Barrington resident Don Macdonald does not call himself an adrenaline junkie, but rather more of an adventurer – who has learned the art of restraint.

Macdonald, 52, previously swam the length of Tampa Bay, the Boston Harbor, Lake Zurich, Lake Michigan, off the coast of California’s Seal Beach and Manhattan Beach, and in the La Hoya Cove off the coast of San Diego.

Reprinted: Barrington Courier Bridget O'Shea

“I think water gives me a sense of freedom, but it’s a very quiet, lonely freedom,” said McDonald, noting that he has sometimes shared this freedom with jellyfish, dolphins and sea lions.

However, a different type of challenge presented itself to MacDonald in 2011, when he began to experience cardiac issues after returning from a trip overseas, where he planned to swim the English Channel but was unable to due to weather conditions.

While taking a break from swimming, MacDonald began experiencing shoulder, arm and chest pain, which he said he was not too worried about.

“When you’re training 10K a day for swimming, your body is going to ache,” he said.

However, it turned out that MacDonald did have mild heart issues. After seeing his doctor, who then referred him to a cardiologist, MacDonald was treated with stents for narrowed arteries, given a typical medication regimen and stress tests. He was later approved to begin training again for the English Channel.

“During that time, I was actually out jogging and I had a major cardiac arrhythmia event that put me in the hospital for 10 days,” he said. “I was standing at a block party after I ran and I collapsed. This kind of came out of the blue, which is why it was so challenging to wrap my head around.”

Luckily, a retired nurse was at the party and began resuscitating him.

“She saved my life,” he said.

MacDonald was taken to Advocate Good Shepherd Hospital, where cardiologists implanted a small defibrillator device just beneath his skin to detect any abnormalities and reset electrical impulses.

“It’s been challenging physically and emotionally,” said MacDonald, who was used to training by swimming up to 26 miles at a time in 50-degree water.

But instead of focusing on any setbacks, MacDonald is now using his experience as an example of the importance of proper health screenings and evaluations for open water swimmers, triathletes and others that engage in vigorous sports.

“People have to pay attention to what they are doing to their bodies,” he said. “Everybody needs to consider their health situation carefully. Here’s a guy who could swim the English Channel and look what happened to me.”

Particularly with high endurance sports, MacDonald said, a feeling of being indestructible can sometimes develop, leading to a false sense of security. He uses himself as an example.

“Before this, it had gotten to the point where I was no longer afraid to swim in any body of water regardless of seals, sharks or the temperature of the water,” he said. “The biggest thing is that you go from being able to do anything and everything to, ‘OK, what do I do now?’”

Since his 2011 stay at Good Shepherd, MacDonald has reached out to the community, working with high schools, middle schools and the District 220 Educational Foundation by speaking to young people as a living example of the importance of cardiac and other medical tests and screenings for athletes.

While less vigorous exercise is now part of his recovery, MacDonald, who has swum since he was a young child, has not lost his love for the water.

On June 28, he will kayak the perimeter of Manhattan Island in New York as his friend Doug McConnell swims in the Manhattan Island

Marathon Swim.

“Instead of curling up and being the wilting flower, I decided that instead of swimming every day, I would do kayaking,” he said.

MacDonald will kayak next to a 9-foot boat with food, water and medical supplies for the swimmers. His main objective, he said, is the safety of his friend.

MacDonald has kayaking experience, most notably the 28 miles from Catalina Island to Los Angeles, a ride that began in the middle of the night.

“It was pitch black,” he said. “You could hear dolphins and whales.”

Originally from Goshen, Ind., MacDonald said he moved to Barrington from Chicago about 15 years ago and he and his wife enjoy raising their daughter here.

“It’s a great community,” he said, describing Barrington as a place where you can go to the city, go horseback riding or go into town for ice cream.

“It truly has everything you want from a small town,” he said. “It’s kind of the quintessential experience.”

How to increase your performance and recovery with nutrient timing

Second in the series on natural food fueling, alternatives to Gu's, energy drinks and junk food.

Follow these three essential steps to extend your performance and optimise your recovery from both training and racing:

1. Fuel correctly pre-exercise when your sessions are greater than 60 minutes

Training on an empty stomach is essential to turn you into a fat burning machine, but when your duration extends beyond 60 minutes, such a strategy is likely to negate your performance. Body stores alone are insufficient to supply the energy needs during longer sessions or events.

The solution? Eat a small amount of carbohydrate prior to your session. This is the perfect time to eat fruit, as the sugars will be broken down, utilised as fuel and not shuttled off to the liver for fat storage. Which, we know, is what happens when we consume fructose in excess, or at the wrong time.

 * Race Day

On race day, our requirements differ slightly, due to the timing of the event and the increased energy requirements of the day. A pre-race meal is simply designed to top up liver glycogen, which has depleted overnight during your sleep. General guidelines are 200 to 400 calories of complex carbohydrates, consumed two to three hours prior to the start. Be flexible however, as sleep is more important than waking up at the crack of dawn for breakfast.

Here are some simple, natural, pre-race meal ideas, all of which can also be used pre-training when your duration extends towards 90 minutes and beyond.

-       Two pieces of gluten free toast with banana

-       A smoothie with one banana and a small handful of berries

-       Quinoa Porridge with rice malt syrup, chopped banana and cinnamon

-       Homemade granola with Greek yogurt and a small handful of raspberries

Your pre-race meal should always be something you practice in training. Nothing new happens on race day.

Reprinted from:

THE NATURAL NUTRITIONIST

Reprinted from

Healthy Nutrition - What 2000 Calories Looks Like

Heart healthy nutrition for athletes (of any age) is a subject often not spoken about at the family dinner table, the team locker room, or often by coaches until you reach perhaps the elite level and even then selectively or at best incorrectly.  

Coupled with ninja marketing campaigns from babyhood ranging from outright miss-information to subliminal marketing, these messages cross the airwaves and internet bombarding our kids, teens and families. 

So for starters lets begin with some basics:

Cold-water swims - Rewards, Risks, and Your Health

Cold Water Swimming and Your Health?

Doug McConnell & Don Macdonald taking a dip in sub 60f Lake Zurich early March

What that means is that cold-water swimmers probably aren't any better protected from the elements than anyone else. Plus, at least in the Bay Area, most of them aren't elite-level athletes either. But something about them makes them better able to tolerate and

overcome the cold.

It's a commonly held belief, by swimmers and landlubbers alike, that an extra layer of fat insulates regular bay swimmers from the deep chill of the water. But Nuckton, a fairly trim swimmer himself, wasn't so sure the tourist was right.

Last week, the Bay Area was quivering through a cold snap, and the tourists along Fisherman's Wharf were, for once, dressed for the weather, bundled in jackets and scarves, mittens and caps.

Down at Aquatic Park, Dr. Thomas Nuckton was stripped to his swimsuit and neck deep in 50-degree bay water. And he wasn't alone. Winter is the time of year that the truly devoted - or truly crazy - swimmers come out, those hardy folk who dive nearly naked into San Francisco Bay, into waters 25 or 30 degrees colder than the average swimming pool. The health benefits of these swims are debatable, the risks less so. And yet every year, dozens, maybe a hundred, people swim all through the winter months, putting in miles and hours in the water. "People will go down there to swim, and it's almost like a spiritual experience," Nuckton said. "It's not quite the same for me. I hate getting in the water," he added with a laugh. "But I have my good days. And I'd much rather be there than in a pool, staring at a black line and just going back and forth." Nuckton is a doctor at UCSF and California Pacific Medical Center, focused primarily on studying survival prognoses for patients in intensive care wards. But he's taken a side interest in swimming and, in particular, the effects of cold-water dips.

Last month, after a yearlong study of people in his swimming club, Nuckton was able to show that these swimmers are, in fact, just about the same size as the average American. Crazier, maybe. But not fatter.

"All of these factors probably come into play," Nuckton said. "How good is your engine in terms of generating heat? How cold is the water and how long are you going to spend in it?"

Aided by extra fat? More fit, but why? Risks overstated Peril of sudden shock

Nuckton's most recent study was prompted by a comment he overheard from a tourist standing on the Hyde Street Pier, watching the Aquatic Park swimmers. "He pointed at the swimmers and said, 'They're fatter than us. That's how they endure the cold,' " Nuckton recalled.

There is no doubt, doctors say, that regular cold-water swimmers are healthier overall than most Americans. But whether it's the cold or the simple act of regular exercise that helps them is unclear.

Over the past decade, Nuckton has made a hobby of studying the members of his swim group, the Dolphin Club. Along with the South End Rowing Club, the Dolphin Club encourages no-wet-suit swimming in the bay. The clubs' members host several group events year-round, including a New Year's Day swim from Alcatraz to Aquatic Park, and they operate hot showers and saunas for post-swim recovery.

"I'm not convinced that, physiologically speaking, cold-water swimming helps. I think these people are already healthy to begin with and they want to challenge their bodies," said Dr. Malini Singh, medical director of emergency medicine at San Francisco General Hospital. There are theories, but not much evidence, about how cold water can improve health. Some studies have shown that people who swim through the winter have higher immune cell counts than nonswimmers. And some scientists, and swimmers, have speculated that cold-water swimming increases production of what's known as brown fat, thought to be a healthy fat that burns energy and creates heat. Many cold-water swimmers believe they're burning more calories in the bay as their bodies struggle to stay warm than they would in a heated pool, but scientists aren't convinced that's the case. Cold water, in fact, slows the metabolism, which may mean that the body is actually burning fewer calories. Even if there is a larger calorie burn, it's probably negligible, doctors say.

It's not just the benefits of cold-water swimming that are tough to document. The risks are poorly understood and probably overstated too, some doctors said. Two studies of athletes competing in long-distance, open-water swims found that most of them were suffering mild hypothermia by the end of the race, even when the water temperatures were in the 60s or higher. "I know people do it. Anecdotally speaking, they say they feel refreshed, they feel less stress and less fatigue," she added. "But I've been in that water, in a wet suit, and I just felt terribly cold to my bones." Nuckton studied 11 participants in a 2000 Alcatraz swim and found that five were suffering mild hypothermia by the end of the event. And perhaps more concerning, their temperatures continued to drop after they got out of the water. But mild hypothermia on its own is not necessarily a dangerous thing. In Nuckton's study, most swimmers' temperatures dropped about 2 degrees below normal, which probably wouldn't produce any noticeable symptoms or discomfort. In order for hypothermia to cause major damage or become deadly, the body temperature needs to drop to the low 90s.

The concern with hypothermia is twofold. First, that someone may experience early symptoms of it and become sluggish or disoriented, which could be deadly when a swimmer is in deep water and has trouble making it safely back to land. And second, some older or less fit swimmers may not be as well adapted to handling the cold as their younger or more experienced peers.

"The important thing is, I wouldn't be doing this for the first time, just jumping right in, if you're elderly or have significant medical issues," said Dr. Joel Levis, assistant chief for the emergency department at Kaiser Santa Clara. "Those people are better off just swimming in a pool."

Aside from hypothermia, there is a small risk associated with the sudden shock of jumping into cold water. Anyone who has dived into frigid water knows the feeling - the heart rate soars, breathing becomes erratic, and it usually takes a minute or two to calm down. That's rarely a problem, but there have been a handful of cases of people suffering heart attacks and subsequently drowning from that initial shock.

And then there's the native aquatic life. For the most part, swimmers exist companionably with the critters, but several years ago a rogue sea lion bit dozens of people in Aquatic Park, requiring a few of them to get stitches and antibiotics.

But on the whole, a swimmer is probably more likely to be injured by someone doing a sloppy butterfly stroke at the pool than by, say, a great white shark in the open water.

"The chances of getting eaten by a shark are pretty low. You just don't think about it," said Robin Rose, an Aptos resident who swims regularly in Santa Cruz, usually doing a mile around the wharf several times a week.

Rose started open-water swimming in 2009, and she swam regularly even through treatment for breast cancer in 2010. She wears a wet suit for now - but she's seriously considering joining the "skin" swimmers sometime in the near future.

"I went to Aquatic Park, just to try it, and it actually felt really good," Rose said. "I was only in for about five minutes, and it was so cold, but it was so invigorating. There's nothing else like it."

Article Reprinted from: Erin Allday is a San Francisco Chronicle staff writer. E-mail: eallday@sfchronicle.com

Marathon Swimming and Heart Conditions - Who would have Thunk?

Endurance athletes who exercise for three hours or more have an increased chance of dying from a cardiac arrest


Heart attack risks are greater for athletes who compete in endurance sports. I wish someone would have explained this to me before. I have recently learned that I am one of these athletes, now 50, that faces this challenge. This could be my biggest test of resilience yet. Not getting to swim the English Channel last summer due to poor weather may have just saved my life...read on and I implore you to get a full stress test (not a regular EKG) before you jump in the water.




Channelopathies



(A) Two essential elements precipitate a cardiac event in LQTS. First, a cardiac channel defect results in a 'recharging glitch' that often can be seen on the surface ECG by a prolonged QT interval. Second, a trigger is often needed (in this case, swimming) to cause the stable but prolonged recharging system to degenerate into the trademark arrhythmia of LQTS, torsades de pointes (TdP). The outcome (if the heart ever loses control), fainting, seizing or dying, depends on whether or not order is restored to the rhythm, either spontaneously or by a defibrillator. (B) The linear topologies for the three principal cardiac channels that account for two-thirds of LQTS are shown. The gene responsible for LQT1, KCNQ1 (commonly known as KVLQT1) encodes the alpha subunit of the IKs potassium channel. The gene behind LQT2, KCNH2 (commonly known as HERG) encodes the alpha subunit of the IKr potassium channel. SCN5A, responsible for LQT3, encodes the INa sodium channel. Additional heritable arrhythmia syndromes are shown.


© 2004 Nature Publishing Group Ackerman, M. J. Cardiac channelopathies: it's in the genes. Nature Medicine 10, 463-464 (2004) doi:10.1038/nm0504-463. All rights reserved


Article from Peak Performance:

About 1 in 50,000: if you run marathons or participate in other forms of exercise which last for three hours or more, that's your approximate risk of suffering an acute heart attack or sudden cardiac death during - or within 24 hours of - your effort. For every 50,000 athletes, one will be stricken during such prolonged activity(1). Running a marathon or cycling intensely for three hours is riskier than taking a commercial airline flight, even in these troubled times!

You might think we shouldn't make such a claim in a newsletter which appeals to serious competitors, including a large number of marathon runners. But at Peak Performance our job is to provide you with all the facts about your sport, not just the pretty ones.

The truth is that marathon runners, ironman triathletes and long-distance cyclists, swimmers, rowers and cross-country skiers are all in the same boat. In fact, any athlete who participates in a strenuous test of endurance lasting about three hours or more has an increased chance of dying during - and for 24 hours following - the exertion, even when the athlete's chance of a death-door knock is compared with the risk incurred by a cigarette-smoking, sedentary layabout who spends the same 24 hours drinking beer and watching TV. The reasons for this are not entirely clear, but the heightened risks of a visit from the Grim Reaper are unsettling to most athletes, especially those who exercise in the hope of improving cardiovascular and overall health.

To find out why strenuous exercise temporarily increases the risk of death, researchers at the University of Innsbruck in Austria recently studied 38 male participants in the 1999 Tyrolean Otztaler Radmarathon, a cycling race which covers 230k, with an altitude change of 5,500m. The Radmarathon is often said to be comparable in difficulty to the hardest mountain stages of the Tour de France (2).

All 38 subjects were experienced, well-trained amateur cyclists who were free of cardiovascular risk factors and without evidence of heart disease. The Austrian researchers were especially interested in monitoring their blood levels of a specific heart enzyme called cardiac troponin I, which happens to be the most sensitive and specific marker for the detection of heart-muscle death.

Cardiac troponin I values, which were essentially at zero in all athletes before the beginning of the Radmarathon (thankfully, since you don't want your heart to start dying on you just before you begin a 230k bike race!) increased in 13 (34%) of the cyclists immediately after the competition. The risk factors for elevated cardiac troponin I included: age - being young was 'bad'; race time - racing fast increased the risk, and the highest post-race cardiac troponin 1 level was detected in the athlete with the fastest Radmarathon time; pre-race training distance - the higher the overall training volume, the greater the chances of increased cardiac troponin I after the race.

Taken together, these results suggested that younger, fitter athletes, who put more stress on their hearts (via greater training volume and higher racing intensities), were the ones most likely to incur myocardial damage.

Why heart muscle cells may die during prolonged exercise

Why were cardiac troponin I concentrations up after the Austrian race? According to the researchers, many of the well-trained athletes probably experienced sub-clinical cardiac injury during the event and this was associated with the actual deaths of heart-muscle cells. The mechanism underlying such cardiac cell deaths is unknown, although one popular theory suggests that the heightened adrenaline/noradrenaline levels sometimes observed during prolonged exercise rather perversely lead to the constriction of coronary arteries, which results in localised cell death within the heart. (Adrenaline and noradrenaline - also known as epinephrine and norepinephrine - are hormones released by the adrenal glands in response to stressful situations.)

Heart-cell death during strenuous exercise? Yes, it is a bit like having a small heart attack at the same time that your heart is performing magnificently! In fact, cardiac troponin I is usually undetectable in the blood serum of healthy people but is typically found in those who have suffered a myocardial infarction (heart attack), congestive heart failure, or myocarditis (inflammation of the heart muscle). In fact, the enzyme is used predictively by heart specialists: the higher the level in a particular patient, the poorer his prognosis.

This sounds bad! But has anyone besides the Austrians uncovered evidence of heart-structure damage after strenuous exercise? Actually, yes: one study of finishers in the Hawaii Ironman Triathlon found that 9% displayed elevated cardiac troponin 1 levels and, further, that these individuals also exhibited abnormal heart wall action and function during echocardiographic analyses(3). Another investigation found cardiac-troponin increases in 11% of the finishers of an alpine cross-country marathon (4).

Is the positive post-exercise increase in cardiac troponin I really something to worry about? Were the heart cell deaths merely a small piece of the cardiac pie? Could the lost cells be replaced by regrowth of healthy heart tissue? These key questions are very difficult to answer, especially as no histological analyses of heart tissue were performed as part of these studies, and neither were echocardiograms or electrocardiograms (ECG) carried out to determine whether heart function was impaired. To play it safe, the Austrian researchers suggested that endurance athletes 'should at least undergo serial cardiovascular examinations looking for subtle evidence of myocardial dysfunction'.

The good news for endurance athletes on the cardiac front

Before you get too spooked by these findings, bear in mind that there is also some good news for endurance athletes on the cardiac front. For one thing, it's clear that regular exercise protects you from heart attacks over broad time frames; for example, over the course of a year regular exercisers will have fewer cardiac failures than their sedentary counterparts. Also, some studies have not linked extremely strenuous exercise with cardiac damage: for example, when sports medicine specialists at the University of California studied 23 ultramarathon runners who completed the 100-mile Western States Endurance Run, a rugged race through the Sierra Mountains over steep terrain and through temperature extremes, they were unable to find any race-related cardiac damage (5).

The 23 runners completed the 100-mile race in an average time of 23.5 hours, with a range of 18.9-27.1; their ages ranged from 29 to 62 (with an average of 45) and all but three were men, none with a history of heart disease. Although all of the subjects suffered massive skeletal muscle damage during the competition (as evidenced by huge increases in serum creatine kinase levels after the race), not a single runner exhibited heightened cardiac troponin levels after the extremely prolonged exertion was over.

None the less, an increasing body of evidence indicates that some heart damage can occur during extreme exercise. In the very latest study completed at Massachusetts General Hospital and the Harvard Medical School, researchers tracked 82 runners with an average age of 47 who ran the Boston Athletic Association Marathon for five consecutive years, from 1997 to 2001. These runners had no history of coronary disease, were non-smokers and averaged 25 training miles per week(6). But their cardiac troponin I levels increased roughly 6.5-fold both four and 24 hours post-race.

No one knows how long exertion related heart damage lasts

Again, we must pose the key question - is this exertion-related damage to the heart long-lasting, or does the heart recover promptly without long-term negative effects? Unfortunately, no one knows the answer to this question right now. If you are interested in running marathons, you will have to decide for yourself if the real risk associated with the race is tolerable or not - and whether the long-term perceived risk is serious enough to warrant changing your competitive activities.

Our traditional argument that prolonged endurance activity is not bad for the heart is based on evidence that marathon runners have fairly low death rates from cardiovascular disease (when you look at them away from the race itself and the 24-hour 'window' that follows it). Essentially, research indicates that well-trained endurance athletes have about 40% of their sedentary counterpart's risk of dying from a cardiac problem on a typical day (7). If strenuous exercise is really so bad for the heart, why aren't endurance athletes keeling over at higher rates?

Note, though, that this latter argument is not entirely compelling. It is possible that marathoners might have even lower frequencies of heart attacks if they gave up marathoning and focused on shorter events which are less taxing for the heart. In support of this theory, former marathon runner Dr Arthur J Siegel of McLean Hospital in Belmont, Massachusetts (one of the investigators in the study cited above) recently told Reuters Health that running a marathon is, in effect, like overdosing on a good thing. With a more moderate approach, cardiovascular risk would still be lowered, while the elevated risks associated with marathon-like events would be avoided. Add marathon efforts to the brew, and you get the general reduction in risk but with an added risk associated with the race itself (and perhaps its long preparatory runs).

If you are having second thoughts about running marathons, you should know that the previously quoted rate of one death per 50,000 marathon runners might be a bit high. For example, there is evidence that in male runners aged 30-64 who have not been diagnosed with heart disease, there is approximately one death for each 800,000 'person-hours' of running or jogging (8). This implies that if 800,000 healthy middle-aged males began running the New York City Marathon, one of them would probably die during the first hour of the event, another during the second hour and another during the third. This kind of death rate would create some bad publicity, so it is a good thing that the New York Marathon limits the number of entrants to less than 30,000 (thus trimming the incidence of death to about one every seven years). If one assumes an average finishing time of four hours, the 800,000 figure projects a death rate of one per 200,000 marathon entrants, considerably lower than the earlier estimate of one in 50,000. Incidentally, it is known that females have a much lower risk, although the relative mortality rate has not been quantified.

Expressing the 800,000 statistic in a different way, we can say that healthy, middle-aged males who run for one hour each day can expect to die while running once every 2,192 years (800,000 hours divided by 365 hours of running per year = 2,192 years). By the same token, individuals who run two hours per day should die while running about once every 1,096 years. When the risks are seen in this light, many endurance athletes will consider them acceptably low, especially as the general risk of heart disease is reduced by strenuous training.
Heart deaths are not random events

In addition, when deaths do occur, they are certainly not random providential events. Post-mortem analyses usually reveal that something was wrong with a dead athlete's heart prior to the race (no surprise there). For example, in the study which led to the death estimate of one per 50,000 marathon entrants, a total of 215,413 runners who competed in either the Marine Corps Marathon from 1976 to 1994 or the Twin Cities Marathon from 1982 to 1994 were monitored. Three of these 215,413 runners died during their races (always after the 15-mile point) and one succumbed shortly after completion of the event. Autopsies revealed that three of the runners actually had atherosclerotic coronary artery disease (narrowing of two or three key coronary vessels), even though they were symptom-free before the races. The fourth victim (also symptom-free before death) had an anatomical defect related to the left main coronary. Thus, marathon racing didn't destroy these athletes' hearts as they paced along the streets of Washington or Minneapolis but rather uncovered 'weak links' in their cardiac systems which could not stand up to several hours of strenuous, continuous exercise.

This brings us to the issue of screening: could you take a test which might reveal that your heart was vulnerable to trouble during strenuous exercise? The relevant test in this case would, of course, be an exercise stress test, during which an ECG reading is taken as you run at increasing intensities on a treadmill. These 'exams' can frequently unmask fat-filled coronary arteries.

Unfortunately, the tests do not have a very high predictive value since as many as 63% of those who 'fail' a stress test actually have completely normal cardiovascular systems(9). Furthermore, the rate of such 'false positives' among endurance athletes can be 100% (ibid), because the natural thickening of the heart in response to endurance training changes ECG readings!

This high frequency of 'wrong calls' is troubling, not only because of the inaccuracies associated with stress testing it reveals but because many of those with false positive results are then subjected to more rigorous and invasive medical procedures, including thallium stress testing (in which a dye is placed in the bloodstream during exercise) or coronary catheterisation (in which a long tube is snaked through blood vessels into the heart). These tests are expensive and not without risk; in fact, coronary catheterisations may be riskier than marathons!

None the less, about 34% of physicians who run the Boston Marathon believe that people should undergo an exercise stress test before beginning a strenuous exercise programme(10). Interestingly enough, though, only about half of these doctors actually permitted stress tests to be performed on themselves before they began training for Boston!

Stress tests carry their own risks

One reason for this 'do as I say, not as I do' attitude may be that stress tests themselves are not without risk. The risk of dying during a stress test is a matter for debate, but has been estimated at anything between 1-in-20,000(11) and 1-in-500,000 tests(12). As you can quickly calculate for yourself, if the true stress test death rate happened to be 1-in-25,000 and the true marathon death rate stayed at 1-in-50,000, and if stress testing was used to 'screen' marathon entrants, two people would be killed during stress testing for every one athlete potentially saved!
There's more! The vast majority of individuals who die during or shortly after exercise would have had completely normal stress tests, even if the tests were given the day before they died (13). Some experts believe that stress testing can only detect about 20-25% of the likely victims of sudden, exercise-related death. None the less, if you have one or more of the known risk factors for coronary disease (obesity, diabetes, cigarette smoking, high total cholesterol, low HDL-cholesterol, high blood pressure, high stress levels, or a family history of heart disease) you may want to talk to your doctor about stress testing. If you happened to be in that 20-25% group, it would be helpful to have your cardiovascular problem detected.
Distance eventers should look for signs of heart trouble

Whether or not you have risk factors for heart disease, if you compete in distance events you should monitor yourself closely for premonitory symptoms of heart trouble. The warning signs we all know about include chest discomfort or squeezing, throat tightness, and pain that radiates into the jaw or left arm. There are other signs of trouble which are less well-known, including unusual fatigue. If you are uncharacteristically tired and are confident that this is not due to an increased training load or a recent infection, don't ignore it; mention the problem to your doctor and see if you can arrange for a routine physical examination.
In addition, a sudden, unexplained drop-off in performance which is not associated with overtraining could also indicate that something is amiss with your ticker, as could the sudden onset of heart palpitations. Finally, be particularly wary of chest discomfort of any kind which appears during exercise and then disappears afterwards. Angina often does not express itself as sharp pain; typical symptoms include squeezing sensations in the chest, and feelings of pressure or chest tightness. It is possible that up to 50% of people who have heart attacks while exercising experience a fair number of small warning signals during the days or weeks leading up to the attack - so watch out! As noted US cardiologist Paul Thompson points out, 'If you think there is something wrong, there usually is, and a physician should be consulted'.


Pheidippides, one of the first endurance athletes in recorded history, dropped dead shortly after his 21-mile, 1,470-yard run from the plain of Marathon to the agora of Athens in 490 BC. True, no autopsy was performed on the Greek messenger, and his death could have been caused by dehydration or an unsettling encounter with the god Pan in the mountains north of Athens (described in some early accounts of this first 'marathon'). In addition, we don't know how fit Pheidippides was before his fateful run, which certainly would have delivered a great shock to an untrained cardiovascular system. None the less, it is certain that exertion-related deaths do occur at a low frequency, even in well-trained athletes. The paradox of exercise is that it increases your risk of dying at the same time that it reduces it.

Re Print from Peak Performance Owen Anderson


References

1. Journal of the American College of Cardiology, vol 28, pp 428-431, 1996

2. American Journal of Cardiology, vol 87, pp 369-371, 2000

3. American Journal of Cardiology, vol 83, pp 1085-1089, 1999

4. Journal of the American Medical Association, vol 282, p19, 1999

5. American Journal of Cardiology, vol 80, pp 379-380, 1997

6. American Journal of Cardiology, vol 88, pp 920-923, 2001

7. New England Journal of Medicine, vol 311, pp 874-877, 1984

8. Journal of the American Medical Association, vol 247(18), pp 2535-2538, 1982

9. New England Journal of Medicine, vol 293, pp 367-371, 1975

10. The New England Journal of Medicine, vol 301, pp 792-793, 1979

11. Chest, vol 77, pp 94-97, 1980

12. Running Research News, vol 5(6), pp 1, 6-10, November-December 1989

13. The New England Journal of Medicine, vol 321, pp 320-324, 1989

Skin on fire ... Water temp drops 65f to 58f

Independence day (july 4th) plus one brought a great swim in a calm lake Michigan this morning with doug McConnell, Marcia Cleveland and cool water. Sun was shinning, water was crystal clear and we had the lake to ourselves.

Walked into the water with my usual smile with what I thought was gonna be a nice casual training swim, the lake had other ideas, it was time for a reality check and lesson. I immediately began to feel my feet burn from the cold water, i splashed water up on my chest to adjust to the cold, kept walking up to my waist. I noticed my heart was beating quickly and breathes were short and shallow reacting to the cold. At this point I was thinking to myself "wow, how does the lake go from 65 to 58f?", two days ago I was swimming in 78 f pool water. Appearently the wind had been blowing across lake Michigan west to east late in the week and this drives the colder middle lake water to shore. Welcome to open water swimming.

To know what this feels like, take a large glass ice water and pour it over your head the next time your outside, at the pool or lake or stick your face in a cooler filled with ice water. The physical shock is something. Imagine putting your whole body in this and swimming for over an hour.

We swam down 1200 yards or so to a large peer and then back, twice. Each length was around 17 minutes. The first was really rough, I was hyperventilating so my strokes were very short and erratic. Length two eased up, the third more so allowing me to relax and work on taking long strokes with better body rotation while breathing on both sides. The last length, coming back in, I was back to my old self stroking away, having navigated the cold was building my confidence, and I could have kept going when we finished up around 1:10 minutes later.

This was a great experience and re-focused me back to how critical cold water accimilation is to this effort. After all the training I realize I have so much more to learn.