At approximately 8:30pm on July 25^th, I jumped into Lake Tahoe to attempt to swim the length which is a total of 21 miles starting at Camp Richardson and ending in Incline Village. I swam through the night, to sunrise, into the day AND I actually completed it. Going into the swim I felt very confident being ready both physically and mentally. My training leading up to the swim was on point and had completed my final 4 hour swim on a Saturday about 2.5 weeks prior, followed by an 8 hour swim on Sunday. I had relatively little soreness after my biggest training swim as I had already done several 5-6 hour swims. I thought I should be able to finish in less than 13 hours but I did not quite accomplish that. Last summer I completed the Vikingsholm Swim on July 15^th which was a 10.5 mile swim in just over 6 hours. I also completed the True Width on August 3^rd in 6 hours and 29 minutes with Lake Tahoe Open Water Swimming Association and my pilots Bryan and Sylvia of  Pacific Open Water Swim Co.. The completion of swimming the length of Tahoe was also the completion of the Tahoe Triple Crown! And I am beyond thrilled with that accomplishment. This event is a solo event and it is just me swimming across the lake with my pilots, an observer and crew. I had already swum with the pilots, Sylvia and Bryan on countless occasions so they know me and my swimming well. My observer was someone who I swim with from South End Rowing Club, Brad. And my husband, Matt helped to crew in addition to support from the pilots. They throw me food over the side of the boat like I am a dolphin. My feeds are largely liquid with water, Carbo Pro and Ucan Hydrate which I “feed” on every 30 minutes from a cycling bottle attached to a rope. You cannot touch the boat at any point during the swim. If you do the swim is over so I just tread water while I eat/drink my feed in 30 seconds or less. I also supplement with Gu gels. Swimmers are only allowed a swimsuit, goggles, cap, ear plugs and no swim aids. The pilots and observer can call the swim at any time due to safety of the swimmer or support crew.

I learned a tremendous amount on this swim. Similar to my old triathlon days, you learn a lot when you ramp up from 70.3 (half ironman) to 140.6 (full ironman). And that was very similar for going from 10-12 miles swims to 21 miles. Last summer I tested two theories. For the first swim, I drove up the night before arriving at 6pm and jumped the next morning around 5am. For the true width, I went up 5 days in advance to acclimate to the altitude. Lake Tahoe is at 6000 feet and I have never done great with altitude. What I have heard from many other people who race at altitude is that you either get up there right before so you are not yet impacted by the altitude (you have about 24 hours). Alternatively, you should get up there at least 5 day (many would argue more) in advance of the event to acclimate. Since I felt like both tactics worked equally well, I decided to drive up the night of the 21 mile swim arriving at 6pm. I am not the best sleeper so getting really restful sleep in my own bed leading up to the swim seemed like the winning choice.

Life Lesson One:

What worked for acclimation for a 10-12 miles swim was not enough for me for the 21 mile swim. The altitude hit me hard around hours 10-11 and significantly impacted my pace causing me to go from swimming ~ 2 miles an hour to 1 mile an hour the last 3 hours. I would recommend considering arriving a minimum of 5 days early to acclimate for the length swim. My father having been a high altitude climber felt that this was my biggest mistake and felt I should have been up there 1 -2 weeks in advance. I don’t know that there is any right or wrong answer to this question but based on the condition I personally ended the swim in, I think maybe for me that would have been better.

I jump at 8:30pm and I was loving every minute of the swim. The sun was going down and the sky was lighting up for the sunset. I was swimming from feed to feed and time literally just flew by. Minutes turned quickly into hours. I absolutely love swimming at night in the darkness in Lake Tahoe. Time just seems to disappear as I just focus on my stroke and my breath. Many people think about a ton of things while they swim. I tend to go into a very meditative state. In the nighttime hours, I have a few lights on my cap and my suit so the boat can see me. The boat has lights on that I just follow. A few times, they gave a holler for me to be a little further from the boat so I obliged. The thing was they were feeding me every 30 minutes my carbo pro and electrolytes. I had my Gu multi serve pouch in my suit which I should have been taking about every two hours. But I was cruising and I was feeling so good. I didn’t want to waste time on that and I did not supplement the Gu. I remember thinking to myself that they must have just finished up the 11 feeds I brought prepped as the feeds they mixed tasted ever so slightly different. So that would have put me at around 5 and half hours of swimming. And I had not taken any GU yet! Of course I did not realize this during the swim as I was so focused, having fun and even joking with the crew on the feeds. One feed they joked that I had gotten faster and I was “yup, been practicing”. Post swim we definitely discussed that I had created a calorie deficit leading to the slowness in the last few hours. We tried to play catch up but it was probably just too late.

Life Lesson Two:

I should not own any part of my own feeds. Feed from the boat on the right schedule so you don’t create a calorie deficit which could have cost me finishing the swim and my health. Ultimately it was likely a combination of altitude and messing up on my feeds that caused the significant slowdown in the last few hours of the swim.

So I am cruising and the crew definitely seems excited about my pace. I am excited because up through what I believe was 10-11 hours I felt amazing. I had some minor shoulder pains during my training swims back in  May/ June but after having my stroke looked at, some phenomenal coaching from Ahelee Sue Osborn and some drills, I did not have any major arm or shoulder pain during the swim or much soreness after. In fact, when I felt anything, I went back to everything Ahelee told me. If you feel pain, get it looked at sooner rather than later. If not, it could derail your training. Another part of my training which also was great was my core training. Lake water is less buoyant than swimming in the ocean. After hours of swimming in Lake Tahoe last year I noticed my lower back started to ache, likely because of the less buoyant water. Having a strong core is absolutely critical for swimming, your back and your kick. This year I doubled my core workouts adding in longer planks, a variety of core exercises and increased the frequency of those in my weekly routine. All that core work resulted in absolutely no back pains throughout the entire swim and I got less leg cramps. After I finished I came to find out that at one point I was on pace to complete the swim in about 12 hours.

And then everything fell apart. I am not exactly sure when and how quickly it fell apart but I know my pace started to drop. I had some cramps and they became more pervasive. Cramps tend to be more prevalent at altitude so I did increase my electrolytes which did keep them at bay longer than expected. I had some mild cramps come on around hour 9 (I think). Eventually, I couldn’t stick to freestyle and started to supplement with breast stroke. They were saying 25 strokes of free and then 25 stokes of breast. Then it was 20, 15, 10 strokes of each as things continued to unravel. Then I was rolling onto my back to catch my breath.  Every time I rolled on to my back, Bryan yelled that if I was not swimming he was going to pull me. And every time I was like hell NO and rolled over and kept swimming. I was so close to the beach but it was still also so far away. And somehow I pushed through to the get to the beach and exit the water. After that everything is pretty much a blur. I swam back to the boat and they pulled my dead weight back on the boat as I had no strength to do so myself.

Once on the boat, they were watching me intently. I slept all the way back to Camp Richardson on the boat. I had a nagging cough which I was complaining about when we arrived at Camp Richardson. The pilots (Sylvia and Bryan) were watching the cough to see if it was “productive cough” as that is a red flag indicating swimmer induced pulmonary edema (SIPE). They outlined the signs of SIPE and what to watch for. I walked down the dock with the help of Matt and Brad and sat on a bench with Brad while Matt got everything off the boat.

As Matt & I were both exhausted, we headed directly to the hotel arriving around 2pm and thankfully we got an early check in. I showered to get all the zinc off with Matt’s help. I was coughing and I thought the phlegm was now tinged pink. As soon as I went to lie in bed, I immediately heard the crackle in my lungs which I knew was not a good noise. Within minutes we were on our way to an urgent care which was 5 minutes from the hotel. I am so thankful for what Bryan and Sylvia outlined and what I learned about Swimmer Induced Pulmonary Edema (SIPE) at Infinity’s Hit the Wall Training Camp. They had talked about the “crackle” so I knew this was bad and got help right away. Urgent care ushered me back almost immediately. I was in an ambulance to the hospital on oxygen and IV within 10 minutes. Upon arrival to the hospital emergency room, we had a team working on me. They took blood, x-rays, got me on fluids, on oxygen and gave me steroids along with other treatments. It was all happening so fast. I had never been in a hospital before and thankful for the amazing team at Barton Health in South Lake Tahoe! The doctor came in and said “well we have one really sick girl here”. And then the doctor started to talk about a helicopter or ambulance to Reno. I was terrified. I looked at Matt and said “call my Dad”. I was diagnosed with Swimmer Enduced Pulmonary Edema and Rhabdo which require opposite treatments. I think the altitude lead to the pulmonary edema and the calorie deficit led to the Rhabdo, thus the critical lessons learned. These are just my hypotheses as swimmer induced pulmonary edema has little research. There is also altitude induced pulmonary edema and I think that there is potentially more than one culprit in this situation. Rhabdo is when you are breaking down your muscle fibers which release into your bloodstream. Those fibers turn into protein that then are processed by your kidneys. This can lead to serious complications such as kidney failure. The good news is that my Rhabdo was relatively mild and likely something I encountered at the end of my ironman events. The key signs are muscle pain in the shoulders, thighs, or lower back; muscle weakness or trouble moving arms and legs; and dark red or brown urine or decreased urination. Keep in mind that half of people with the condition may have no muscle-related symptoms. Treatment is typically IV fluids if not a severe case.

Luckily within 10-15 minutes my vitals improved which came as a welcome surprise to the doctor. Thankfully the doctor let us know that they felt confident they could now treat me in their own ICU department. I was rolled up to ICU and was in the hospital for about 24 hours in total.

Many people have asked if I should have been pulled. I know it was a topic of conversation on the boat. And I firmly believe there is no right or wrong answer to this question. I honestly believe that the damage was done. If they had pulled me a mile off shore, I would have been devastated, not completed my swim, the Tahoe Triple Crown and very well may have still landed in the hospital. So for me, I am really glad I was able to finish. I have also been asked if I knew during the swim what was happening. I definitely had no clue and truly thought it was just exhaustion. And even at the dock waiting to go to the hotel, we just thought it was exhaustion. The lead theory while in the water was that it was the calorie deficit driving my exhaustion. What scares me most is my ability to push myself + my body through things that others may not. Ironman Whistler was similar in that my mental capability to push through challenges is impressive and at the same time frightening. That race had a 25% DNF/ DNS (did not finish/ did not start). That said I am sharing this so others are aware of some things that can happen, so they know the signs and seek help if they see these signs.

For Swimmer induced pulmonary edema, the signs are:

• Shortness of breath out of proportion with the effort being exerted. For me, I truly thought it was in line with having swam 21 miles
• Cough, usually distressing and productive with little pink, frothy or bloody phlegm
• Crackles, rattling or junky feelings deep in the chest

Someone shared a great article that reviewed 45 cases. And the good news is that all cases resolved in 24 to 48 hours. If treated, you will be able to recover. The questions I still have are:

1. How long until my lungs are fully recovered. I am cleared to swim again but I am not cleared to swim the Catalina Channel which was scheduled September 15^th. It was a tough call but the right call to postpone. I have swam up to an hour but I am a bit unclear as to how far I can push it. At almost a month post swim, I am feeling significantly better and will start to swim a bit longer. That past week has felt like a step change in how I feel which is great. I am waiting for my appointment with a Pulmonary specialist which is about a month out as it is now a routine visit
   • Update 10/23/19: At about 3 months after the swim I am feeling 100%. I have completed a few 3 hour swims. I did get confirmation from a doctor that I should allow 3 to 6 months for full recovery and I agree with that statement! Within 1 week I did a 20 minutes swim followed by 40 minutes the following week and ramped up slowly from there.
2. The other question is regarding my risk of re-occurrence. Now that I have had this episode, am I now more at risk for future swims? Was it the altitude that was more of a factor so if I swim at sea level are my risks less? The article referenced above gave a wide variance of reoccurrence (17% to 75%) which was not super comforting. At 17%, I would absolutely attempt Catalina. At 75%, I would not even consider it.
   • Update 10/23/19: Per one doctor who has been studying SIPE, the re-occurrence rate is estimated at 30%. The doctor also reviewed my file from the hospital and immediately asked what and how much I drank before and during the swim. Since it was an evening swim I hydrated all day. So likely drank 60oz between 1pm and the jump at 8:30pm which by itself seemed normal but coupled with my feeds, it was a lot of fluid. My feeds were about 8 ounces every 1/2 hour. Well that is 16oz per hour or 160oz over 10+ hours and your body cannot process that amount of fluid. Net, the leading theory on the cause was over-hydration. And my electrolytes were dangerously low even though I take approximately 600ml per hour. I will be training going forward with 4-5oz feeds and watch how much I hydrate before hand. The smaller feeds will also allow me to feed much faster so WIN WIN!

For now I am waiting patiently for my answers. The understanding of SIPE is still evolving. In my research, I was able to get a few interesting article that may be worth a read:

Diagnosis of Swimming Induced Pulmonary Edema—A Review

American College of Cardiology: Swimmer-Induced Pulmonary Edema

Sadly I have had to postpone my Catalina Channel this year as I am not cleared to swim by my doctor. More importantly, it was just the right decision and I also think I have put my family through enough worry for one year. Lastly, when I attempt the Catalina channel, I would like to be in the position to succeed. Coming off the Tahoe swim, I would not be in the optimal position to succeed. And it will be there next year!

I really wanted to leverage the Catalina Channel Swim to raise awareness around ocean plastic. That said, I am still launching my crowdwise fundraising page to support 5 Gyres as one of their ambassadors. If you are so inclined, I would appreciate any donation. I did swim 21 miles 😉

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