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2019-06-06 11:12 AM

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Subject: Autonomic responses on the swim
Greetings fellow athletes, I wanted to share an experience with you in hopes of finding out how many other triathletes may struggle with the same issue.

I participated in the Escape the Cape last weekend and had my first DNF...it was painful. The race and staff were great and I have no problem recommending the race at all, but it was my first "cold" water swim and things went downhill right after the 12 ft plung.

I have always struggled with a robust dive reflex and vagal autonomic response on initially hitting the water in other open water swims, but after about 50-100 meters, I could get my composure and carry on with my swim. I did not anticipate, nor could I have imagined what was going to happen in 65F water.
Typically in open water, as soon as I hit the water, I have the sensation of not being able to breath. For about 50 to 100M its a series of stroke and gasp until I either settle down, or roll over on my back to recover.
As a physician, I chalked this up to the Dive Reflex (DR) but the experience was so profound this time in the cold water (even with a wet suit) that I knew it was time for some research.

This article was a good start. If there is interest, I wlll follow up my posts with updates from my ongoing research.

https://www.teamusa.org/USA-Triathlon/News/Blogs/Multisport-Lab/2015...

My point here is to get an idea of how many (if any) of you have the same issue?


2019-06-06 11:55 AM
in reply to: clinicisopen

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Subject: RE: Autonomic responses on the swim
Yes. I have to spend some time splashing my face with cold water, squatting down and exhaling into the water several times if the water is cold; otherwise, I will start gasping and gulping in the first 100 meters of a race with cold water. (And I'm an otherwise decent swimmer who has never panicked on the swim.) At best this leads to uncomfortable bloating on the swim (from swallowing air); at worst triggers something similar to asthmatic wheezing for several hundred yards into the race until I can settle into a rhythm. (I do have asthma but not typically exercise induced; more typically triggered by smoke, dust, mold, sometimes cold, dry air.) Not sure if the swim issues are related to asthma or dive reflex, or both.)

A swimming warmup solves all these problems but I can't do it if the air is cold and/or there is a prolonged wait before the start as I will shiver too much once I get out of the water, and cramp. (I am a true cold-water weenie!) The splashing and exhaling does definitely help with the breathing issues for a cold-water race. This typically happens to me in water in the 50's or low 60's; 65 would be possible, though. Anxiety may have lowered your tolerance threshold or something; if you don't typically swim in a wetsuit, that can also feel confining and contribute to uncomfortable breathing at the swim start.
2019-06-06 2:01 PM
in reply to: clinicisopen

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Subject: RE: Autonomic responses on the swim
Typically I do not have issues on the swim to begin with, so I'll relate via my coldest swim to date.

Indian Wells 70.3 last year was like 52 degrees.
They debated having the swim and in the end, went ahead with it.
I opted not to touch the water until the race started.

HOLY S was that the most painful water entry.
Luckily we went in from shore, but I grabbed some water, splashed it on my face and tried to get some into the suit before I was in fully.

Didn't matter.
THAT WAS SOME COLD A$$ WATER.
My face hurt.
It was a shock to say the least.
Luckily from racing the past 15 years, I have my routine at the start breathing every stroke to keep air coming in and trying to purposefully go slow and not get caught up in the excitement. Nice big breathes. Start wide until I find my rhythm and slide back into the group.

Adrenaline mixed with anxiety makes a daunting situation worse.

I tell my athletes to get to open water swims, and first time in, treat like race day.
Go in full speed, stay close to shore so you can stand up if needed.
Get experience going aerobic in the swim and work on trying to relax while swimming to get back to ok.
Repetition is key.

IMO
2019-06-06 4:55 PM
in reply to: clinicisopen

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Subject: RE: Autonomic responses on the swim

I probably should read the article before I reply because I am not a physician and am don't know the definition of autonomic responses, drive reflux, etc.  I do have experience with cold water though and am always happy to see experience in context with theory so I will share what I know about cold water.

 

Camp Steiner had the reputation of being the coldest Scout Camp lake in  Utah when I was growing up.  I went there as a 13-year-old scout and later when I was 15 years old as a staff member. Its aquatic activities are all done in a glacier lake at 10,300 feet above sea level in the Unita mountains.   two years after I was on staff they still had 3 feet of snow on the ground when the Camp was supposed to open up the middle of June so they postponed opening the came until July then offered a modified program that include the shoe shoeing meritbadge and the snow skiing merit badge.   

 

The first day of Scout camp always involved a swim check for every scout in camp.  To participate in the aquatic activities (Small boat sailing, rowing, canoeing, etc. you had to jump in the water over your head, swim 50 yds of a front/side stroke, made at least one turn in the water, swim 25 yds in a stoke of your choice, swim 25 yards in the elementary backstroke, and  float on you back for a minute.  The surface temperature of the water was in the low to mid 60's on warm days but I am sure that if you went down a few feet and/or got out of the shallo water near the shore that to the water temperature was in the high 50's on a hot day. 

One of the leaders explained to me that the reason that we had to jump in over our head (and let out head go under the water) was that may people would go into shock and that someone who might be a great swimmer could go out in a canoe and it tipped over in the middle of the lake if they could not handle the shock could drown.  

Yes, there was shock jumping into that lake.  I did it about 7-8 times in the two summers I was up at came (all of them on purpose).  The first thing that I remember feeling is that the air in my lungs collapsing and not being able to breathe.  70% of the scouts failed the swim test in the first 3 seconds of the test.  They jumped in and couldn't take the shock and jump straight back out.  After about 3 times I learned that it helps to scream like you are in a panic.  It made a good show for the people watching but it also helped to get the lungs moving air in and out.  Then you had to start swimming hard.  that helped get the breathing going too as well as some circulation to the extremities.  We didn't have wet suits, goggles, or swim caps.  the worst part of the swim was about the first 90 seconds in the water after that your body went numb and you couldn't feel anything so cold became bearable.   When I was 13 years old my strategy was to get in swim my laps and get out so that I could have fun sailing and canoeing for the rest of the week.  When I was a staffer at age 15 I learned that after being in the water for 5 minutes that I was numb and that I might as well try to stay in longer to see how things went.  I think one weekend after all the scouts had checked out that 2-3 other staffers and I swam for a good 30 minutes in the lake and actually had fun. 

Cold water is NOT for everyone.  I have never done a Polar Bear Plunge and never hope to but some people do.  I believe that you can prepare yourself for the cold water shock by doing it a few times so you know what it feels like and how to react to it.  I am interested to hear what a physician and scholarly study has to say about this phenomena and how it might relate what I went through and saw others go through every week as Scout Camp.  I have to say that since I started doing Triathlon I have been a little sinister with regards to cold water complaints.  Doing OWS in northern California Oceans and Utah and Wyoming creeks and lakes every summer was part of growing up.  We were in the water every chance we got and we would never let the adults hear us say we were cold (even though I always was) because if we ever did they would make us get out and that ruined the fun for everyone.   

2019-06-06 9:10 PM
in reply to: #5259589


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Subject: RE: Autonomic responses on the swim
Worth a read:

http://www.endurancetriathletes.com/sipe.html

Swimming is the most dangerous leg of the triathlon. People get in the water and their heart rate is already up because of race jitters. Hit cold water and it compounds everything. Then add if someone does have a cardiac event or emergency, it’s a lot harder to manage in a body of water versus a sidewalk or street.
2019-06-10 2:07 PM
in reply to: Hot Runner

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Subject: RE: Autonomic responses on the swim
Thank you for the comment!
You bring up some important additions: underlying pulmonary/allergy issues- those of us who have a "twitchy" pulmonary system can clearly react with the vast number of stresses swimming brings to the table. Curious if you ever prophylax with an MDI (inhaler) prior to the swim? While it may help with lung reactivity, it could increase the anxiety component.
Speaking of anxiety, you also mentioned this and I think its a very good point. Strange we would find air hunger as a threat
Dive reflex, air hunger, anxiety, no pre-swim (wasn't an option), first wet-suit (with a tight neckline) all likely contributors.
It's like I was asking for it.
I have scheduled a number of open swim practice session...


2019-06-10 2:39 PM
in reply to: TriJayhawkRyan

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Subject: RE: Autonomic responses on the swim
Thanks Ryan, no way I could consider 52 degrees...that's insane, your more of a man than I am.
Question: you mentioned going wide?
Question; you mentioned breathing every stroke...my issue was that everytime I put my face in the water (thank you vagal response), it was back to gasping.
One thing is for certain, your comment repetition being key is well documented in the literature. Here is an interesting findings:
Fabian Steinberg compared experienced divers and novice undergoing breath holding and EEG activity (alpha wave) disparity.. the disparity was most likely due to conditioning and cognitive over-ride to our innate desire to breath.
Neurocognitive Markers During Prolonged Breath-Holding in Freedivers: An Event-Related EEG Study.
Steinberg F, Doppelmayr M.
Front Physiol. 2019 Feb 6;10:69. doi: 10.3389/fphys.2019.00069. eCollection 2019

Moving forward in addition to additional OWS I am changing my breathing pattern during my pool swim. This induces air hunger. My hope is that as I become more familiar with the feeling, I will be able to regulate it.
2019-06-10 3:05 PM
in reply to: BlueBoy26

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Subject: RE: Autonomic responses on the swim
Curtis, thanks for your comment. Your message took me back to a very special place. I served 24 years on active duty, 8 of those years were in Kenya were I served as advance chair for our scout unit. All 3 of my boys were in scouts, such fond memories. I also own chickens now for what it's worth.
As a primer on the dive reflex, you describe it below very well. On entering the water the temperature and the pressure of the water send a clear message to the brain that your going to die. While this is tempered a bit cognitively, physiologically your body does some interesting gymnastics. First, your heart rate drops, this is followed by peripheral blood (your arms and legs) being shunted to your brain and heart which makes those of us who really need to use our arms and legs annoyed and subject to more anaerobic type energy sourcing. Not fun. So, in short, your body is in conservation mode and it needs to be in "lets get going" mode. [On hitting the water, my heart rate dropped to 29 per my HRM]. There are also special nerves in your face (trigeminal) which also send important messages to the brain about just how much danger you are in (thus, getting your head underwater and your face used to the temp can be very important..which I did not have an option to do at this event).
It seems, based on the literature, that many of these primitive reflexes can be "addressed" on a cognitive level (clearly not my cognitive level yet). See the study I sent in a previous post.

Something interesting you mentioned regarding about a slight lack of empathy for those complaining about cold water. I was discussing this issue with a friend of mine who is pretty elite as an Ironman (the real deal), as a kid he had the same issues, but as he practiced it got easier, so much so, that he doesn't even really think twice about cold OWS. Prior to his Ironman, the water was about 68 and it had been a very long time since he swam in cold water (he hadn't brought a wet suit). He said he jumped in, swam a bit and thought..."yeah, I got this".
It may be that once your brain learns to deal with it, it has a substantial half life. This could be the case with you and all the cold water.
I spent most of my childhood in the water also..but that was in Oklahoma (your home!). I the paper I sited, the authors reviewed the possibility of a conflicting cognitive process (negative avoidance vs positive goal achievement). I know with many kids, they can endure unbelievable discomfort, if they find what they are doing "fun". As we get older, I think our assessment of "fun" is tainted (less things are new and exciting) and we tend to be acutely aware of risk. This could tend to push us toward the negative avoidance side of the equation...all just speculation of course.

Shon
2019-06-10 3:33 PM
in reply to: clinicisopen

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Subject: RE: Autonomic responses on the swim
Yes, the inhaler is a two-edged sword. I do use it before a race if I am having allergy symptoms, have a cold, or have good reason to believe there will be triggers like smoke or dust on the course. There's also one particular race in the past where I have had to use it because (weird, but true) I am just violently allergic to a large flowering tree that one passes twice on the bike course! But asthma meds do tend to elevate heart rate and anxiety levels at the start. I guess the good thing is that I recognize both the dive reflex and inhaler side effects for what they are. I don't panic, or think I'm going to die. I have developed ways to get through it, mainly starting a little slower if the water's cold or my breathing feels iffy, positioning myself so I have more clear water at the start, and gradually picking up speed as I go on, and just do that.
2019-06-10 5:26 PM
in reply to: Hot Runner


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Subject: RE: Autonomic responses on the swim
Cold water is definitely a different experience. I had my wetsuit for a year and a half before I got brave and trained in cold water. I'm sure it is not as cold as some of you have experienced because I live in Florida, but water under 70 degrees was a new experience for me. I had a hard time swimming with my face in the water, because all I could think was wow this is so cold. Luckily, my swim group has open water practice year around and this was just practice.

The first couple of times I went to practice when the water was cooler, I had a difficult time swimming freestyle. When I felt panicked, I switched to breast stroke or back stroke. I also learned when the water was below 70 degrees, I needed a super long warmup or my swims would not go well if my body was not used to the cooler water. One day, it was cold outside and the water temperature was 59 degrees. This was by far the coldest water I have ever been in. The second I stepped in the water my feet cramped so badly that I didn't want to swim. The coaches were very patient, but everyone admitted how cold it was. Once all of me was in it felt like my body was trying to fold itself up to stay warm. I didn't want to move.

What I have found has worked for me in these situations is a super long warmup, not necessarily swimming, but getting used to the water, and taking your time. If you get panicky, do back or breast stroke and count to 3 as you breathe in to get a nice deep breath, which will help calm you down, but overall it is about you and noone else. You don't know anyone else's experience level or experience in cold water. It is most certainly a learning process.

2019-06-10 6:06 PM
in reply to: clinicisopen

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Subject: RE: Autonomic responses on the swim
Ha, more of a man, to be determined. More crazy, maybe!

Ironically just got done with Escape from Alcatraz yesterday. Everyone on high anxiety alert for a "cold" swim at 56ish degrees...
Luckily for all my experiences in cold water to date, I knew what I needed.
Full sleeve suit.
Neoprene cap.
Did NOT use aqua socks or anything else.
Knew when I hit the water to be ready for shock and start moving IMMEDIATELY and breathe bilaterally every 3rd stroke.
Worked like a charm.

I will admit I was curios how it was going to work since we had to jump off the ferry with no way to test the water or do a warm up swim. Just put my suit on 20 minutes before the start, kept moving to stay warm and trust my past experience that the cold and shock would pass as long as I kept breathing on short stroke count and the numbness of the cold would settle in.

By going wide, I mean starting on the outside of the group. The fast and aggressive swimmers stay tight to the buoy line and there's more contact that there that increases anxiety.

For the stroke count, I do a LOT of swims with various stroke counts. I will ladder up to 8 strokes per breathe. Teaches you that you will not die without air, and if you have issues, just stand up in the pool. I do hard sets and cool down while still swimming to learn to control intake when anaerobic.

One key that I was reminded of in the Escape yesterday was with the salt water. That stuff tastes nasty and I didn't even think about it until we jumped in. It made me start blowing air out IMMEDIATELY upon my mouth going under with force. That forced me to exhale completely with face under continuously and immediately go for air when my face came out. It kept water from getting in my mouth and getting complete breathes when face out.

And to your point with Steinberg, in my breathing drills, I will admit that I have had a few freak out moments where I hit the wall, push off and didn't get enough air to make me comfortable, but forced myself to complete the stroke count. The death response is real. It's an odd sensation that you are not passing out, but you can see how it would happen without air much longer... I don't like those instances, but they have helped.


2019-06-13 8:52 AM
in reply to: Parkland

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Subject: RE: Autonomic responses on the swim
Thank you for the article. First, hats off to Kathrine for being in the kind of shape that most of us can only dream about.
SIPE is very intriguing and distressing as the etiology remains illusive.
Interestingly, there was a case report in MDPI Sports this month

http://www.endurancetriathletes.com/sipe.html

I suspect, as the case report alludes, that SIPE (or maybe pre-SIPE) is far more common than we suspect.
The fact that individuals who are predisposed tend to be in great physiological shape, it really demonstrates how we, as human athletes, come up against our physiological limits.
One interesting side note was the thought that fish oil may be a predisposing factor. I am an advocate for fish oil, but it is possible to overdue it as it tends to act as mild anticoagulant. It makes sense that in these extreme situations of alveolar pressure, anticoagulation could be a predisposing factor.

Thanks again!

Shon
2019-06-13 9:02 AM
in reply to: sbrtheplanet

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Subject: RE: Autonomic responses on the swim
Thank you! I could not agree more
Your experience was very similar to mine, although, strangely I could never catch my breath and because I spent so much time on my back, I had motion sickness. I remember thinking..."your hyperventilating", after about a 20 meters of freestyle my respiratory rate would be around 30..it was crazy.
Our face in the water sends strong safety signals through the vagus nerve, I suppose I am just a sensitive guy

Your points are well taken: the extent is individual, experience/practice is paramount (as others have noted), a good warm up is highly advisable.

Thanks again

Shon
2019-06-13 10:20 AM
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Subject: RE: Autonomic responses on the swim

This has been an interesting question and responses.  I just wanted to add one thing that seems to be different from the others experiences. 

I was extremely anxious about swimming in races. I don't mind the lakes, or even the cold (too much), but I started from scratch as a swimmer and just wasn't sure I could do it.  The only way I could swim normally during a race was if I had a warmup.   If I couldn't do a warmup (per race rules) then I had to treat the first part of my swim as I would a warmup.  Start when I was ready and swim alone.   Normally with lake swims in Minnesota, everyone just starts on the beach.  The good swimmers run in, I would walk in and take my time.  The extra 30 seconds on the front end allowed me to swim better overall.  There's NO WAY I could get my composure while starting to swim with the group.  (This is where my experience differs from others).  I would rather stop and hang on a buoy or dock than try to swim if I am panicking.

I did a race in Wisconsin that was a series of sprint races you completed, one after another, over a period of 5 hours.   You start together (so, I hang back a bit) and the next time you just get into the lake after your run.  It was cold enough that I lost feeling after approx 50 yards, so pretty cold.   I never panicked on those swims, even with the cold, because I was not freaking out about the situation.  

So, my I agree with the theme above which is that confidence is key no matter the temperature or situation.  It may be that the new wetsuit and cold water added to your anxiety and you probably expected to have trouble breathing.   Meditation before getting into the water, and while swimming (the purpose behind stroke counting, I think) also really helps.   I would sing a song in my head that had a tempo that matched my pace.   I also knew that in most races the swim is such a small percentage of the time it's not worth working so hard that I am breathing hard.   The swim was merely a warmup/necessity for getting on the bike - the actual fun part of a triathlon    

Best of luck to you!  



Edited by BikerGrrrl 2019-06-13 10:23 AM
2019-06-13 9:52 PM
in reply to: BikerGrrrl

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Subject: RE: Autonomic responses on the swim
Originally posted by BikerGrrrl

This has been an interesting question and responses.  I just wanted to add one thing that seems to be different from the others experiences. 

I was extremely anxious about swimming in races. I don't mind the lakes, or even the cold (too much), but I started from scratch as a swimmer and just wasn't sure I could do it.  The only way I could swim normally during a race was if I had a warmup.   If I couldn't do a warmup (per race rules) then I had to treat the first part of my swim as I would a warmup.  Start when I was ready and swim alone.   Normally with lake swims in Minnesota, everyone just starts on the beach.  The good swimmers run in, I would walk in and take my time.  The extra 30 seconds on the front end allowed me to swim better overall.  There's NO WAY I could get my composure while starting to swim with the group.  (This is where my experience differs from others).  I would rather stop and hang on a buoy or dock than try to swim if I am panicking.

I did a race in Wisconsin that was a series of sprint races you completed, one after another, over a period of 5 hours.   You start together (so, I hang back a bit) and the next time you just get into the lake after your run.  It was cold enough that I lost feeling after approx 50 yards, so pretty cold.   I never panicked on those swims, even with the cold, because I was not freaking out about the situation.  

So, my I agree with the theme above which is that confidence is key no matter the temperature or situation.  It may be that the new wetsuit and cold water added to your anxiety and you probably expected to have trouble breathing.   Meditation before getting into the water, and while swimming (the purpose behind stroke counting, I think) also really helps.   I would sing a song in my head that had a tempo that matched my pace.   I also knew that in most races the swim is such a small percentage of the time it's not worth working so hard that I am breathing hard.   The swim was merely a warmup/necessity for getting on the bike - the actual fun part of a triathlon    

Best of luck to you!  




Ah! I like the idea of the beginning of the swim as a warmup, this is a good mental warmup as well
I get anxiety when I am "attached" be fellow swimmers. This is caused by some trauma from one of the versy first races, where the waves were organized in such a bad way that younger guys followed women age group. I had a nice start, everything was beautifyul, and I got ...smashed... by two very fast and very strong guys. I barely finished, could not get my head under the water, completed the swim in the "don't wet your hair" type of breaststroke.

Thanks all for sharing the very helpful tips regarding cold water swim. This is very useful discussion.
2019-06-20 6:32 AM
in reply to: sbrtheplanet

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Subject: RE: Autonomic responses on the swim
Thanks JJS for your input!
Certainly noting a theme around those of us who struggle with colder water and totally agree with a good "warm up" or acclimation.

One thing you mentioned is important and I was not able to achieve (others may want to comment). Taking a deep breath in..for me I simply could not do this on my swim. Ok, yes, I could take as deep a breath as possible, but the kind of breath where you fully expand your lungs and contract the diaphragm. Way back in 1938 Dr. Maytum described a syndrome called "sigh dyspnea" (the sensation that you can't get a full breath). There are a number of physiological things that happen with a deep sigh in terms relaxation, slower breathing, slower heart rate and general calming. Regarding the swim see various comments from Ryan.

Over the past several weeks (as an experiment) I have forced myself to change my breathing in the pool, such as breathing every 4th stroke. This was to generate that sensation of oxygen deprivation in an attempt to "get used" to the feeling and the anxiety that it generates. I noticed that I full deep sigh on turns (if it could be accomplished) was literally like a "breath of fresh air" and significantly addressed any anxiety...no full sigh had the opposite effect. Thanks for the 3 second inhale point.
Also, for those who struggle with motion sickness, when turning over on ones back, its important not to stay too long in that position in open water as you tend to take on the wave motions...feeding the fish is a real possibility. Even alternating 10 strokes, on the back for a 10 count, then 10 strokes can really help

Shon


2019-06-20 6:39 AM
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Subject: RE: Autonomic responses on the swim
Thanks Bikergrrl!

What you describe is completely in line with the USAT article I posted earlier. It notes to "take your time getting used to the water" stressing putting your face in the water as well.

https://www.teamusa.org/USA-Triathlon/News/Blogs/Multisport-Lab/2015...

You have a good strategy for sure.
  • .and I agree, first wetsuit swim may have been a factor as I felt it was compressing/impeding my breathing.

  • There was a nice paper I reviewed which demonstrated that seasoned swimmers and beginner swimmers have the same basic physiological response to water (it's hardwired), but clearly they dealt with it differently. My guess is that we each have an intrinsic ability to address the psychological responses to the physiological responses...yours sounds pretty strong


    Shon

    Edited by clinicisopen 2019-06-20 6:43 AM
    2019-06-22 9:37 AM
    in reply to: clinicisopen

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    Subject: RE: Autonomic responses on the swim
    You might want to read some on SIPE. This is more common in cold water swims with no warm up swim period allowed prior to the start (i.e. cold water Dive Reflex). I have a friend/team member that has ended up in the ED twice because of this (the first time, she was life flighted from the race site, and luckily on the second she recognized the signs and symptoms and had a water craft pull her from the swim and she was brought to the ED by vehicle).

    I've attached an interesting article on SIPE out of Duke. It looks like it has promise.

    I hope your future swims go well and you get this kicked!!

    https://anesthesiology.duke.edu/?p=833915

    *disclaimer I am a physician but this is not my specialty and I am in no way try to diagnose or treat you over the internet. We triathletes see more of these difficulties brought out on cold water swims and I am just trying to provide some additional information.
    2019-06-26 9:32 AM
    in reply to: Rdracer99

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    Subject: RE: Autonomic responses on the swim
    Thanks rdracer99!
    -Indeed, Moon and colleagues at Duke are really the ones making breakthroughs in the field of IPE/SIPE.
    Based on the current phenotype of those at risk for SIPE and the current epidemiology, its clear I'm not in good enough shape to have SIPE

    That said, physiologically, there is considerable overlap and mechanisms have action that overlap with SIPE. Richard's work on SIPE at Duke has illuminated much of the physiological responses to cold water stress and (IMHO) sheds considerable light.
    It may be that IPE constitutes a spectrum in which an exaggerated vagal component plays a role.

    Thanks again!

    Shon
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