Channel Swim Abandoned Due To SIPE
Well that didn't go to plan. Instead of recovering from a celebratory Babycham in the White Horse in Dover I found myself in a hospital bed in Ashford on Sunday morning. My attempt to swim the English Channel was foiled in French inshore waters by Swimming Induced Pulmonary Edema (SIPE). I'd been airlifted from my support boat and was in a resuss bed.
The First 11 Hours
I started my Channel swim just after 7am on Saturday morning. The training had been done, it was a beautiful morning and weather was forecast to be improving. I had the pilot and crew that I wanted. I was raring to go. I was greased up in the mixture of sun cream and udder cream which it’s basically a mix of Vaseline and lanolin (good for cows and Channel swimmers and even better for Channel swimming cows). Over the side and a short swim to the beach at Samphire Hoe for the official start. A few Pilates moves on the beach and some wise motivational words to myself about not stopping until I hit France and I was off.
I fed every 45 minutes for the first six hours then every 30 minutes thereafter. As is normal on long swims it seemed to be an age until the first feed but then time weirdly starts to lose its meaning altogether. The White Cliffs slipped away slowly but I was pleasantly surprised when I was told sooner than expected that I was in the middle of English shipping lane and this encouraged me to plough on. My stroke rate remained constant and I was just starting to feel that I'd really settled into the swim when I reached the Separation Zone, the area between the English and French shipping lanes.
Apparently the collective noun for jellyfish is a smack. There were plenty of them in the middle of the Channel and I remember swimming through two large smacks of Blue Jellyfish but also saw lots of Compass Jellyfish and a few Mauve Stingers. Most passed harmlessly beneath me and I only picked up two or three stings which weren't too painful. I have to admit that I hadn't been looking forward to the Channel Jellies but on the day I enjoyed seeing them: they're really beautiful and give you something to focus your mind on. I'd add that I didn't see any of the large thug-like, but harmless, Barrel Jellyfish that the papers would have you believe terrorise swimmers along the South Coast.
My stroke was constant and I was really happy, swimming well until around the 11 hour mark. The swell had settled down in the separation zone but appeared to pick up again as we progressed through the the French shipping lane. I had a fantastic crew who knew how and when to encourage me. In fact their methods of encouragement were perhaps unorthodox but I should let them explain that themselves - what occurs in the Channel stays in the Channel!
Onset of Breathing Difficulties
I started to feel short of breath as we cleared the shipping lane and entered inshore waters. The conditions were now much rougher and I felt like I'd been swamped several times. I kept my stroke rate up and maintained speed but it felt progressively harder to catch a breath and I'd developed a rattling wheeze. I remember stopping, hoping that a good cough would clear the fluid on my lungs. It seemed to help at first but what I wasn't realising was that the fluid was coming from within my lungs rather than from the sea. My condition continued to decline as fluid from my blood stream flooded my lungs. In layman's terms pulmonary edema is fluid on the lungs and as it practically affects a swimmer in the water it's like secondary drowning.
The more my lung capacity decreased, the harder my heart had to work and the worse things got. It was probably a vicious circle that couldn't be reversed. In retrospect I should have quit at this point as it was never going to get any better. It felt like I was suffocating and I now know that technically speaking this was because I was. But the mind of a determined swimmer who has trained hard and made sacrifices for three years to achieve their goal of swimming to France is not rational! I was frustrated as up until recently I'd been swimming well and making good progress. I could see French shoreline ahead and remember thinking that it just needed a solid hour or so swim and I'd have broken the tide and would be within spitting distance... There was no way I was quitting and was determined to carry on... I'd have to be dragged out.
I was dragged out five minutes later after 12 hours 32 mins. Hypothermia can cause a confused mental state but my crew reported that I'd been fine and totally responsive right up until the final few minutes when hypoxia really set in. Once back on the boat my condition was assessed and swimming induced pulmonary edema (SIPE) was immediately suspected. The pilot assessed our position and it was decided that even if an ambulance was waiting on the dock then there may not be enough time as we were pretty much 1.5 hours from any major port.
I was on the edge of consciousness and it was decided to request assistance from the coastguard. The helicopter arrived within minutes and evacuated me from the deck of Sea Leopard. They immediately gave me oxygen before airlifting me to Ashford Hospital where I was further treated with oxygen and administered diuretics to clear fluid from my lungs.
I spent four nights in hospital. My blood tests revealed high levels of troponin which can indicate heart attack so I was admitted to the cardiac care department where they ran several tests and procedures including an angiogram. In the end the consultant seemed satisfied that although my heart had been severely stressed I hadn't suffered a heart attack but non-cardiogenic pulmonary edema.
Is SIPE More Common Than We Think?
One of the reasons that's I'm writing this in as much detail as I can remember is that I feel that there is some ignorance about the condition in the long distance swimming community. It's often reported as being rare but I think that it's probably just under reported. This may be because it happens at the end of a long swim and doesn't reach a critical stage. But if untreated and allowed to progress it certainly has the potential to be fatal. Since my story was mentioned on social media I've had several swimmers contacting me already suspecting that they’ve suffered from it. Also the consultant at Ashford hospital said a patient presented with it just a week before me after a training swim in Dover.
I've been truly humbled and moved by the messages that I've received from family, friends and even people I've never met. Although I'm never going to be able to reply individually to you all I hope that if you get to read this you will realise how appreciative I am.
My crew kept me entertained and made the first 11 hours of my swim a lot of fun. When the chips were down they made the right call at the right time. Without them I'd probably not be around. On top of this they've all been fantastic since and really helped me with the disappointment of not achieving my aim of landing in France. Any negative thoughts have been offset with the joy of still being here to write about it. I know naming them will embarass them but I'm going to do it anyway as they all deserve medals!
Stuart Gleeson (Cold Wet Pilot)
Gary Clark (Cold Wet First Mate)
André Roberts (Cold Wet Official Observer)
Tom Watch (Old Wet Bloke)
Marc Newman (Fast Wet Bloke)
Sarah Pascoe (Funny Wet Girl)
Karen Rees (Cold Wet Bon Jovi)
Sarah Oldrey (Cold Wet T-shirt)
Katja Tribbeck (Cold Wet Wife)
The helicopter crew were Martin, James, Garry and Ian. They arrived swiftly, assessed the situation and evacuated me to safety whilst administering first aid and preventing further deterioration in my condition. Proud to be be British but I guess I shouldn't have expected less. All done in a calm, efficient and friendly manner, even with a smile. Total credit. Thanks guys.
This was my longest ever hospital stay and I found myself fairly bemused. You spend all day with no idea what's going on then get 10 minutes with the consultant during which you forget to ask all the questions you've been saving up for the last 23 hours and 50 mins. I spent most of my time looking forward to mealtimes and the highlight of the day was to guess what I was eating. Systems and admin aside, the medical staff were fantastic. I had a brilliant consultant and fantastic nursing care. Special thanks to David who made me smile every day and the woman who come around with the tea trolley.
I learnt that I'm not immortal. That actually came as the biggest shock to me. I would still like to continue within the sport of long distance swimming but will not do so before I've answered some questions. I need to know if I'm prone to SIPE or whether this was a one off. I also hope that I can help raise some awareness of this phenomenon which I suspect happens more often than we think.
My training regime, crew selection and pilot selection all proved to be spot on and if I was able to go again I wouldn't change a thing in those respects. After preliminary reading it doesn't seem that there's total agreement on the exact cause of SIPE, other than it could be a "perfect storm" of a several contributory factors. There are some things we can't change such as vasoconstriction due to cold water and long term exertion, but other variables that have been suggested are over hydration, hypertension and even fish oil supplementation.
I'd also urge all other long distance swimmers to learn about SIPE, it causes, symptoms and first aid. There are degrees of severity but it seems that once a swimmer has begun to suffer the effects it can only be reversed by treatment. If you suspect SIPE, you must and without delay:
- Remove swimmer from the water
- Sit patient upright
- Seek urgent professional medical attention. (Oxygen is not normally carried on board pilot boats as it is a prescribed substance but professional treatment will probably include administration of oxygen and diuretics.)
If you're thinking of putting a team together for a Channel swim I'd urge you to make sure that your team is educated and knows the correct first aid procedures. If you are the swimmer don't fool yourself into thinking that you'll know your limits! I knew when I was going downhill and knew when I probably should have got out. But as Channel swimming has totally consumed all rational thought processes of late what I lacked was objectivity. The type of endurance that an English Channel swim demands makes it an extreme sport which requires extreme preparation.
I really hope that SIPE can be more fully understood. It would be a good thing if we were even able to build up a risk profile so swimmers could self-assess and minimise their personal risk factors. I was lucky as I had a great personal crew and a great pilot and boat crew. They were empowered by knowledge and skill and did everything right.
Don't let my recent experience put you off open water swimming! Whether you're interested in long distance swimming or fun dips, join your local club or Facebook group. If you're in the Bournemouth area I'd recommend East Dorset Open Water Swimming Club, Beyond The Blue, Durley Sea Swims and Just Swim. I regularly swim with all these groups and membership ranges from lunatics to World Champs! All the nicest people you'll ever swim with.
So sorry you had to go through SIPE Jon but I can’t think of a better person to inform the swimming world of the condition. You have given us the necessary tools to assist should we suspect the condition in fellow swimmers and this will save lives. I promise to share far and wide so that the ‘perfect storm’ that you suffered will not have been in vain!
KEEP SWIMMING MATE MUCH LOVE KAT
That,s a terrible situation to be in after your great wild swimming and all the work you have done to get to your fit swimming goal . thanks for the Information . hope you have recovered to full health now .
Best wishes and good fortune .
Thanks Colin. All fine now and all set to try again in July.
Thank you so much for such a frank and detailed discussion of the condition. I had never heard of it. I can fully understand the danger of such a condition towards the end of a long and extremely challenging swim when you would be expecting perhaps to have to push through some discomfort normally. Being able to recognise the difference between acceptable discomfort and a condition like SIPE, which is only going to deteriorate and could easily prove fatal, is absolutely essential. In my book you have succeeded wonderfully. You did the hard training, you did a momentous swim, you put together a top crew who could make the right calls, you recovered from SIPE and you’ve raised awareness of an important issue for folk like us who regularly get into cold water for fun.
Wow, just read your story. What a palava. Live in jersey, many of us swim a lot, hadn’t heard of it before. thank you for sharing your experience.
Well done. Hero for having done all that swimming. Having crewed on long distance swims have always worried would know whether to pull the swimmer out, Well done crew.
Hi Frank, thanks for raising this subject. I wasn’t aware of SIPE but I think that this has happened to me several times. The first was swimming in a lake in April so the water was cold. I was wearing a wetsuit. It started with a cough which grew worse and was frothy and I was coughing up brown mucus. I had to get out as I couldn’t carry on swimming. I was concerned so went to A&E but it had nearly cleared up by then. They suggested that I had inhaled water and did an ECG which thankfully was OK.
The next time I was pretty sure I wasn’t inhaling water. It happened about 500 metres into the swim. A Doctor at the event said it may be because the wetsuit was too tight.
In the end I bought a wetsuit that was thinner and looser. My next event was in a lake and it happened again after 750 metres. This time the water wasn’t cold but I still started coughing which grew worse. I recognised the symptoms and got into the rescue boat.
I’m beginning to think that it now may be an automatic response to open water swimming.
Thank you for sharing your story and I am so glad that you are alive and well! I have heard of SIPE and am curious if I have some strange sort of similar reaction to open water swimming in the cold. I swim in Maine, USA and the water is cold, even in the summer months. My lungs react to the open water and I have a hard time breathing about a mile into the swim and usually swim 1-3 miles. Singular (an asthmatic medication) helps with this. However, I have had an unusual reaction 5 to 6 hours after a swim race only, not during practice or a regular open-water workout. Later in the day after a long race of 2-3 miles in cold water, my chest feels like I am having a heart attack, my lungs hurt, it is hard to get a full breath, I have chills am light-headed and feel so terrible. I hydrate well and have good nourishment, as I am an experienced endurance athlete. I do not typically have wet lungs during this period. I have been to the ER and have had EKGs, etc and they say that my heart is fine. However, it is an awful feeling and very scary later. I usually feel better the next day. I am waiting for an allergy specialist to help me out, as my primary doctor, my osteopath and my cardiologist can’t seem to find out what is wrong.
I appreciate any further guidance and recommendations. Thank you so much for this forum! All the best.
I think that I have also had this, both times in open water. One time in the bay (salt) and another time in a fresh water lake. Both times I was wearing a wet suit. I may have inhaled water after panicking due to wheezing and shortness of breath. Starts with wheezes and a need to cough and also to be upright in the water. I was swimming short distances (500 to 750 distances) when the symptoms began. I was able to make it to the shore, but could hardly walk up a short hill, I was so short of breath. The cough and wheezes lasted for hours afterwards. I have no history of asthma or chronic cough.
The first time, I went to see a pulmonist, had an EKG, found nothing cardiac wise, but who was sure that SIPE was limited to deep sea divers……… So yes, I think it happens a lot, doctors are not versed in it and people may chalk it up to just inhaling water, so it is underreported. This same thing appended to my sister as well.
Sorry to did not get to complete the channel swim, but glad u r ok. It is definitely scary.
Interested in your story
I have tackled the channel in relay one solo attempt
I am cardiologist
Would love to talk off line here as I am trying to put cases together with a friend and cardiac colleague for research
I had a non-acute episode of this some years ago when triathlon training – verified as such by the fact that it was blood I was coughing, not water. (Those above confusing this with inhalation of water – it isn’t. It’s blood crossing into the lungs from various pressures.) Saw a cardiologist later but all well by then, though I did get very good advice by telephone from one of the country’s leading experts in the field. I now compete only in water of 15 degrees or above, take hypertension medication (I was marginal before, and family history not good), underhydrate when about to swim open-water, use a wetsuit that doesn’t compress the chest, and warm up well before going in, amongst other measures. Geoff Toogood, happy to contribute to any research. Are you the Aussie Geoff Toogood who used to work in Plymouth, as listed on Facebook? If so, happy to message you my email address if that could be of use.
Hi Geoff. Thanks for posting. I’ll certainly get in touch with you off line. I’ve had several medical professionals contact me who are interested in further research so hopefully more can be understood about this condition which certainly seems to be more common than may people think.
Hi Geoff, think I may have had several occurrences of this. Just wondered if you got anywhere with your research as there is very little information about it.
Hi. Thank you for sharing your experience. I, too, have experienced SIPE. I was pulled out of the water in the Ironman Lake Placid 2016, and stayed in the hospital for 2 days. I have also posted a blog recounting my experience. I hope you don’t mind, I’ve updated my post and included a link to this post. I do hope people become more aware of this “rare” occurrence, and the possible ways to prevent it from happening.
Thanks for your comment. I’ve read your blog post and your account certainly sounds very similar to mine. I’m really hoping that people will learn how to recognise the signs as judging by the amount of people I’ve heard from who’ve experienced SIPE to varying degrees it certainly doesn’t seem to be that rare.
Thanks to everyone who’s commented on this post and also sent me direct messages. Sorry I haven’t been able to reply to all of you yet but I went on holiday to deepest darkest Dorset after my experience and had little of no Internet! Judging by people’s reactions it seems that many people (including myself) hadn’t heard or encountered SIPE until they, or a friend, had been directly affected by it. Hopefully this situation will change. SIPE doesn’t only affect Channel swimming so I think it’s really important that swimmers educate themselves about the causes, symptoms and first aid. It certainly seems to be a condition that is very under reported snd so is probably not as rare as many would have you believe.
Hi Jon – a well written account of what SIPE feels like when on long distance swims. I had the same on a 20Km swim a couple of years back and like you did quite a lot of research on the matter only to find that no one really knows. A close friend also got SIPE in the same race but a year before so have a “baseline” to work from. Weather conditions in either year were not like the English Channel as swim is based in Australia during peak of summer where temperatures are a little more kind. This also meant no wetsuits were used in either swim. There was also no evidence of swallowing water (which is a common “theory”) as conditions in one of the years was completely flat. One possible aspect that came to light was the degree of hydration as we both followed an almost identical nutrition plan and the level of hydration was higher than a couple of coaches thought it should be once it was more heavily discussed after my swim. I, like you, believe this occurs more often than what is diagnosed as aware of others who have also had SIPE during long open water swims.
Hi Shane and thanks for your comment. I’m coming to same conclusions to you in that nobody seems to know the exact causes, only that a combination of factors is probably to blame. Originally I thought that I’d inhaled water but I now think that could be a red herring and that all the water in my lungs had come from within. I’m also looking at over hydration. I certainly ended up seriously over hydrated but I’m not sure whether that was a cause or a symptom.
I’m also going to change my training regime. Usually I train by swimming hour-long loops and then coming in to a beach to feed. In the future I’m going to try and incorporate more sessions with feeding from boats or kayaks so that the body has to stay used to being horizontal for longer periods.
I got this too after my 19 hour swim to the Farallon Islands. Thank you for alerting others to this. I though it was a bit strange that it hadn’t happened to others. Not happy to hear it has but very interested none the less.
Hi Simon and thanks for reading. I’ve just read accounts and reports of your Farallon Islands swim and I’ve got to say that for anyone to even consider it is a feat in itself. Totally awesome swim. The English Channel does throw up a few difficulties but at least I can’t complain about being circled by a 12′ Great White Shark! I’m also very interested in your feed mix as have experimented along those lines. Are you still using the rice, almond milk, banana, and Nutella mix? I’m booked for another EC solo in July so hopefully the SIPE thing won’t be a problem.
Thanks .. great information for the swim community .. and glad to hear you are out the other side
Thanks Fergus. All fine cheers and set to go again soon!
great article and commiserations on having to pull up early. Congratulations on still being alive, though! My crossing is in August with Stuart and I’m heartened by your tales of everyone’s professionalism. Thanks for bringing this serious condition to my attention.
Thanks Jevon. Good to hear from you and glad to hear you’re going with Stuart. I’m going with him again in July too. Hope your training is going well.