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.
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.
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.
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.
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
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.
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.
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.
It can be caused by heart or kidney failure, poisoning, widespread infection or stroke
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.
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!
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
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
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.