You didn't mention if you've had a lung x-ray or even endoscopy (little camera they shove down yer lungs). If your doctor won't investigate further, get a new one, better yet make sure you get referred to a specialist. Coughing up blood is NOT NORMAL no matter what.

I did get a lung x-ray and it was normal. Didn't have an endoscopy tho. Thanks for that advice. The doctor I was seeing is a specialist and was very thorough in his questioning. I just wonder why this problem is so random and doesn't happen all the time.

I must agree: coughing up blood (even 2-3 times a year) is NOT NORMAL no matter what. If your doctor doesn't take this very seriously, get a new doctor ASAP.

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Where would you want to swim ?

[reply]Today about a mile into my run, I was really short of breath and wheezy. Then I started coughing and up came some pink-tinged spit foam (blood no doubt) Not a lot, but some. I stopped, turned around and walked back home. The symptoms abated. This happens to me about 2 or three times a year (for the past two years) and it's always at the start of a run. Never at a swim or bike start, and never on the run if I've biked first. I've seen the docs and had an echocardiogram, lung function test and ultrasound done on my heart and the doc said everything looked normal. He thought perhaps I was starting with too much exertion and blood was backing up into my lungs. He suggested starting more slowly. However, I didn't do anything different than I normally do. I'm a 43-year old slow 9-10 min pace runner and this is baffling me. Anyone else come across this or have a theory that I can pass along to the docs? Thanks.[/reply]

If the blood was backing up in your lungs then your heart was failing. This could be the sign of something bad in a 43 yo. However, it sounds more like just an excuse (in the place of "I don't have a clue") to get the patient out the door. You need another opinion. Perhaps with a cardiologist.

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Frank,
An original Ironman and the Inventor of PowerCranks

My doctor was a pulmonary specialist. Is that similar to a cardiologist? Perhaps you're right in that he just doesn't have a clue as to what is causing it. I probably will see a different doctor ASAP. A friend just told me his buddy had a similar problem in that the stress of jogging was jarring loose his bronchial tubes which caused him to cough up blood. He had to give up running. I hope it doesn't come to that for me.

hey there foamy -

i'm not a doctor but do some medical research - i've seen frothy pink coughing, but in people with pulmonary oedema. this was caused by high altitude. you neglected to mention whether the first mile of your run was straight uphill from 5000 meters, but i suspect it's not. . .

often at sea level plumonary oedemas creep up (immediately) after surgeries. it's basically a matter of fluid oozing into your lungs because of a pressure imbalance. these patients (at sea level) get oxygen and drugs, usually, and it's a-ok.

still, i'd have to concur with the others and say "get this looked at soon!"

-mike

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____________________________________
https://lshtm.academia.edu/MikeCallaghan

http://howtobeswiss.blogspot.ch/

As has already been stated, pulmonary edema is the buildup of fluid in the lungs, usually resulting from the heart's inability to pump blood through the body effectively. It can be caused by heart or kidney failure, poisoning, widespread infection or stroke.

Symptoms of pulmonary edema include difficulty breathing, restlessness, shortness of breath that is worse when lying down, rapid heart rate, and a cough that sometimes produces foamy pink fluid. You appear to have most of those symptoms.

This is very serious and I can't believe you're asking anonymous people on this forum about a problem like that. If you're not satisfied with your specialist's treatment seek diagnosis or treatment from another, but do it stat. At your age this is nothing to procrastinate about.

[reply]My doctor was a pulmonary specialist. Is that similar to a cardiologist? Perhaps you're right in that he just doesn't have a clue as to what is causing it. I probably will see a different doctor ASAP. A friend just told me his buddy had a similar problem in that the stress of jogging was jarring loose his bronchial tubes which caused him to cough up blood. He had to give up running. I hope it doesn't come to that for me.[/reply]

A pulmonologist is a lung doctor. A cardiologist is a heart doctor. You really need someone who can look at both systems from an athletes perspective. Sounds like your first doctor was lacking in this regard.

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Frank,
An original Ironman and the Inventor of PowerCranks

So how are you and the missus getting along?

P.S. Don't take offense at Mojojojojojojojojojo's comments about asking advice. First of all, you are seeking professional advice; secondly, there is a wealth of knowledge in the people who read this forum, and you just might hit on someone who either has had the same problem, or knows about it, and can give some ideas for your doctors. Oh, and thirdly, I can't believe that Mojojojojojo is giving medical advice/information out to strangers on the internet!

Thanks for that bit of levity Monk. All these posts were beginning to alarm me (which they should). That's exactly why i asked this forum, in hopes someone has run across it or had the same problems. I'm going to make an appointment tomorrow with my GP doctor and he might be able to set me up with a different specialist. I'd make it now but it's 3:00 am and I can't sleep for worrying about this. I've got IMCDA in a few months and hope to get this problem figured out soon.

I'm going a different route here and suggesting acid reflux. Been checked for it?

No, haven't been checked for acid reflux, but I would think if I had it it would be more prevalent and not just occur a few times a year. And I'm not sure it would cause the shortness of breath. However, I'll definitely mention it to my doctor. Thanks.

Acid reflux can sometimes cause asthma-like symptoms. You may have it and not know it (I did for some time). Or, you may have accute instances of it, brought on by the jarring your body experiences from running.

Or I may be totally off-the-mark.

Give me a break! This place is notorious even for triathlon-related misinformation, and my medical advise was to SEE A DOCTOR. This is not a time for levity... he's not trying to decide between a Felt or Cervelo, or 650 v. 700... this is serious.

You're right Mojo. It is serious and I have/am going to see a doctor. However, I still feel this is a great forum for information. For all I know someone may have had a similar problem and could have pointed me/my doctor in the right direction. And though I've found the forum members to be very knowledgable on a variety of topics, I'm not about to let any of this advice supercede my seeing a doctor.

And it's always time for levity. When my mother had her cataracts removed at 75, instead of saying "Oh, I can see so much better," or something of the sort, her first words were, "My children aren't as good looking as I thought."

Hey ST's...

Looking for some updated info on this post.

I am an Iron Distance triathlete, with a swimming background and have recently experienced what I think to be Swimming Induced Pulmonary Edema...

At the Mooseman 1/2 IM I had the first episode... shortness of breath at the 750m mark in the swim... fluid building in the lungs until a cough began... at that race, I tried to keep going and pushed through the bike, stopping at the beginning of the run - unable to get 'air'... ended up in an ambulance on oxygen...

Saw my GP and he did a lung scan, "echo" on my heart, x-ray's lungs, throat and sinus'... did blood tests, checked thyroid... all were clear and normal... we thought it was acid reflux, so I began taking Pantaloc to combat that... we thought it was the source and I continued to train without incident...

Under my doctor's supervision, I did Dev Paul's Epicman in LP in early June... no problem...

then, I raced at the Tinman 1/2 and was fine as well...

The 2nd incident came back to haunt me at IM USA on July 22nd... this time, it was much worse. 750m into the swim, same 'tightness' in the chest, shortness of breath and a gradual build up of fluid in the lungs. I struggled to finish the swim, and upon exiting the water, began coughing up a pink frothy foam... I tried to continue, but couldn't breathe on my own - I was taken by ambulance to the Saranac Lake Hospital, where they gave me Lasex and oxygen.... the lungs cleared and they released me to the loving care of my husband Kevin, who had PB'd at the race that day...

Since returning home, I have had contact with one of the doctors who was at the swim exit who suggested it could be Swimming Induced Pulmonary Edema... so my search begins...

I have been searching the web for articles on this subject, and have attempted to contact the doctors who authored several of the studies in order to find out more about the causes and preventions of this condition.

I think in my own case, perhaps warming up before the cannon goes off might help... but it's only happened twice so far and only while swimming - never on an intense bike or run...

I trained at Epicman in Lake Placid... I swam the IM course in the three days leading up to IM USA... same water... but at a faster pace than race pace ie. 31mins/2km... IM pace is 33-34min/2km... wetsuit on... so why only on race day?... I love swimming and am confident in the water, and managed to get 'clean air' at the swim start in LP... I'm guessing it was too rapid HR in cold water, with a slight over-hydration... but would like to find out more if anyone knows of something similar.

At this point, I'm scheduled for a VO2Max test with a cardiologist to monitor my heart under "load"to see if something unusual is happening - although I am regularly tested on VO2Max here by my coach... meanwhile, my doc has been allowing me to train at intensity as I'm not having any issues at all (thank God he's a cyclist)...

I'm ready to test myself at a sprint this weekend, and two 1/2 IM's before racing at IM Florida in November... but I know it's a serious condition and need to inform myself further...

If anyone has suffered something similar, or has updates, I'm all ears and will share whatever I find out as well...

Thanx,
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

Kat, sorry to hear about your troubles. The symptoms do sound identical to mine. I never did fully solve mine but I think, based on what docs said and my own experience, that I'm able to control it. First of all, it's only happened maybe once or twice since my original post. But for me, it was always at the begining of a run. One time, I forced myself to slow down and it alleviated the problem and I was able to finish the run. So...I think it's caused by an elevated heart rate without proper warm-up. Sometimes I get very short of breath walking up the hill on my street yet I'm doing IMLOU in two weeks. Go figure! I don't know if you have hypertension but that may have contributed to my problem as well. Perhaps your state of anxiety caused an elevated rate and the fact of being submersed just exacerbated it. Let me know what you find out from the docs. PM me if needed. Good luck.

-Jean Paul

Hey JP,

Thanx for the update!... Yeah, I'm guessing that a long swim warmup might be the key... too quickly elevated HR might be the cause - seems that the heart gets a 'preload' and can't pump the blood fast enough, then the lungs take the pressure of the backup and the capillaries rupture - causing the fluid and pink 'foam' - which is actually blood... I did try to completely slow things down on the IMUSA swim, even when it first began. My HR was at 167 - Z3 for me - at the start... at the 750m mark, stopped for 30 secs and it dropped to 157, so I continued... by the 2nd lap, I was treading water getting it down to 110-120bpm - no even in Z1, but the problem kept getting worse. Maybe once the 'fluid' process starts, it can't be reversed... I will let you know if they find an answer. It seems odd that it happened to you 'running'... as all the stuff I read about what happened to me seemed to be 'swim induced' - cold water, rapid HR, over-hydration... very interesting...

Good luck at IMLOU... !!!
KR,
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

I'm pretty sure your diagnosis is correct. I've had it myself. As you say, swimming induced pulmonary edema is thought to be a combination of expanded plasma volume from training and hydrostatic pressure from the water centralizing your already expanded blood volume. Cold water being worse because of the peripheral vasoconstriction that goes with trying to stay warm and therefore further centralization of blood volume.

There's also some suggestion that the alveolar capillary membranes are in a hyperpermeable state, maybe from oxidative injury or shear stress, because it often follows short periods of particulaly brutal training. Special Forces soldiers - particularly Navy SEALS get it in training, and some of the best epidemiological studies have come from the Israeli Naval Institute's studies of Special Ops guys getting it in training.

It's not the sort of thing you'd really want to reproduce in the lab (for safety reasons) even if you could, and cardiopulmonary testing returns to normal after a couple of days, so there will likely always be some element of mystery as to what the actual cascade is.

As for avoidance, you might look back through your training logs and see what you were doing the week before your events. Training in hot weather (further expanded plasma volume) or big increases in ventilation (through intensity or volume - leading to oxidative stress or alveolar shear stress) are also likely culprits.

Hi Trey...

Thanx for the input. I have tried to get in touch with some docs who did some in-depth testing with the Navy SEALS, and also with three docs from the Israeli N.I. as they seem to have done a fairly extensive series of tests on this as well.... prevention is what I'm trying to tap into as on the two occasions it has happened, I haven't been able to reverse the symptoms on my own. I needed emergency medical help to clear the fluid in the lungs and give me some much needed oxygen.... I will take a closer look at my training logs and try to see if that provides a pattern.

Yes, I was completely fine within 24 hours, so it's not something with a lasting effect or that is permanent. But, it has stopped me in a race - and an IM at that. Not fun... but at least I am trying to deal with it and inform myself.

I appreciate the input and will share this with my doc tomorrow in hopes it offers some encouragement... I just don't want to stop training and racing... I'm having too much fun...

KR,
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

It's very unlikely that you'd be able to get it to resolve while you're still in the water. Once your lungs start to flood, your alveolar capillaries are compromised and you need to get out of the water at the very least. Especially if you're in open water. It's very difficult to predict how bad it's going to get and how quickly it's going to get there, and a half mile offshore in pulmonary edema is not the place to try to salvage your game. Depending on how bad it is, you may need Lasix to draw down some volume and O2 to get your pulmonary capillary pressure under control.

Since you can't turn it around on the swim, prevention is key. It may be as simple as a better taper and not being too aggressive with the fluids before the swim (but of course catching up on the bike). Also, if you live or train where it's hot, adequate heat acclimation may also be helpful.

YES! Oxygen and Lasix were administered when I exited the swim in LP... More Lasix at the Emerg. room... Luckily, one of the kayaker spotted me in trouble and followed me for the last mile of the swim. I would hold onto his kayak, catch my breath, take 10 strokes... and there he was, waiting for me to grab the boat again... I guess I was pretty much nearly drowning - although the weird thing is that I'm a competitive long distance swimmer - go figure!... I really want to 'prevent' this so that I don't have to become a duathlete!

How do you know so much about this condition? You're the first person who has been able to give me this much insight, and understands EXACTLY what I experienced...

THANK YOU!
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

I am a scientist in a university cardiovascular surgery department. We deal with a lot of things that affect fluid balance and organ function, and pulmonary edema is always part of the picture.

I have also had first hand experience with swimming induced pulmonary edema, and, like you, I learned in the emergency department that not too many doctors know anything about it. One of the first things doctors learn in their training is that common things are common, and so the first assumption about a person who shows up in pulmonary edema is that they've had a heart attack, which is the most likely reason for someone to come in off the street in pulmonary edema.

Swimming induced pulmonary edema is rare except in special populations, and is pretty much unknown outside of the small groups of doctors who work with those populations. When I had it I didn't know what it was either, and I'm in the business. I knew it was pulmonary edema, but I figured I had a pulmonary embolus from a deep venous thrombosis because I had gotten real dehydrated the day before from a 3 hour run in the heat and then had a long car ride immediately after. As it turns out I had overcompensated for the dehydration and was probably too tanked up on fluids when I got in the pool. When I got to the hospital the ER doc thought I'd had a heart attack but was surprised by my normal ECG, and my chairman, a heart surgeon, thought I'd probably blown an aortic valve leaflet and had an OR on standby. All I can say about that is thank God for echocardiography.

The cardiologist who consulted on me didn't know anything about it and just told me I was killing myself training so much. I knew that was nonsense so I searched the literature when I got home then went to see a colleague who is an expert in cardiac physiology under extreme conditions a few weeks later. So between getting a workup from him and reading all the medical literature I could find, I kind of put it all together.

By all means take some articles to your doctor and discuss with him / her. Also, review those training logs!

Ahhh, this explains everything! What a great wealth of knowledge you possess... Thank you!

Yeah, the Echo I had done showed everything to be normal, as well as the ECG... that's what had my doc stumped. Plus, I've been biking and running in Z3 & 4 without ANY issues... If I had something wrong with my heart, you would think I would feel it on the bike and run as well...

The next test will be a VO2Max while they monitor the heart activity, but I'm guessing it will turn up normal as well - just as all the other tests. I feel I have to go through the 'motions' though, just in case... after that, I feel it's up to me to try to find my own prevention technique... I will look closely at the logs... thanks for that advice.

Luckily my doctor is a cyclist, so he has been wonderful at understanding my love of training and racing and doesn't want me to stop - he just doesn't want me to be a statistic either...

Your info will add a great piece to help bind the puzzle together... Thank you SO MUCH!

KR,
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