Swimming Induced Pulmonary Edema (SIPE) - ever had an experience?

loneswimmerloneswimmer IrelandCharter Member
edited June 2014 in General Discussion
After I wrote a recent blog article on the dangers of extreme cold water swimming, I got talking with a Sandycove friend of mine and he reminded me of swimming induced pulmonary edema (oedema), aka SIPE.

It turned out he had experienced it to a degree one day last year, (but not seriously). Another of the SISC Channel swimmers has been hospitalised for days with something very similar from a very rough Channel swim. I recall the frightening description from forum member and crew @CraigMoz.

The symptoms of SIPE are breathlessness, low levels of oxygen in the blood, coughing up red froth and a crackling in the chest. It seems to happen in cold water, and also seems to be most common among scuba divers and triathletes. Apart from the cold water the common factor in both groups is wetsuits. In the lesser case of my first SISC mate, the day he experienced it he was wearing a wetsuit, whereas my other Channel mate wasn't. The Channel swimmer was subject to a lot of airborne salt spray with conditions of Force 5 and 6. With SIPE the person can't get enough air in, and can't expel the carbon dioxide.

There seem to be a range of causes from infection to injury, blood transfusion, wetsuit constriction and more.

I asked my wetsuit mate what he experienced, he said: "pretty mild, but worrying, coughed up a half a dozen loads of pink sputum..., bit crackly for an hour or so but was fine after than".

For precautions he says: " Now take care on speed, temp and full lung breaths now.... ie. when really cold and not wearing a wetsuit, I don't do 100% effort - try and keep heart rate lower... don't prehydrate and warm up/ acclimatize a bit more".

He gave me a few links. They seem to agree that it's not fully understood. One of them, Athlete's Heart blog was wondering about specific occurrences amongst swimmers, and well, I just happen to know a place to ask.

I'm curious if it's something that distance swimmers not wearing a wetsuit may have experienced. It's my guess that it will seem initially similar to atrial fibrillation, i.e. racing heart or heart palpitations, which is reported more in extreme cold water, but latter stages will have the coughing and crackly chest.

loneswimmer.com

Comments

  • gregocgregoc Charter Member
    Here are a few thoughts, non-cardiac pulmonary edema (NCPE) has been reported in cases of people recovering from hypothermia.

    PE is usually caused by increased BP in the veins between the lungs and the heart. The result is fluid buildup in the avioli (small air sacks in the lungs where O2/CO2 exchange takes place). The fluid blocks the gas exchange and the body becomes O2 starved.

    Maybe the constant inhalation of salt water can mimic PE. Maybe a tight wetsuit around the chest can increase the BP near the lungs. Maybe the cold water causing arterial constriction at the extremities results in an increase in BP at the lungs.

    Maybe a perfect storm of all of these.
  • gregocgregoc Charter Member
    edited June 2014
    BTW, I'm not a doctor, but I play one on the MSF
    VLMSydneD
  • emkhowleyemkhowley Boston, MACharter Member
    edited June 2014
    I'm not a doctor either, but I did talk to a few of them for an article I wrote for the March/April 2013 issue of SWIMMER. Trying to link it here--I've put it up on Google Drive, so hopefully you can access it and hopefully this sheds some more light on the whole SIPE thing. I'm hearing more and more stories about people who have experienced symptoms that could be related to the condition. My takeaway after writing this piece? Don't wear a wetsuit that's too tight. https://drive.google.com/file/d/0B-Aic2fVb-F3X2lDWkt4TFZnYjg/edit?usp=sharing

    Stop me if you've heard this one...
    A grasshopper walks into a bar...
    https://elainekhowley.com/

  • wendyv34wendyv34 Vashon, WASenior Member
    Glad you were able to post your article @emkhowley. I wanted to post a link to it when this discussion started, having read it in my hard copy of SWIMMER, but I couldn't find it online anywhere. Very interesting to me, being a lifeguard as well as a swimmer. Thanks!

    It's always a bad hair day when you work at a pool.

  • emkhowleyemkhowley Boston, MACharter Member
    edited June 2014
    Yeah, we're mostly a print pub, so not a lot of the content is available for free online. However, USMS members can access digital version of every issue since 2009 via the MyUSMS link in the upper right hand corner of the usms.org home page. I find that helpful to reference sometimes. All the more reason to join!

    Stop me if you've heard this one...
    A grasshopper walks into a bar...
    https://elainekhowley.com/

  • lakespraylakespray Senior Member
    A recent article on SIPE.

    Note, once again the wetsuit is cited as a possible influence.
    But a just-released paper from MacIver and colleagues, published in the Journal of the Royal Society of Medicine, proposes a mechanism.

    MacIver and his team hypothesized that the pumping efficiencies of the left and right sides of the heart become unbalanced under the conditions of swimming in a triathlon. Both the left and right sides can be perfectly healthy, even highly efficient in a triathlete. The right side pump accepts blood from the body, then sends it to the lungs to be oxygenated. The left side pump accepts it back from the lungs and pumps it through the body.

    Swimming in a triathlon can throw this balance out of whack. First, there’s extreme exertion, which raises blood pressure. That may not be a problem for most athletes, but in chilly water, blood and its fluid parts, like plasma, are drawn from the limbs and into the core, raising core blood pressure. MacIver also suggested that a tight wetsuit could further restrict blood vessels and raise pressure. Now the left side of the heart would have to pump even harder to keep up with the volume put out by the right.

    outsideonline.com/fitness/triathlons/The-Fatal-Risk-in-Triathlons.html
    loneswimmersuziedods
  • JenAJenA Charter Member

    Stumbled across this SIPE research update: http://www.swimmingscience.net/2016/04/swimmers-fear-death-sipe.html

    I found it interesting that they link wetsuits to SIPE:

    "Avoid restrictive or tight wetsuits."

  • suziedodssuziedods Mem​ber

    "avoid restrictive or tight wetsuits".. "extreme exertion".....
    Uhm.. wetsuits are supposed to be tight right? or at least form fitting.
    And how is swimming a mile, a half mile or two miles "extreme exertion"
    ? I mean if you are not a competent , confident swimmer then yes of course it can be "extreme".. I don't know .. it just seems more and more as if ,well.. if people would just respect the swim more ( dare I say it but LEARN HOW TO SWIM better or at least more confidently) respect the environment of the swim ( ie cold water) then that could have a less deleterious effect on the athlete.
    I realize there are geographical restrictions but if you are paying $1000 to enter a race ( number pulled from nowhere) then take a few days to know the environs, spend time in the water.
    This does not address the SandyCove swimmer mentioned above.. but.. just ruminations.

    timsrootflystorms
  • slknightslknight Member
    edited June 2016

    Has anyone ever had SIPE NOT wearing a wetsuit (with the exception of the person mentioned in the first post who inhaled a lot of spray)?

    suziedods
  • suziedodssuziedods Mem​ber

    MacIver and his team hypothesized that the pumping efficiencies of the left and right sides of the heart become unbalanced under the conditions of swimming in a triathlon. Both the left and right sides can be perfectly healthy, even highly efficient in a triathlete. The right side pump accepts blood from the body, then sends it to the lungs to be oxygenated. The left side pump accepts it back from the lungs and pumps it through the body.

    Swimming in a triathlon can throw this balance out of whack. First, there’s extreme exertion, which raises blood pressure. That may not be a problem for most athletes, but in chilly water, blood and its fluid parts, like plasma, are drawn from the limbs and into the core, raising core blood pressure. MacIver also suggested that a tight wetsuit could further restrict blood vessels and raise pressure. Now the left side of the heart would have to pump even harder to keep up with the volume put out by the right.>
    ( bolding is mine)

    How is swimming in a triathlon different , or "more extreme" than say swimming from Alcatraz, or swimming "The Suck, or Pennock Island, or 8 Bridges or Sandy Cove , or Dover , or that cool swim in Denmark".
    The issue seems to be cold water ( and what constitutes cold is personal), and a wetsuit. The heart works the same in a triathlon as in ... well... life , right?

    Am I missing something?

  • suziedods said:

    How is swimming in a triathlon different , or "more extreme" than say swimming from Alcatraz, or swimming "The Suck, or Pennock Island, or 8 Bridges or Sandy Cove , or Dover , or that cool swim in Denmark".
    The issue seems to be cold water ( and what constitutes cold is personal), and a wetsuit. The heart works the same in a triathlon as in ... well... life , right?

    Am I missing something?

    I'm clearly missing something too because I don't get it. I feel like it's got to be the wetsuit and would love to see some hard evidence. Anecdotally, I have heard of two people around here who have had it, and they were both wearing wetsuits and were quite anxious swimmers.

  • JSwimJSwim western Maryland, USSenior Member
    edited June 2016

    Elaine Howley @emkhowley wrote a very good article on SIPE called "The Big Squeeze" in the March-April 2013 issue of USMS "Swimmer" magazine. I can't find the article online... maybe Elaine can comment?

    Some interesting points from Elaine's article:

    quote from reseacher and SIPE sufferer Dr Charles Miller: "We weren't able to separate the effect [of the wetsuit in our study] because everyone wears a wetsuit in wetsuit-eligible swims, but I do think the extrinsic compression of the wetsuit is important symptomatically."

    theorized risk factors for SIPE: Over hydrating, too tight wetsuit, cold water (forcing fluid from the extremities to the core), training primarily on land, inadequate warm up, stressful mass start and possibly mega doses of fish oil supplements.

    suziedodsgregoc

    Life begins at the end of your comfort zone. --Neale Donald Walsch

  • suziedodssuziedods Mem​ber

    So, here's (yet another) untested theory of mine. When you wear a wetsuit, you do not allow your body to adapt to the cold( whatever temp that is, if you are wearing a wetsuit, you probably THINK it's cold right?.)
    Your body does not do what it's supposed to do.. ie force the blood to the core, because it doesn't get cold and because the compression of the wetsuit inhibits that action. So, by wearing a wetsuit you actually inhibiting the cold reflex action of your circulation.
    Your body doesn't learn how to , for want of a better term, "flip the switch/thermostat" to warm you up, it doesn't need to. It has the neoprene keeping you warm ALL OVER , rather than just in the core and that, I think actually makes you colder in the core.
    Does that make sense?
    Suzie Dods ( PHD as in piled higher and deeper)

    rosemarymintJenAJSwim
  • emkhowleyemkhowley Boston, MACharter Member

    JSwim said:
    Elaine Howley @emkhowley wrote a very good article on SIPE called "The Big Squeeze" in the March-April 2013 issue of USMS "Swimmer" magazine. I can't find the article online... maybe Elaine can comment?

    Hi all. Here's a link to the SIPE story @JSwim mentioned: https://s3.amazonaws.com/external_clips/1874848/SIPE.pdf?1463609139

    Also, if anyone is interested, here's a link to my website, which offers a link to my Contently portfolio where you can find other assorted open water and swimming-related stories (among the other writing I do). Happy reading. https://elaine-howley.squarespace.com

    ssthomasJSwimrosemarymintJaimie

    Stop me if you've heard this one...
    A grasshopper walks into a bar...
    https://elainekhowley.com/

  • JenAJenA Charter Member

    For what it's worth, one of our own experienced SIPE in the English Channel. I'll leave it to him to tell his story, but I believe he described his vision as going brown -- perhaps like tunnel vision.

    JSwim
  • LOSTswimmerLOSTswimmer Oakville, Ontario, CanadaMember

    Yup, I had SIPE when swimming across the English Channel in 2006. I didn't know that's what it was at the time... or actually until a couple of years later when someone contacted me to be in a medical study about it. The way I knew that I had SIPE was that when they pulled me out (literally) in and out of consciousness and I got back to Dover, all I wanted to do was sleep. But I had to sit up in bed and cough up a "pink frothy liquid" all night. I attribute it to not being able to pee. Which was my fault. I was properly acclimatized for the cold water and wasn't able to pee. The water was so rough that I wasn't able to get close enough to the boat for solid food and therefore only drank liquids for 12 hours. About 400mls every 1/2 hour. Enough pressure built up in my system that it forced body fluids into my lungs... and it went downhill from there. Hey, everyone was new once. At least I learned from it and was lucky enough to go on and do some other majors. Maybe I'll be back sometime, wiser and stronger. Hope that little story make others wiser too. Do the acclimatization... and make sure you pee.

    ssthomasJenAevmoIronMikepavlicov

    Cheers,
    Rob

  • tortugatortuga Senior Member
    edited August 2016
  • JenAJenA Charter Member
    edited August 2016

    Here's a study that suggests one way of reducing the risk of SIPE:

    Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil
    http://www.ncbi.nlm.nih.gov/pubmed/26882910

    Three things are interesting about this study:
    1) Some people seem more prone to SIPE than others.
    2) The participants were cycling in 20 degree C water, not swimming, and they still experienced increases in pulmonary artery pressure and pulmonary artery wedge pressure
    3) the brand name of sildenafil. ;-)

    Perhaps it would be worth bringing along in case of emergencies.

    tortugasuziedods
  • lakespraylakespray Senior Member

    JenA said:

    3) the brand name of sildenafil. ;-)

    Perhaps it would be worth bringing along in case of emergencies.

    Yes, us men may end of swimming with a rudder ;-)

    JenAtortuga
  • lakespraylakespray Senior Member

    In light of the latest fatality on a English Channel crossing I'm bumping this thread. I have no knowledge it was SIPE, however SIPE is seemly a cause for several fatalities and swimmers who were pulled but survived. The reason I'm bringing it up, it seems prudent for boat crews/observers to bone up on the symptoms and be able to provide initial first aid: Including having supplemental oxygen on the boat, diuretics and yes sildenafil.

    JenAkejoyceIronMike
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