Part of the problem is that there are so few cases in the literature no one really knows what the natural history is. The military studies have the most controlled follow-up, but not much of it is long term. I am hoping to get some case-finding surveys out to the various triathlon governing bodies before the season starts up again. I am awaiting human subjects committee approval at my university at the moment. Ideally, I would like go get an MD or EMT in the swim exit / medical tent of every wetsuit swim triathlon in the nation. My guess is that many unrecognized cases are occurring, and I woluld love to be able to document that and to identify the spectrum of case evolution.

So you did get blood drawn? Do you know your potassium yet?

Well my letter caught the Dr's attention. He has already referred me to a really good Respirologist. The same one as a matter of fact that will do the analysis of my Methacholine Challenge, so I'm getting to the right specialist. He had not heard of the condition and thanked me for educating him. He left me with the comment- "we just need to make sure you can continue to perform!" It good to see Doctors out there that are passionate about their field...

Blood was drawn on Thursday, but won't hear for a week I think.

Trey- can patent foramen ovale be a factor? Apparently one in four people have it anyways. A friend pointed me to Chris Legh's problem "I, in fact, have a congenital heart defect, known as a patent foramen ovale (PFO). This is completely separate to my other much publicized intestinal problems. It is basically a hole in my heart which didn't close over properly at birth. When I get to about four hours into an Ironman, the pressure becomes too much and the hole flips open a little bigger and blood starts to backflow into my lungs. My breathing starts to get shallow, I start to wheeze, and then I start to cough. Eventually I start to cough up blood, as my lungs become congested with it."

Trey- can patent foramen ovale be a factor?

Sorry, Rob, I am just now seeing this. Since your reply was to a post that wasn't mine I didn't get the email notification.

Yes, absolutely, a PFO can be a factor and is what Chris Legh's problems have been attributed to. He had problems on the bike, not just in the water, but there is no question that transmission of left ventricular pressure across a defect in the ventricular septum can raise pressure in the right ventricle and cause cardiogenic pulmonary edema.

That is not to say, though, that swimming induced pulmonary edema is likely to be caused by a PFO. But it's certainly in the differential diagnosis.

Hey Guys - thought I'd drop in an update here...

To summarize, my first occurence of SIPE was at Mooseman in 2007, then again at IM Lake Placid that same year. For 2008, I raced SIPE free at Ironman Germany and Ironman Florida... Then, I got it again in 2009 at The Canadian Iron 226 in Ottawa. I thought after good races at IM Cozumel in 2009 and IM Brazil in 2010 that I had it figured out, but it was BAAACK at Ironman France - one month after Brazil.... Then I raced Ironman Canada in August and was fine.

So, basically I have had SIPE in 4 out of 11 Ironmans - only 1 DNF (the 2007 race in LP) - the other times I was able to keep racing. I do not recommend this strategy to anyone, and I will say it's very difficult to race with fluid in the lungs, but I have been learning how to cope with it. Trey and I are on a quest to find the answers, and I think my pre-race routine has been helpful in preventing the onset of SIPE. In the races where it happened, it seems as though the physical contact and crush of the swim, combined with no warm-up prior to the start may have contributed to it.

I have posted updates on the SIPE page of my website at : http://www.endurancetriathletes.com/sipe.html

One area of research currently being done by Dr. Richard Moon at Duke University is looking at Pulmonary Arterial and Pulmonary Artery Wedge Pressure in those of us who have experienced IPE/SIPE. They are also looking at a possible DNA link as part of the study. I was fortunate enough to participate in this clinical trial on Feb 14 & 15, 2011 and have posted a report on my experience there on my site as well at: http://www.endurancetriathletes.com/duke_ipe_sipe_study.pdf

Dr. Moon will have to test more participants and gather more data before he can make any final conclusions. In the meantime, he will share the findings of my testing with me so that we can review the data and share that with my cardiologist and perhaps implement some additional pre-race strategies into my routine.

Feel free to check it out and contact me if you have any questions.
Kat

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5x Ultraman Finisher
18X Ironman Finisher
2013 Ironman World Championship Finisher
2012 Canadian Ultra Distance Female Triathlete of the Year
http://www.endurancetriathletes.com

Thanks so much for posting that, Kat. I was planning to go, too, and was really bummed to get an email from Claire a couple of weeks ago that they were rejecting me after all... something about not liking the anti-hypertensives I was put on after my SIPE. The question about the Viagra is very interesting, though. What's the physiology behind that?
Marla

Viagra is used to treat pulmonary arterial hypertension.

Interesting thread and I really enjoyed reading this. As a RN that worked for 10 years in cardiac intensive care I have heard of this happening.
There was actually a story on the national news last summer about "dry drowning" in a child.

You just never know what will come of medical oddities and chances are, you have helped someone and did not even realize it. All the best in your endeavors racing!