Hopefully this is the guy you heard about. From the comments...

Quote:

He was not found unconscious, he called out for help and then went under the water and water safety immediately pulled him up from the water and transported him on a jet ski.

Article in the national paper here in Canada:

http://www.theglobeandmail.com/...lon/article23760785/

And this

http://business.financialpost.com/...-in-hawaii-triathlon

He had been recovering but unfortunately passed away. he suffered a heart attack and was unconscious and beneath the surface of the water when rescued. He was on shore with no pulse and not breathing by 8 am HST on Sunday and was revived at that time.

His swim wave started 5 minutes before mine. I saw nothing and know only what i was told at the race by swim course officials that I know. Wherever on the course he was, he was behind me as at 8 am I was quite close to shore.

It's a sad thing regardless of why.

Aloha a hui hou.

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The difference between stupidity and genius is that genius has its limits. -- A fake Albert Einstein "quote"

very sad. condolences to his family and friends.

It is very sad. I must admit, I get a little anxious at the start of every race. I'm 49.

Argh how do I not die from a race....

Certainly it is sad.

OTOH, at the risk of seeming whatever, if we assume that the guy actually loved triathlon, then he died doing what he loved. Can't think of a better way to go myself. At the USMS short course nationals a few years ago, a 73 yr old guy died during his 400 IM and the results book was dedicated to him. His wife was vacationing elsewhere but she was quoted as saying he died doing what he loved doing. The guy was pretty quick too as IIRC he was seeded 2nd or 3rd in his AG in the 400 IM.

"Better to die out in the heat of some passion than to fade and wither with age" -- James Joyce, The Dead, 1914.

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

Reynolds began his race on Waikoloa Beach at 7:30 a.m. Sunday with dozens of other participants in his age group of 44 to 54. Emergency crews were called to assist him at 7:50 a.m., or about 20 minutes after the start of the Olympic-distance triathlon in Anaeho’omalu Bay on Hawaii’s biggest island.
Reynolds, competing three days after his 52nd birthday, was about half-way through the 1,500-metre swim when one of race patrol paddlers who follow the swimmers heard him say, “Help me,” Rott said.
When rescuers arrived nine minutes after the emergency call, they found him unconscious in the water. He was taken to shore by jet ski, treated and revived before being transported to the North Hawaii Community Hospital in Kamuela, according to a report from the Hawaii County Fire Department.
The Lavaman is an Olympic-distance triathlon, and includes a 1.5 kilometre swim, 40-kilometre bike ride, and 10-kilometre run, according to its website. Reynolds completed the race last year in a time of 3 hours, 38 minutes, according to the race results.
Daviau said Reynolds talked about his triathlons all the time and was always running, swimming and biking to get ready.
“This wasn’t some big fat guy jumping in the water and dying of a heart attack, that’s not what this was, to be crystal clear,” he said. “This guy had done this race already,” and invited other partners and Bay Street friends to join him.
Men between the ages of 40 to 60 are most at risk of cardiac arrest caused by the vigorous exercise associated with triathlons, research has shown. The death rate for triathlons is about twice that of marathons due to the increased intensity of the competition, according to a 2012 study published last year in the journal Mayo Clinic Proceedings.
The swimming portion is especially treacherous, research shows. The bulk of triathlon fatalities have occurred during the swim event and USA Triathlon has estimated the odds of death are 1 in about 76,000 participants.
Open-water racing triggers a “fight or flight” response from physical exertion, cold water temperature or anxiety. That can speed up the heart rate which can cause hyperventilation as the body tries to slow the heart to conserve oxygen with water entering the nose, mouth and throat, according to researchers at the U.K.’s University of Portsmouth.
Reynolds, born March 26, 1963, is survived by his wife and four children.
More on thestar.com

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+1. Always extremely sad for the family and friends, but if it happens to me, the ST community will know that I my last thoughts will be a) about my family, b) damned, dnf!

Condolences for the family

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Francois-Xavier Li @FrancoisLi
"We don't stop playing because we grow old; we grow old because we stop playing." George Bernard Shaw
http://www.swimrunfrance.fr
http://www.worldofswimrun.com

Seems like 99% of deaths occur during the swim.

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Proud Representative of Slowtwitch Anti-Atheists Society.

Upper body workout is harder for people with cardiovascular risks. In cardiac rehabilitation patients are not encouraged to go swimming due to the water pressure on thoracic cage and upper limbs effort increases heart workload.

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Francois-Xavier Li @FrancoisLi
"We don't stop playing because we grow old; we grow old because we stop playing." George Bernard Shaw
http://www.swimrunfrance.fr
http://www.worldofswimrun.com

Ya, hopefully if i die while racing that will be my one and only DNF ever, i.e., no DNFs in races yet, though i have DNF'd a few bike rides due to crashes:)

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

very sad. I was in that race, same age group.
I didn't know anything was wrong until the emergency vehicles were coming as I was headed out of T1.

The ocean conditions were very calm, clear and decent temp. Fairly uncongested swim as triathlons go.

Lavaman changed their swim start a couple of years ago. That has made the swim a much less congested and less body contact swim. There is the usual jostling at the start but honestly it's one of the better swim experiences I've had since they've changed it.

Water temperatures were USAT wetsuit legal at around 76 F. It was a smooth swim start for that wave with very little chop and an extremely light breeze. And bright, very bright.

I'm in the old guys division (55+) which was the next wave. If he was being pulled onto a SUP at 7:50, it may have been a bit before the first buoy turn (That is a bit over 1/2 distance wise). Saw some water patrol folks getting someone onto a board and having a hard time of it, I just presumed it was one of the backstroke swimmers that had been heading across the course towards the water patrol people.

Swimming as a discipline never gets the respect it's due. Nobody knows why this happened, but being prepared for the swim is as essential to an enjoyable experience as being prepared for the run or bike. Aloha a hui hou.

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The difference between stupidity and genius is that genius has its limits. -- A fake Albert Einstein "quote"

Very interesting, I have not read/heard this before. This reinforces my idea that swimming is really the hardest of all aerobic sports including cross-country skiing, although as a lifetime swimmer who swam his first 25 at age 5, I am obv biased in my viewpoint:)

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

+100 on this, you gotta be fully prepared and comfortable in the water, which generally only comes after spending quite a few hrs in the water:)

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

Wait. Is this true? Is there data on this?

Andy

Very sorry for the family and friends. As a 52 yo who is now training for my first full IM I always cringe when I read such articles. I however, take it nice and slow during the swim part, mainly because of the stuff I read. I go to the back of my wave and ease into my swim very slowly. Good luck everyone and stay safe.

Firstly, my condolences to his family :(


However I would like to know how the statistics on MIs/VSAs at triathlons compare to the general population. My husband is a first responder, he sees 4-5 VSAs a week, and about half as many again "shortness of breath/chest pain" calls. He's acutely aware that the vast majority of these are people in their late 40's and 50's - guys his age, but with underlying health issues: high BP, type 2 diabetes, overweight. All things that fitness helps to prevent.

Yes, we hear a lot in the media about these awful events during triathlon. We don't hear about the number of this same demographic that are dying in their home, cars and offices.

Yes. My wife is a cardiac rehab instructor. I don't have papers in hand to support it. but this is the policy they apply and the rationale behind.

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Francois-Xavier Li @FrancoisLi
"We don't stop playing because we grow old; we grow old because we stop playing." George Bernard Shaw
http://www.swimrunfrance.fr
http://www.worldofswimrun.com

I wonder if this might be due mainly b/c most people are not used to using their upper body for endurance. I would think that a life-long swimmer would not have this problem, but then he/she would prob not be in cardiac rehab, although obv i would imagine even well conditioned, life-long swimmers occasionally have heart attacks, but i would think it is pretty rare.

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

Quick google search supports what you say about cardiac rehab guidelines.

But quick pubmed search comes up empty.

I'm not trying to argue with you. I'm a sports medicine physician, but cardiac rehab is outside of my areas of expertise. If there really is data that UE work carries higher cardiac risk, I might counsel some of my older or post-MI patients differently.

Thanks for bringing this up. I'm going to circle back with some of my preventative cardiology colleagues.

Andy

Fair point. I will see if my wife has some decent evidence-based papers. No argument there, let's try to find out! ;)

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Francois-Xavier Li @FrancoisLi
"We don't stop playing because we grow old; we grow old because we stop playing." George Bernard Shaw
http://www.swimrunfrance.fr
http://www.worldofswimrun.com

The rub is that we are not like the general population, we exercise to maintain our health and quality of life, and put the effort in to control the factors that we can (exercise, diet, etc.). While everyone who has a cardiac event is surprised, it is very surprising (read newsworthy) when there is a death at an athletic event. Sudden cardiac death doesn't seem like an appropriate biological response to an exercise episode in a conditioned athlete, while it does seem very logical for someone with serious health issues.

I'm 75 and looking forward to st Anthony's in 3 weeks. Not having been swimming for a year I was worried. However after doing 2000 yards this am at my usual race pace I feel better. Having been there with a friend with chest compressions and a defillibrator a year ago(he died)when it's time to go it's time to go. The good news is he did not have to live out his days in a wretched nursing home.

Very sad indeed. And I don't buy the "died doing what he loved" stuff. It's just plain sad for him, his friends and his family.

It would interesting to know more about his actual fitness level this year versus the previous year and if that played a role. In 2014 someone posted earlier that he completed the race in 3:38. That's a time that one would associate with a "fit" triathlete...unless he had an issue on the course. I did this race in 2012, and the slowest competitor in my age group (55-59) finished in 3:01.

Cannot say I know any type of scientific data on this, but to me it has nothing to do with swimming - essentially. To me, I think most deaths in triathlons occur in the water because, well, its the first event. Meaning, if running was first, they would still have had a heart attack.

I think most people do not properly warm up enough and try to go from 0-100 and it's very demanding on the body. At least that's just my thought. Either way, regardless of what you are doing, when the heart stops, the heart stops. It's inevitable for all of us, live life up while you can live it up!

I don't think this is correct but I don't have any handy stats to refute this yet. If you look at running races, very few deaths happen early in the race near the start. It seems that most running related deaths happen near the end of the race when athletes are tired, dehydrated, and blood volume is lower and viscosity is higher than early in the race. Unlike swimming when we start running, we have infinite access to air and no one is going over our back further limiting our access to oxygen as may be the case in the swim.

I think a very useful technique for all of us older athletes to learn and to practice is to breath on every stroke, meaning on every hand entry, not every second or third hand entry.

In the case of the fellow athlete who died at lavaman though, my understanding is that it was not near the start line either though and further into the swim.

You are very correct there on the run aspect no doubt. And again, I'm not saying I know anything or claim to. I've just always thought that was a reason why it may happen. Either way it sucks for family/friends

Don't you mean every right hand entry? Or every left hand entry? Because that is considered 'once every stroke cycle.'

If yes, this is a good practice for every distance swimmer, not just older ones.
Why? If your stroke is even half decent, you'll be able to swim faster.

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I meant EVERY HAND entry (both left and right)...double the oxygen of right hand entry (pick your side) only. Monty has talked about this technique in several threads.

Ah, gotcha.

But would this be for the whole swim?
Or, just the 100-200yd sprint in the beginning?

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I mean.. at that point, why don't I just do the "lady just got her hair done swimming breast-stroke at the pool without head going underwater" stroke I see at the Gym?

My wife was on the beach when I was competing and she saw them bring the poor guy in. My wife is a doctor, she said the medical folks did a great job, refusing to give up and get his heart beating again but in her opinion even if he had survived he would have had brain injury. FWIW, he was a very large guy. When I talked to Gerry Roth (RD) after the race, she was optimistic that he would recover. Very sad, you know that someone was waiting for him to come home from this trip.

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Live long and surf!

You guys don't get it. Every hand stroke entry breathing is actually quite fast. It is different from heads up crawl. Ask Monty or Slowman. Think about it this way...if your stroke rate is 60 per minute breathing every third hand entry you breath 20 times, with every second hand entry it is 30 times, with every hand entry it is 60 times. When you are in a one minute sprint while running, do you only breath 20 or 30 times per minute? I'll breath 60 to 90 times per minute (90 times is once every right foot strike). So why do you guys think that breathing more in swimming is bad?

Having said that, you don't need these high breathing rates in steady state aerobic performance, but for the first 100-200m its not such a bad thing especially when you are getting battered in a mass swim start already missing breaths because of the presence of turbulent water or body parts of other swimmers.

Nowhere in my run at 5k+ do I breath faster than every 4 steps (for a complete cycle). So 40ish times a minute. 60 times is a lot higher, I cannot sustain that much breathing... wears out my diaphragm.

If people die from starting too fast, shouldn't they start slower and ease into the swim?

Relevant link.

http://www.webmd.com/healthy-aging/news/20150406/fit-at-50-cardiac-arrest-during-exercise-unlikely-study-finds

From the article:

I can see taking extra breaths as needed but breathing every single stroke for 100 m would make me dizzy i think, but obv everyone has to go with what works best for him/her. I think the start of any tri is where having a good swim background comes in the most handy, and then the second half of the run is where it becomes much less useful:)

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

This, I think, is where the problem starts for the old guys. They are racing differently than they are training. I'm 65 and I don't swim with a masters group so maybe I miss it but I never see older guys busting it for 200 to 300 sprints. Come race day and they are in the water with no warm-up acting like they have to get on the feet of the leaders.

Old guys, swim within yourself. Don't jamb your heart rate up from 0 to 180 in the first 100 yards. You can't be first in your age group if you don't finish the swim.

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''Sweeney - you can both crush your AG *and* cruise in dead last!! 😂 '' Murphy's Law

I do not care what the age of the person is, one needs to do something before the swim start to get ones heart rate up.

I am always amazed how many folks I see just sitting on their butts before the swim start. No pre swim. No running. Nothing.

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Dave Campbell | Facebook | @DaveECampbell | h2ofun@h2ofun.net

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Food for thought, why aren't there more deaths at masters swim meets?

 

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

Someone just died at Lavaman, and here you are proclaiming about how stressful it is what others might think of a masters swimmer relative to his peers. DO YOU REALLY THINK THAT IS GOING TO CAUSE SOMEONE THAT MUCH STRESS THAT THEY WILL DIE? Seriously? This is all you could come up with?

Triathon swim starts in open water, often mass starts with people swimming over your back, depriving you of oxygen are an entirely different world from a masters swim meet. To some degree you are being like the swimmer version of H2ofun...in other words, everyone should do like you do because it is the only way. I won't deny you that more swimming is helpful, but you're making the assumption that our peer athlete who dies in lavaman did not train for swimming.

One of my very good friends died at mile 25.5 at the Philly marathon a few years ago. He was on sub 3 hour pace at the time. Earlier in the year, he went 10:0x at the IMLP on a no wetsuit swim day. You know what people were saying when they heard some poor guy died in the final mile of the Philly marathon? They were saying, "oh yeah, another out of shape dude that did the marathon on a whim and dies during the race." But no, he was not out of shape and he trained really well. Shit happens sometimes to guys who train too.

Do people did in swims because they are not training for it? Perhaps, perhaps not. I think it's unfair to get on this thread where one of our peer athletes passed away and then tell people they don't train enough for swimming. I know what you are getting at, but it is disrespectful at least in this thread. Some guy left behind family and friends doing what we love. We can always suggest better ways to handle the mass start, but just saying people die in mass swim starts because they don't train for swimming seems to be crossing the line...at least it comes off as saying that our man who died at lavaman, would be here today if he trained for swimming...at least this is how it came across when I read your comment. I think there is a time and place for that commentary, and its not in this thread.

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

Dev, are you sure you didn't mean this breathing every hand entry as an April 1st idea? You would need to be an experience swimmer to pull this off without becoming disoriented and you wouldn't have time to adequately exhale. Breathing this often would only encourage inefficient technique and improper pacing thereby enhancing one's chances of experiencing problems on the swim. Proper training, a good warmup, and pacing commensurate with one's abilities are the best ways to avoid a cardiac event in the water.

Trying to find an in between answer as well to Dev's suggestion and your concern.
While it may be less efficient or streamline, well trained every stroke breathing may give the opportunity to get in as much oxygen as the body requires, which should be good.
Dev, my concern is that less trained/more panicked swimmers may breathe too much and too frequently, blowing off CO2 ->vasoconstriction especially to brain and heart -> lightheadedness to loss of consciousness -> loss of breathing reflex (again due to low CO2) -> drowning (or heart attack if cardiac coronary arteries vasoconstrict).
Hoping to hear and learn from other opinions, medical or otherwise.
Disclaimer: bad swimmer.

I would think that one thing that might benefit most people would be to have a medical / cardiac assessment and to speak to a physician on a regular basis.

I'm 40, need a Med Cert for an IM this summer and I called a colleague who's the CEO of a cardiology facility and he asked me a series of questions; family history, sudden deaths, any personal history etc, asked for a diagnostic and said that if there were no issues with the 12 lead that it was not necessary to investigate further

Now I suppose that does not completely rule out the possibility that something could happen, but I think its one means of providing assurance and minimising the risk of entering an event without having done anything to mitigate the risk of a cardiac event.

Dev, I have NEVER EVER stated that what I do for training is the only way, or a way that will help anyone else. It is just what I do, just like you say all the time what you do.

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Dave Campbell | Facebook | @DaveECampbell | h2ofun@h2ofun.net

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Lions don't lose sleep worrying about the sheep

Like anything, it is something that needs some practice, but it is pretty fast. If one's streamline is decent while breathing doing it every stroke when going quite hard results in almost no penalty. Mark Montgomery (Monty on here) who used to be a lead Kona pack swimmer has reported that he swims just as fast or faster this way when going hard compared to 2 or 3 strole breathing. In his day Monty was a sub 50 Kona swimmer. I believe he is now in his late 50's and oxygen is more of a premium resource than when he was younger...that's just how aging works for everyone as cardiovascular capacity declines.

Dave lots of people on here post what they do. The entire 1 stroke breathing came from what Monty has posted for example. The difference is that when he posted this he did not talk down top others like it is the best way and everyone is wrong and "wait till you get to my age" type of talk. When I was 42 and you were 50 you were always "that's easy for you young guys, wait till you get to 50"...now I am in 50-54 and you are in 55-59 and it's the same thing even though I am doing many of the things you said are near impossible for 50-54 guys.

Anyway, we are taking. This far off tangent. Swim starts are tough, and I agree with you we must warm up swimming or running, or start really slow. TT starts are really nice because you can start really slow. Mass start or even wave start, I have been in half IM's swimming 30-32 min and instantly been overrun by 40 min swimmers even though before the start I explicitly ask what times everyone around me is targeting...and I'm not even talking about young guys...at IM South Africa last week I placed myself in front of a 90 min swimmer (the entire wave was above 45) and this guy dives into my back from the beach start and sprints passed me only to die off quickly after that.

^^ This

I was racing that morning - saw the jet ski hauling ass and knew something wasn't right...the gurney was coming down the beach as I exited the water, emergency personnel coming in fast as I exited T1...

This past monday I saw a fellow resident and competitor at Hapuna after my workout - he mentioned (not sure if this is accurate) that the gentleman that passed weighed around 300lbs, down from 500lbs a couple years ago. He hypothesized that the history of obesity perhaps caused unnoticed heart damage/issues. Sounds plausible.

Condolences to this man's family and friends. A very sad situation.

If you do this in a competitive mass start, or even rolling start you will get swam over which will further compound the issue.

Eh get 3 feet behind the wave start, no one to swim over you until the next wave...

I'm very sad for the family left behind.

A very useful idea, I'll try this out. I'm a slow swimmer and want to improve but work gets in the way and with no easy access to pools it's just hard to get the time in. This might save my life in the future or have another tool in the arsenal. I normally start on the end since I know I'm slow and I do my swim warmups before the start but it's always good to be proactive. Thanks for the input.

Not an option for mass start or rolling start, at least if you want to compete

The people worried about hitting podium are not the same people who get swam over and drown at the start.

There is a difference between being competitive and shooting for a podium. For example I typically finish top 10% of the population and only seldom make a podium, but I compete. I am also a capable swimmer but could easily see how this happens and don't believe that this is exclusive to slow, non-competitive swimmers. But if it makes you feel better believing that and discounting the risk, go on ahead.

I would beg to defer. In most Half IM's I am in a podium hunt (on or close) and at an IM, I am in the group of 10 guys usually just outside the Kona qual slots (so I am in the group of bubble guys hoping to compete). I also have a family history of heart disease (all 4 grandparents died of stroke or heart disease). I'm racing 50-54, and my swims are right in the thick of IM prime time (usually 64-70 min range).

On the one hand, I don't want to die in a swim start and choose to start at a relaxed pace (like 50-55 second for the first 50 m when I could go sub 40 seconds), on the other hand, I'm trying to compete with my peers and don't have the luxury of starting 2000 people behind and giving away 10 minutes out of the gate. It is a calculate risk to start seeded in the 65-70 min range, but invariably there are less experienced guys who will race in the 90 min range and take 14 hours to finish the race, who will swim over my back as they bolt out in sub 35 second first 50 meters while I am cruising out at 50+ second pace as I try to get a 65 min swim in and target sub 11 on a hard course.

Add to that older men who are decent but not great swimmers in the hunt in their age groups and there are certainly many people who have the high potential to die in the swim start who are also chasing their age group podiums. The rolling start is a good start for dealing with this. Even wave starts in our own age groups are often problematic with over ambitious "sprint out of the gate guys".

I've been following sudden cardiac death news in athletes for over 10 years, and there's a lot of misconceptions. The primary one is that the athlete is out of shape, or in some way not fit for the stress of the event. The next one is that there must of been some unknown and undiagnosed underlying heart condition. However, the one that troubles me most is that somehow it could have been prevented. It's human nature to try and explain these non-typical unexplainable events, but research has not come anywhere close to causality, and is all over the place on correlation. While I don't disagree with any of the suggestions; warm up, breathing every stroke, wave starts, cardiac check-up, more swim training, or switching to Duathlon, they're just suggestions, and since there is a broad spectrum of athletes who have succumbed to SCD some probably did the above to no avail. I don't know if there is anything in life that is risk-free, and if there were it probably wouldn't be worth doing.

It's logical that we try to find solutions to these terrible tragedies, but the current state seems to indicate that the majority of these cases were, in any way, not preventable.

I bet that if you read the autopsy report for each of these cases you would have a very good idea what the cause of death was. And I will venture a guess that in virtually every instance it was an underlying heart condition that was the culprit.

May his soul RIP, and condolences to the family. What a tragedy.

I came across this study below. It's obviously not swimming vs. running/biking, but its something, and it's definitely interesting to ponder over.

Braz J Phys Ther. 2014 Jan-Feb;18(1):9-18.
Cardiac autonomic responses during upper versus lower limb resistance exercise in healthy elderly men.
"...there was more pronounced sympathetic increase and vagal decrease for upper limb exercise than for lower limb exercise..."

-Kat

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Two wheels good. Four wheels bad.

I bet that if you read the autopsy report for each of these cases you would have a very good idea what the cause of death was. And I will venture a guess that in virtually every instance it was an underlying heart condition that was the culprit. //

And you would lose that bet. You could take each and every death, give that person a pre race check up, and you would find virtually nothing. It does no harm to get a check up, might be the needle in the haystack that has some condition you never knew about, but it will do nothing really to prevent these deaths. Hell, I know a whole bunch of people that had some heart damage from triathlon, and even then had clear EKG's when checked out.(me one of them)

I have chimed in these threads now for a very long time, and I still hold it is not one thing that kills these people, it is one thing too many. It is a very large basket of risk factors that get presented on race morning in that swim, have just one too many hit you, and you die. Have just the right amount, and you have heart damage for life, but at least you are alive.(me and quite a few other pros I know, mostly still alive, a few not so lucky)

Sounds like this guy had his own personal issues to go along with all the ones that any of us might encounter, so he already had a few straws in his basket before he even signed up for the race. Very sad indeed, and dying doing some thing you chose to do would suck the same as slow cancer to me, even worse I think. I would think I would appreciate the time to say good bye to everyone I loved, got my affairs in order, and went out on somewhat of my own terms. Dying instantly with a short period of panic and alone, not what I would call a good death, but that is just me, RIP fellow traveler.

And so this means...??? Does it mean they found the upper body work harder???

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

I'm pretty certain - without going back to it - that I said that its one way of attempting to mitigate a risk, its a sensible course of action that may not prevent something from happening but by having a "check-up / assessment" you can immediately rule out certain diagnoses.

5-6 years ago I was arrived on the tee on the 4th or 5th at La Touquet golf club and this woman was running towards our group, one bloke was on the deck and another was knelt over him and she was yelling for us to call 911 and the club-house where there was supposedly a defribilator.

Anyway we dial the emergency services, call the club house - the ES arrive, the group behind us arrive and start CPR, we move on.

45 minutes later they're still working on him. I go home to London and out for a drink with an ER doc mate of mine and tell him what happened - you know, blokes flat on the deck, turning blue, making strange gurgling noises etc and he says to me "happens all the time"

it does happen all the time - people working in ED's will tell you they see it all day every day - for the rest of us though its a very rare occurrence.

I don't think that there's any downside to having a medical - and there are cardiologists working on algorithms to identify patients at sudden risk of death, so if you can find someone with that interest, it doesn't mean you won't die but you'll have taken a reasonably sensible course of action.

As an aside - the club-house had lent their defibrillator to a hotel in the town for a conference. I subsequently did a first responder course.

I'm pretty certain that there are researchers looking in to understanding patients at sudden risk of death - at least one of my colleagues is involved.

One of the bigger problem with modern medicine is the distance between the cutting edge clinical and translational research and its broader dissemination in to clinical practice. The better we get, the bigger a problem it becomes. I think the stats show it takes more than a decade for new developments to become broadly accepted good clinical practice.

So (and I'm very distanced from Cardiology) its very possible that there have been significant changes in the practice of medicine within a given field but even the best informed, if not involved directly with it, will be reliant on its spread through journals, conferences, symposiums and access to the right research groups and that makes it somewhat of a crapshoot.

Well, ya know, i don't mean to seem like a Neanderthal, but it kinda seems like the risk factors are pretty well understood, and have been well understood for at least 25 yrs or so. Certainly, there are the exceptions like Dev's friend who had a heart attack at mi 25.5 of a mary while running at a sub-3 hr pace, but generally speaking, the people who have heart attacks and strokes are not in super shape, and have not stayed in shape their entire lives. I know it will never happen but, IF you could get everyone addicted to some type of exercise, to the point where they craved at least 1 hr/day, 7 days/wk, and just really hated missing their workouts, then the number of heart attacks and strokes would be reduced dramatically.

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

Really? Then why has the American HEART Association told us to not eat eggs or saturated fat or dietary cholesteral for 30 years? Except now research proves none of them are bad for you (and saturated fat may in fact be good for your heart).

I think the media sucks and publicizes studies far before they are ready for the public to consume.

I think its really hard to understand research of things that take 20-50 years to have an effect on you... we never know something is bad long term until we study it for 30 years.

I think the government is corrupt and is in the pocketbooks of the food industry.

I think most people are lazy as shit and want the easy way out, i.e. healthy while eating McDonalds every dya.

Edit: never mind wrong topic.

Well, the debate over what we should eat will prob never end, as there will always be someone promoting a new miracle diet. However, my experience has been that you can eat pretty much whatever you want, as long as you balance your cals in vs cals out, and as long as you do a lot of fairly strenuous exercise, e.g. SBR 6 days/wk, not just a 3-mi walk 3 days a week. My blood chemistry has always come back perfect despite my love of cheeseburgers, pizza, mac and cheese, cheese omlettes, etc, prob mainly b/c i have averaged 12 hr/wk of SBR over my entire adult life since age 18, and b/c i've maintained same height and weight since age 18.

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

a calorie means nothing in human biochemical usage of food. 2500 cal of celery vs 2500 cal of pure sugar will yield different results.

Well, OBVIOUSLY if you take it to extremes, ya, 2500 cal of celery vs pure sugar vs pure lard will be diff in terms of their effect on how you feel and perform. I did say "pretty much" but maybe i should spell it out as "within reason". In any case, the lowly much abused calorie DOES have some meaning in terms of whether we gain weight, lose, or stay even. So, watching intake vs output is the biggest "nutritional" task we face, since excessive weight is the biggest health issue. Sure, you have to eat something approximating a "balanced diet" but there is a lot of room for variation IF you watch your cal intake AND you SBR at least 6 hr/wk fairly hard. All i can say is that this has been my experience.

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

Man, you make a great post and or course, someone has to post but but but. I also eat ANYTHING I want. I NEVER care about what the "perfect" food is. One day I might eat the celery, the other the pure sugar.
I do try to be smart. Meaning, yep I love donuts, but have not had one in years since nothing good about them. I love pizza but no longer have every week. I seldom snack. I take out a handful of cookies or chips and close the bag. I would not even worry about the need for strenuous exercise since 70% of what you deal with is from how much you eat.

It again is so simple. Just moderation!!! And the only way to tell how you are doing is get on the scale EVERY night. I just got back from Disneyland a week ago. I gained 5 pounds from where I wanted to be, 165. Even though I did not pig myself out too much, I know this happens. So for the last week, I have not eatten any of my reward food, cookies or ice cream. 2 nights ago I hit my low number again at 156. But I knew I was not going to exercise much yesterday or today since I have a race Sunday so stayed with the focus. Last night 157. Now I know I am going to red robin for lunch today and am going to pig out on all the root beer ice cream floats you can drink for 5 bucks. So far I have died at 3.5 of these. I expect tonight with this, and no exercise, I should be at my race weight 160.

So I then get back to training, and repeat the exercise. I just never understand why SO many people make this so hard. If you do not put it in your mouth, you cannot put it on your bones.

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Lions don't lose sleep worrying about the sheep

So you eat anything you want and never care about what the food is. I call BS. You have a massively restricted diet and probably a fairly poor nutrient balance.

You also say the only way to maintain the correct weight is to jump on a scale every night. What happened to 10 ways to skin a cat. You should walk the talk or just drop the righteous approach.

I thought we explained basic math to you in another thread already? You did not gain 9 or even 5 pounds in a week in disneyland. You gained maybe 1 pound and some bloat, likely due to less consistent poopage and maybe some water weight.

So you lost 0-1 pound and pooped in your week since disney land. Congratulations, you are good at moderation.

I think the point is that the risk factors are not understood. if they were understood we'd not have people researching sudden cardiac death's, some of which hit young, otherwise healthy individuals.

Since the 50's the AHA and others have linked saturated fat and heart disease. An editorial in the BMJ last year said that the research that led to that conclusion was flawed.

I think a point was made in the other thread about what tests should you have - and a cardiologist made the point that everyone has heart disease, in much the same way that most men, if they live long enough will die with prostate cancer rather than of it. What they don't understand, as I understand it, is what causes the events leading to a blockage. They know what causes the blockage, they can check to see who has it and to what extent but they can not tell with any degree of certainty when or if it will happen which is why you end up with the usual suspect (morbidly obese, high BP etc) suffering and no one is surprised - they're a walking heart attack, but when it happens to a fit bloke int he middle of the swim, everyone's shocked but the MD's are not better at predicting when it will happen for one group than the other, and no amount of tests give any additional clarity which was why or when.

Would you not agree though that risk of heart attack increases with increasing body fat and decreases in proportion to the amount of exercise a person gets??? Sure, a very fit, lean guy might keel over in the middle of a run or swim but is it not much more likely that the obese, non-exerciser will have the heart attack??? My impression is that those two things are, and have been for quite awhile, well established as risk factors, along with of course family history, which obv we can not do anything about:)

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

I'm not suggesting it doesn't. The point is that knowing the cause and the effect isn't helping at all with the knowing "when"

For me at least - add that nasty wheat protein into the mix, and it's a game changer on how my body deals with fats. I also find that going longer sets of working out - e.g 1.5 + hours seems to help with stoking the furnace to burn anything I eat that might not be the gold standard nutrition.My circulation has improved throughout my body (extremities etc) markedly over the past several years (55 yo)

Discussed with my bud the doc, when you are younger you have much more system margin available when placed under any kind of stress. But that doesn't mean you are immune to possible defects or situations where your systems are overloaded - for example heat, de-hydration and stimulants. Each case is unique.

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Dying instantly with a short period of panic and alone, not what I would call a good death, but that is just me, RIP fellow traveler.

Wanted to bring this particular line back up, as it speaks volumes on so many levels. These sorts of things happen and many of us say things like "well, at least he died doing what he loved to do..." -- that might make us feel better, might minimize a teensy weensy bit the grief someone close to him might feel, but the reality is that you are likely absolutely correct about this man's last moments of life....panic, wondering if this was "it" maybe, and complete helplessness.

Sad all the way around.

Sorry as I didn't comb the entire thread as it seemed to drift a bit.

The physiological phenomena was conventionally studied as "rate loading" versus "pressure loading" in cardiac rehab. My master thesis was on on the topic some 20 years ago (arm ergometry); so forgive me as I go off of my distant memory..

In simple terminology; working small muscle groups aerobically and especially at high intensity "pressure loads" the heart to a greater degree than larger muscle groups. The simple explanation is that when larger muscles work along with the subsequent peripheral dilation of blood vessels to feed them oxygen (blood) it reduces the "resistance" the heart needs to work against to maintain sufficient cardiac output to meet the demand (Stroke volume X HR).

Things like arm ergometry (most of the studies) by proxy; swimming, snow shoveling... all can characteristically pressure load the heart (relatively higher total peripheral resistance as compared to biking, running...); requiring it to produce much stronger contraction to push against the relatively higher resistance. This normal physiological response may unfortunately expose a compromised cardiac arterial system.

By no means am I suggesting this as an absolute, but in cardiac rehab circles (my dated experience) this was well known and a reason to avoid upper extremity training after a cardiac event; unless it was the only method available and then vigilant BP monitoring was required.

Clearly, there can be other factors at play here (e.g. ambients), and this is very sad to read.

Just needed to quote the response to Monty...agreed on all fronts. If you have ever been there, thinking "this it" and miraculously wake up to live on the other side, then you realize that no, "I certainly don't want to die that way...let me die in a bed with a solid amount of time to say my good byes" to loved ones and friends.

Sorry, when I die I hope it is quick doing something I love. I live each day trying to realize it could be my last. I treat folks today as if it could be my last. Compared to watching my Mom die from ALS, I will
take the I go quick anyday!!!!! Do not wait to do or say you love someone for tomorrow, because it may never come.

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Dave Campbell | Facebook | @DaveECampbell | h2ofun@h2ofun.net

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Lions don't lose sleep worrying about the sheep

be that as it may, I'm guessing he would have rather left 4 kids behind. i can't imagine any parent picking triathlon over family. once i'm old and have seen my kids grown and am "ready", yeah, it can be quick, but in panic and without goodbye to spouse and family, nah, not at all gentle into that good night...

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Reynolds, competing three days after his 52nd birthday, was about half-way through the 1,500-metre swim when one of race patrol paddlers who follow the swimmers heard him say, “Help me,” Rott said.
When rescuers arrived nine minutes after the emergency call, they found him unconscious in the water. He was taken to shore by jet ski, treated and revived before being transported to the North Hawaii Community Hospital in Kamuela, according to a report from the Hawaii County Fire Department.

I guess the race patrol doesn't provide aid? When a guy is drowning, 9 minutes is a long time. Just seems weird.

I think the "race patrol paddlers" are on surf boards, and hence it would not really be feasible to try to do CPR on the top of a surf board.

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

The way it is worded sounds like the patrol just called it in and left. 9 minutes later, rescuers "found him unconscious in the water".

But most likely the reporter has no idea how it really went down.

I would guess that the patrol guy/girl would've stayed with him, and tried to do what he/she could, and the paddler would have served as a "marker" for where this guy was. But you're right, prob the reporter does/did not really know the full story, since he/she wasn't out there:)

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

So, if you were single with no kids, would that change your viewpoint??? Perhaps that is the crux of our diff opinions, as i am single w/o kids.

Being an experienced swimmer, I would be shocked to find myself dying of a HA during the swim in a tri, during a masters meet, or during just a regular workout, but if this were to happen, my last conscious thoughts would prob be something like "well, at least i swam until the day i died." A few yrs ago, I had a golden retriever who played ball with me around noon, then died sometime between 4 and 8 pm that day, and ever since i've thought that was the best way to go: play until the very day you die.

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."