mt. Tremblant training. I chose to follow Joe Friel’s plan this year and have been enjoying the variety, inclusion of strength training (more on that in a minute) and periodic time trials to check for improvement.

Strength adds resiliency, power and speed

I added strength training to my regular endurance routine about four years ago. I started slow – first Pilates, which was really hard for me and a serious reality check on how weak my gluteus muscles were. Then TRX, another reality check, but very fun because I notably improved my leg balance and strength over a single winter, then this past year I added more dynamic work like box jumps, squatting with heavier weights, high skipping and jump roping. These are all things that I never could have done as a kid because my hips were much too weak and my knees hurt just from walking. It’s quite satisfying to master these simple movements at the age of 41 and have virtually no hip or knee pain.

Beware of the bench

I did have a minor set back earlier this Spring when I attempted to set myself up with heavier weights to do squats. Up to that point I’d been slinging a 25lb dumbbell over each shoulder but on this fateful morning I clipped 30lbs to each end of free-weight bar and then went to sit down to wait for the trainer to give me further instructions. But I didn’t sit down, I tripped on the foot of the bench and fell over backwards jettisoning the bar and weights off to my side as I went. I landed hard on my elbow and sat there dazed, assessing damage while the entire gym turned to in horror at the sound of 80lbs hitting the floor. My foot hurt and when I took off my shoe I found a bleeding four-inch gash on the big toe side of my foot. Maybe one end of the weights had landed there and bounced off? In the moment I was totally mortified because I am still one of those people that doesn’t believe she belongs in a gym. My foot and elbow really hurt and I had to work the rest of the day so I went next door to the drug store and bought a 10-pack of instant ice packs, stuffed them into my socks and shirt and commenced a full day of teaching. That evening at home I had time to fully assess the damage and discovered several more weird injuries – my pinkie toe was clearly broken, I had a large cut and bruise on my upper inner thigh and a spectacular hand-sized bruise on one butt cheek. Plus I couldn’t get the cut on my foot to stop bleeding. I tweezed out the sock fuzz and tried several times to steri-strip it closed. Finally with my 9-year-old daughter’s help I got it zipped up. So yes, if you’re thinking I should have gotten stitches, you are right. It took that dang cut 6 weeks to heal and another 2 for my pinkie toe to stop throbbing after being jammed into a shoe.

Though the accidental weight-lifting incident humbled me greatly, it didn’t slow down my training.

Swimming break through

I was never a swimmer as a kid. The two main reasons being that the Maine ocean is frickin cold and I hate getting water in my ears (too many ear infections as a kid). So I taught myself to swim 6 years ago when I started training for triathlons. I watched a few youtube videos, found ear plugs and goggles that don’t dig into my eye sockets and figured out how to freestyle well enough to get from one end of the pool to another. But no matter how much force I put behind my stroke I never got any faster. So this spring I ventured down to Bowdoin College for a 2hr swim clinic with their head swim coach and had my entire swim-world turned upside down. I learned about body position and how to use more momentum and less force. I went from sort of dreading the effort of tedium of pool time to eagerly looking forward to working on my newly found technique. I’ve shaved 30 seconds off my 500yd time, which may not be huge, but it’s the right direction, and the amount of effort I exert to achieve this time feels like a fraction of the struggle I was putting into my laps before.

Triathlon swimming is about more than your stroke

Thus I arrived at last weekend’s Sebego Olympic Triathlon excited to try out my new skills. The lake water was a mere 54 degrees but I didn’t think much about it. Heck, every summer I swim 2.5-3 miles across Blue Hill Bay, and I’m pretty sure Frenchman Bay never gets above 56. I love my wetsuit, and usually after I get my face wet a few times I’m good to go. But on the morning of the race I got into the water to warm up and oddly struggled with keeping my face in the water. It wasn’t just the usual reticence to get started, it was more like a visceral aversion – even after swimming 100 yds or so I kept wanting to get my face out of the water. What was weirder is that my body didn’t feel particularly cold. I got out and said to my cousin Samantha “Wow, that’s pretty cold on the face!” and she said “Yeah, but it got better once I got swimming”. There wasn’t much time to think about it as the race was just about to start. We were funneled knee deep into the water and just a few seconds later the race started. I didn’t have time to position myself off to the outside and back where I typically like to be so I ran-walked through the water to get myself out of the kicking fray and started swimming. Usually I start with a minute or so of same side breathing and then after the initial sprint I settle into a more sustainable alternate breath pace. After a few minutes I tried a few slower strokes and alternate breaths but I kept being forced to breathe every stroke – my heart just wasn’t slowing down. This went on for a bit and I figured I was just amped up from the fast start and the cold water and I figured things would settle down shortly. But they didn’t.

SIPE – Stress Induced Pulmonary Edema

I had to take more breaths, not less. Until finally I decided, ok, I’ve just got to stop completely, relax, float a bit, get my bearings and start again very slowly. I’ve never had to do this in a race before but I also realized I had a long ways to go and hacking my way through the water in a panicked state wasn’t the best way to get there. Even as I floated calmly, sculling on my back, looking at the clouds, thinking chill thoughts and reassuring myself that I was totally fine, I still couldn’t take a deep breath. I backstroked my way to the furthest bouy, the waves were getting bigger and every time the water hit my face I had to stop and catch my breath all over again. I thought about letting the lone kayaker out there know that I was struggling but then decided that once I turned the bouy and started going in the same direction as the waves I would be fine. A few friends passed me – also struggling to put their faces in the water and I told one of them I thought maybe I was having a really hard time breathing and it might be dangerous for me to keep going. I don’t think she heard me because of her earplugs.

When I was halfway between the two furthest buoys I heard my lungs gurgling. I thought about asking the swimmer next to me to stay close but when I tried to talk I started coughing with the effort, My wetsuit suddenly felt much too tight and I desperately wanted to rip it off. Then my vision got weird. Or I thought it did. The thing is, it’s really hard to feel or think clearly when you’re bobbing around in the middle of a very cold lake having a hard time breathing. Finally, I got to the point where I could only catch my breath if I floated still on my back. Any stroke or kick immediately made me cough and gurgle. That’s when I decided to call for help while I still could. The kayaker saw me – but he was several hundred feet away helping someone else. I knew I wasn’t about to sink so I just floated and waited. When I got picked up by the recue motor boat I had zero regrets. It was the smartest thing I’ve ever done in a race. We picked up two more swimmers – one who was suffering from the same gurgling and coughing as me. I tried not to puke into the boat, though I did cough up some really nasty foamy pink stuff onto the fake grass at my feet. I was still convinced I was fine and assumed I was having my first ever asthma attack that would surely resolve now that I wasn’t in the cold water. But an hour later, still on the boat, I felt worse not better. Finally deposited on shore I went back to my rental cabin and took a hot shower (though I wasn’t that cold) and tried to lie down to rest. Sadly I discovered that I could not lie down without feeling like I was drowning so I walked slowly over to the EMT tent, trying to breathe and calm my heart rate. They offered me an Albuterol inhaler, which I refused because I had talked to my asthmatic husband and decided this wasn’t asthma. I opted for oxygen instead which made me cough up more pink foamy nastiness but also made me feel much better. I couldn’t remember the name of what was happening to me but I remembered the symptoms from my days as a Wilderness EMT. The weird thing is, none of the race medical staff knew what was going on either. Now I know it’s called SIPE – Stress Induced Pulmonary Edema. A condition caused by increased pulmonary artery pressure due to cold water immersion and increased heart rate (from exertion). According to a study published in the American Journal of Emergency Medicine

“Symptom history compatible with SIPE was identified in 1.4% of the population [triathletes surveyed]. Associated factors identified … included history of hypertension, course length of half-Ironman distance or greater, female gender and use of fish oil supplements. Of the 31 cases reported, only 4 occurred in the absence of any associated factors.”

I don’t take fish oil, my blood pressure is very low and I experienced symptoms after swimming less than 500yds. So that leaves me with being a female, a risk factor that is unlikely to change anytime soon.

What is dead can never die

I began to recover after a few hours and after cheering on all my friends at the finish line and eating lunch I decided to head out on a recovery bike ride. I biked 30 miles up to Norway in hopes of finding a snack at the Nomad Café (closed on Sundays!) and 30 miles back to my car where I had some hearty Tinderhearth bread waiting. I felt ok, kept my heart rate below 130 the whole ride and stopped coughing up foamy stuff after an hour or so. The next morning I felt horrible – like I had drowned the day before. All week I’ve been tired, my legs are slow and I feel under-recovered. The results of my time trials over the last two days were disappointing and I’m wondering if I need another very easy week in preparation for next weekend’s trail marathon up Mont Jacques-Cartier. http://ultratrailma.com/sky/skymaraton-2/?lang=en

Most worrisome is that after my 500m swim time trial in the pool this evening I could feel my lungs rasping – something I’ve never experienced before. More investigation needed . . .

I have ten weeks before Ironman Mt. Tremblant but I think the hardest part of recovering from this will be in re-gaining my confidence and not worrying about whether it will happen again.

If I had to sum up my advice to my future triathlete self it would be

  1. Don’t over hydrate before the swim
  2. Warm up thoroughly – swim at least 200yds of free style before the start
  3. Start slow and stay slow. Slow is better than not at all!

3 Comments on “2016 Ironman training update, accident report and public service announcement

  1. Quite humbling.

    Did you speak with any of the other people who were helped out of the water?

    Wondering if you were all suffering from the same symptoms.

  2. This account sounds so very familiar to a winter experience I has in winter of 2014. Had a full pulmonary eval after I’d “sort of” recovered… to find I’m healthy as a horse in my lungs and heart. Pulmo doc said that lungs can take a while to recover from a full on assault and time is the best medicine with respiratory breathing exercises to strenghten the connective tissue which supports lungs tissue. It was definitely a humbling experience… and as you seem to be doing – a great learning time. You never fail to describe things in great detail and character! (love that) Glad to know you could keep your cool in the midst of physical chaos! Nice skill to cultivate in life, eh?

  3. wow Charlotte! I have heard of pulmonary edema happening to swimmers. Such a good call you made to get out of the water! thanks so much for all the detail so that others can identify what might be happening should it happen to them! Anyway, I went on your website to see when your classes are. See you soon! Do you have a date for the Blue Hill swim?

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