Not to needlessly go too deep into the woods on this, but part of the challenge is that (in the US at least) it can be very hard to actually get proper, real preventative screening.

Sometime last year my wife read an article about how this otherwise very fit, young male dropped dead in a marathon. Details forgotten, but basically: genetic heart defect that ultimately caused death from higher exertion level. This could have been found with an EKG. Well, in a surprisingly willing moment, I decided fiiiiiine, I'll go to a GP and get tested.

Except basically, I couldn't. 29 at the time, ZERO health issues. Called like 4 GPs and clinics, even ones specializing in athletes, and no one would do an EKG. Finally just went for a physical. Told the Dr... "Do you have any problems," she asks. "Nope." Tell the story. "If you had any issues you would feel pain while working out, etc etc." "I know that, the whole POINT of all those articles is that they say that otherwise perfectly healthy people are asymptomatic until they die." "Well if you had heart problems you would know about it by now with how much you exercise."

Honestly at that point I was tired of sounding like the "But the internet says" guy and just said fine and went home and went back to hoping I'm fine.

Point being: Even if you WANT to get checked, sometimes the reality of it can be annoying to make happen.

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JustinDoesTriathlon

Owner, FuelRodz Endurance.

That’s weird. Insurance may not cover it by I don’t know why they’d have issues doing it.

It was super frustrating. I was basically told that it wasn't medically necessary, nothing in my history indicates a need (true,) and that an EKG only shows a 1 second clip of the beat anyway, and not while I'm working out, so it would be unlikely to detect anything.

And hey, I'm not an MD, so I'm not here to claim expertise at all. It's just frustrating that any time an endurence athlete dies, the articles always end with "And experts say that this sort of thing could happen to anyone, and recommend a test to check for pre-existing conditions." Once you let your body go to hell you can use as much medicine as you want, but I can't even get a single piece of prevention. That's a rant for Lavender, though, I suppose.

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JustinDoesTriathlon

Owner, FuelRodz Endurance.

To race in the DL ITU pathway juniors and now elites have to have yearly physical as well as EKG done every 2 years I believe. My elite athlete had some “weird” things show up and they even made her do future screenings. Turns out it was more stress than “hidden” issue as follow ups were clean.

Wouldn’t be shocked if in 5 years to race ITU AG worlds athletes are required to submit medical physicals.

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Brooks Doughtie, M.S.
Exercise Physiology
-USAT Level II

ask for some opoids and you'll probably get 60 pills with 3 refills /pink

It's definitely weird a doctor wouldn't prescribe it even after you explained the situation. I can get where insurance may be a pain about it as they don't like paying for items just because a patient wants it.

I think swimmers get into trouble for a spectrum of reasons, not a one size fits all sort of thing. RD's can and do adjust races if conditions get to a point where it is truly unsafe... hopefully pre-race but sometimes it can/does happen in the middle of the event. I've been at races as both an athlete and staffer where swim cancellations or modifications were made.

I can't jump on board with a blanket statemenet that the sport has a swimming problem. Of the deaths I've been around, they've been cardiac events. Having one in the water is a much worse place than on dry land due to the environment. It does happen in many things, cardiac events that is... older friend of the family had a cardiac event while driving, crashed and subsequently died in the hospital. Not to be crass... but it happens.

I'm not in the health field either, but if you're in the U.S. I assume the doctor wouldn't prescribe the tests for you, a healthy 29-year-old athlete, because the tests are so expensive that your insurance provider would likely not approve them and would be upset at the doctor for ordering the tests when they weren't really needed. I can see the rationale for that, at least in our current system where medical costs have become so expensive. It's a clusterf-.

In reply to the comment that triathlon has a triathlete problem, no, triathlon has a problem that humans are mortal. But isn't that also why we do a sport like triathlon because we want/need a bit of calculated risk in our lives? Obviously, the calculation of the risk is individual for each athlete and changes over time.

Totally fair, no arguments. It's a big picture challenge.

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JustinDoesTriathlon

Owner, FuelRodz Endurance.

I was told by IM that I needed a medical certificate to do the 70.3 WC race in France (in Sept), along with paying the fees for the 'License' in France.
Bonjour Dale! All athletes competing in France, without exception, are required to hold a valid Triathlon License.

Athletes holding a valid triathlon license from France, UK, Germany, Belgium, Luxembourg, Switzerland, Italy, Spain, Portugal or the Netherlands, will not need an additional license.

All other athletes, regardless of whether you hold a license from another country not listed above, must complete the following steps:

1. Purchase a French Federation One-Day License (see below link) and present at Athlete Check In onsite

2. Produce a Medical Certificate and present at Athlete Check In onsite (see below link for template)

Obtain One-Day License:

FOR WOMEN
FOR MEN


Athletes who are required to purchase a French Federation One Day License are required to bring the following to Athlete Check In onsite:
1. French One-Day Triathlon License
2. Personal Identification (ID)
3. Medical Certificate signed by your physician

The medical certificate must state that you are medically fit to participate
in triathlon competition. The certificate must be less than one year old
from the day of your race.

MEDICAL certificate Template

According to French law and the regulations, a medical certificate is compulsory to obtain a sports license in France.* These obligations apply to every organizer of any kind of competition and all sports. To meet the needs, we suggest you download the medical certificate template above to ensure the same information is provided by your physician. If you use your doctor's regular form please mind that the following data is obligatory: the date of issue, last name, first name, date of birth, stamp and signature of the doctor.

Your IRONMAN 70.3 World Championship Nice Team





For ITU Long Course WC next month, I was not required to submit a medical certificate.

Screening athlete's, especially the young ones, is a double edged sword. Screening EKG's are weak in picking up congenital heart defects (which is the most comong cause of SCD <35 yrs-ie Hypertrophic Cardiomyopathy, congenital coronary anomolies) and there is the cost of testing, false positives and not to mention keeping an athlete out of competition-that doesn't go over really well, trust me...

EKG Screening in Young Athletes
http://www.onlinejacc.org/content/68/7/712
http://www.onlinejacc.org/content/62/14/1298

SCD in the Older Athlete
http://www.onlinejacc.org/content/65/5/493

Importance of Family History Screening
http://www.onlinejacc.org/...pplement_1/443?rss=1

Link to the actual Triathlon Paper-L.Creswell, B.Maron et al
http://www.onlinejacc.org/...7/13_Supplement/1632

Agreed!

Thats why its important to have these discussions.

Blaming athletes is way to simple. Every ironman athlete that I have know trained hundreds if not thousands of hours in the pool preparing and they are all were well above average fitness. Most Dr's would consider them at low risk for cardiovascular issues. Yet a Triathlon swim is far more stressful than a pool swim. We have all been kicked in the head, dunked under, crushed going around buoys, swum over, stung by jellyfish, swallowed water, I even seen punches thrown by some idiot. Politeness would go a long way in the water!

But there is also swimmer education, course information, cold water, hot water, swells, currents, rips, tides, chop, wind direction, distance measurements, these factors can and should be monitored by race directors and safety staff. Standardize the swims safe conditions.

I think every death is tragic and every death deserves in depth discussion and analysis with all the stake holders.

In the mean while I will applaud and thank any RD who calls off a swim to protect amateur athletes.

That's so true. Can you imagine taking a few hundred 50 to 70 year-olds that are your completely average people and have them do a mass ocean swim start? It wouldn't be 1 death out of 40 events. It would be more like 40 deaths per event.

I recently did a mass deep water start in 59 degree water and it was ridiculously dangerous. The harder you tried, the more people beat on you. I could feel the constriction of the wetsuit, plus my blood pressure shooting up, plus the panic, plus the freezing water, plus the caffeine from pre-race coffee all pushing HARD on my neck. If I wasn't in good shape, could this have caused a medical "event"? It sure felt like it could. I usually start on the edges to avoid that crap, but I just wasn't thinking that time.

The key that I've found is "family history." I had the same issues. And then the doctor asked what about my family? What sort of history do they have? Any heart attacks (with a knowing nod)? Tell them you have extensive family history with heart issues and you want to get it checked ... they will do it.

Let’s get this story right first l:
The water was not rough. A bit of chop maybe. It started glass and ended up with maybe 2 foot regularly spaced waves at the very worst. I was toward the end waves and swam a minute or two slower than I’d like but it wasn’t rough.

"Every ironman athlete that I have know trained hundreds if not thousands of hours in the pool preparing "
don't take this as a personal attack but that statement means you have not talked to a broad section of triathletes. Listen to the loud cheer next time an ironman swim gets cancelled. That's the large number of triathletes that come to the event grossly undertrained for the swim.

"But there is also swimmer education, course information, cold water, hot water, swells, currents, rips, tides, chop, wind direction, distance measurements, these factors can and should be monitored by race directors and safety staff. Standardize the swims safe conditions. " what makes you believe race directors and safety staff aren't already monitoring these conditions? standards are good. I don't know the ironman standards for safe conditions. What additional swimmer education are you talking about? Unless you make it mandatory that athletes attend a swimmer education course, I don't know what more you can do. they already have swim education in the athlete guide which athletes already don't read. and there are numerous articles on the internet, local tri clubs, etc. If an athlete comes to a triathlon know understanding of the race because they didn't read the guide and didn't once google it then that's their own ignorance that's the problem.

calling off a swim if they evaluate the conditions are unsafe is fine. I don't think they should call it off if they'd deemed the conditions safe and somebody dies unless conditions have changed since the initial assessment

 

I disagree as in 30 yrs of Masters swimming I've only ever seen one swimmer die in a meet, and he was 75. Granted, this is pool swimming but in many respects I think meets are more stressful than triathlon swimming b/c when you get up on the blocks, it is just you in your Speedo, w/o the masses of other swimmers to hide behind that you have in triathlon. Further, in Masters meets you have people actually sprinting all out vs in triathlon most people are just cruising on the swim. People who can swim well are very unlikely to have a heart attack during a tri swim. No way that "you will find plenty of more than competent lifelong swimmers (a lot being males 40-60) that have had cardiac events in the water". I think you are way off base here.[/quote]

The issue is that open water swimming is fundamentally dangerous. I grew up at the beach in New Jersey. I have done a number of triathlons in the ocean and 1 mile swims in the ocean. The difference between a masters meet and an open water swim is not fitness, or age, or experience, or luck. The difference is the size of the space that open water swims take place in and the color of open water. Take 200 swimmers in a one mile open water swim, send them out, they will soon space out over a few hundred yards. I am a poor back of the pack swimmer. I might as well be swimming alone, but there a 200 people only a few minutes ahead of me, and some behind me. And if i stop because i had a heart attack, well, good luck seeing me, especially if i am wearing a dark wetsuit.

The issue is that open water swimming is fundamentally dangerous. I grew up at the beach in New Jersey. I have done a number of triathlons in the ocean and 1 mile swims in the ocean. The difference between a masters meet and an open water swim is not fitness, or age, or experience, or luck. The difference is the size of the space that open water swims take place in and the color of open water. Take 200 swimmers in a one mile open water swim, send them out, they will soon space out over a few hundred yards. I am a poor back of the pack swimmer. I might as well be swimming alone, but there a 200 people only a few minutes ahead of me, and some behind me. And if i stop because i had a heart attack, well, good luck seeing me, especially if i am wearing a dark wetsuit.[/quote]


In my experience, OW swims are mainly dangerous for poor swimmers. Improve your swimming skills and speed and you will feel more confident, swim faster, and not feel afraid of OW swims. Triathletes in general simply do not take the swim seriously enough as the typical tri guy only squeezes in 2 swims of 30-45 min per week in during the tri season, and then stops swimming altogether over the off-season. Swim 5-6 times per week for 3-4 months every winter, then maintain during the tri season, and your swim will improve. :)

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

I am still to read the 4 pages of respondents but people die doing every sport. Lawn bowls. Curling. Cycling. Etc...

Race organizers are not forcing people to swim.

Those people that can’t swim need to find a new sport.

I can’t rock climb. I’d probably die doing it. So you know what? I don’t do it.

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On last weeks IM talk they discussed getting medicals for people to be able to do it.

Well in the last decade we have seen a number of Premiership/ international footballers drop dead/ or have heart attacks on the pitch. These lads will have the best medical care available in the world yet they still can't detect it. Unfortunately I think its just one of those things.

You don’t need to be fast to feel confident in the water. And obviously dependent your base fitness level, one can swim a couple times a week for say 45-60 minutes and have no problems in an IM swim. I’ve done it for IM and HIM and have no issues completing the swim. And I’m a MOPer. Granted it doesn’t help if people’s normal training swim is 45 minutes of continuous steady state swimming. If I wanted to get faster at the swim, yes, of course I would swim more. But I’m completely confident in the swim leg and it has nothing to do with me being fast.

You are certainly correct. The bloke I was replying to said he was a BOP swimmer which is why I suggested swimming more to get faster and feel more confident in the water. BTW, I liked your response to the OP when he said most triathletes have trained "hundreds if not 1000s of hours in the pool"; as you said, most hardly train the swim at all and then most of them pay for it on race day. :)

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

OK, I'll take your word on this. I guess I just don't pay enough attention to the shapes and sizes of all the other people in any given race. It is kind of a sad commentary though that there are obese "influencers" out there. I would have never thought that could happen in a million years. 20 yrs ago you would see maybe 3-4 obese guys in a race with 300-400 entries but I guess now the big guys are much more commonplace.

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

okay. I see. I certainly agree that if someone is not confident on the swim leg or is concerned they might miss the cutoff or just have trouble on the swim in general, then swimming more is obviously recommended. And of course, if one wishes to get faster swimming more is also the way to go. It just seems that many people aren't doing the bare minimum to prepare themselves for an IM swim. It's probably why so many pray for wetsuit legal as that's another safety blanket.

Before my first triathlon (a sprint distance), I was swimming 3-5 days a week. Most of them short lunchtime swims but I was very concerned about being prepared for the swim. Then I did a practice open water swim. And ever after that, on race day for a 400 yard swim there was the chaos of the start and the ocean swell and general nerves of race day. I can't imagine showing up to IM distance not having practiced that distance before or coming in way undertrained.

I am still shocked when I talk to friends or overhear other athletes before an IM say things like "oh. I haven't been in the pool in weeks" or "I've only swam twice in the past two months"

obviously, being prepared for the swim and overall event doesn't mean you won't still have a heart attack on the swim but at least if you did what you could. Bottom line, everybody is different as far as the amount of preparation they may need for the swim. Some may need more work to get more confident. Others, like myself, can skate by on 2-3 days a week swimming. But swimming more is not a bad thing for sure.

Ya, me too. Last year I overheard this friend of mine talking about how his brother had finished the Chatt 70.3. I asked him how it went and told me a long tale of his brother's woes. Apparently, his bro is a strong runner and trained consistently for the bike, but only swam once to be sure he could make it through 1.2 miles in the pool. So, on race day he manged to float/swim downstream at Chatt in something like 50-55 min for the 1.2 mile swim. Gets on bike and is doing fine until mile 40 when he starts getting cramps, but he makes it through the bike. So then he walks/jogs the half mary to finish in 7:55. And this from a 1:38 open half mary guy who is only 40 yrs old!!! Just shows the import of being well trained for all three legs. :)

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

Obesity is becoming ok. Three words: Body Acceptance Movement.

Doctors continue to tell their patients to exercise vigorously and fix their diets...patients continue to eat poorly.

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Washed up footy player turned Triathlete.

Apparently so. I've noticed that even some of the personal trainers at my gym are overweight, maybe even verging on obese. You would think that there would be height/weight standards for the trainers but I guess that is too much to ask. Similarly, I've noticed that about 2/3 to 3/4 of the MDs, PTs, PAs, NPs, and nurses that I know are overweight.

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