I work for Heidi Dohse, a life-long elite athlete living in Hailey, Idaho. Heidi is an experienced endurance racer but one who had never done a triathlon let along an IRONMAN. She came to me for help in achieving this goal with a target race of IRONMAN Arizona on November 24, 2019. In preparation for that race, she signed up for two Half IRONMANs and an XTERRA race: IRONMAN 70.3 Whistler, XTERRA Pan-Am Championships and IRONMAN 70.3 Tempe.
The first two events went well, with our main focus on learning to become comfortable in the swim. What happened at IRONMAN 70.3 Tempe, and the choices Heidi made, was a total surprise to us and arguably saved her life.
Thanks for sharing this experience Heidi! Can you briefly let folks know your medical condition?
Heidi: I have been a lifelong heart patient and athlete. When I was 19 years old, I had an experimental surgery that left me 100% pacemaker dependent. In 2010, after 7 pacemakers, I learned that I needed to have open heart surgery, and I did not want to be a victim of heart disease. Instead I wanted to focus on endurance cycling events. As a way of preparing for heart surgery I picked out a bike race to train for. It happened to be the LOTOJA Classic, a 200 mile single day bike race. Since then I have completed that race 6 times and moved on to mountain bike stage races. I got tired of people asking me if I had ever done an IRONMAN and decided that 2019 would be the year to check the IRONMAN box!
When you came to me, we had to start our swimming from scratch even though you were a competitive swimmer when you were young. How did you get yourself ready for that first 70.3 swim in Whistler CAN?
Heidi: My triathlon journey has been an adventure. Getting myself to the start line of the 70.3 Whistler CAN event actually started 9 months earlier. I had to do the basics like buying a swimsuit, goggles and swim cap an then laps in the pool. I could only swim breaststroke for any length of time and couldn't swim a full 25 meter lap of freestyle. I needed to build up base endurance and feel comfortable in the water. One of the issues was teaching my pacemaker to provide enough heart beats during my swim. I had never done any open water swim training until the MPI Open Water Swim Clinic. That was a great experience and helped me understand what I was going to need to do to complete the swim leg of a triathlon.
So leading into IM 70.3 Tempe, I think we felt fairly good about our ability to swim 1.2 miles comfortably. You had a great swim in Whistler and also in Ogden, Utah, at XTERRA Pan-Am Champs. What was your mindset and prep during the week leading up to the race?
Heidi: I actually felt really good, mentally and physically, leading up to the 70.3 Tempe event. I was having great swim workouts and finally found a wetsuit combination that I was comfortable with for Tempe. I arrived in Tempe the week before the event to acclimatize to the heat and dry weather. Knowing that I would need to stay hydrated, I started drinking more water and electrolytes a couple of days before the event.
OK, let’s get down to it: walk us through the race start, your swim, and then when everything started to feel “off”.
Heidi: Early morning, I focused on hydrating and taking salt tablets then went down to the lineup for the start. The day had perfect weather, and this was the best I had felt for a swim start. I knew I had the swim distance in me, and I really wanted to get to the bike leg. When it was my turn, I hit the water and started swimming. I got around the first turn buoy and felt a short heart arrhythmia but just kept swimming. I noticed that it was becoming hard to get enough air in my lungs. I thought it was just adrenaline causing me to be short of breath so I focused on being calm.
I stopped at one of the water safety kayaks just to catch my breath, and I sounded wheezy. I kept going, however, and it continued to be harder to breath so I thought maybe I just needed to take my wetsuit off. I did and gave it to another kayak on the water and also noticed that I was starting to sound crackly when breathing. I continued swimming and it became harder and harder to breathe. It sounded like I was gurgling on each breath. Of course, I kept telling myself that I could keep going.... I started getting lightheaded and stopped again at a kayak and it was very difficult to get air in my lungs. I really thought I could keep going... all of the work, expense and thoughts of failure went through my head.
The safety boat came to check on me and I realized I was in trouble and wasn't going to make it. I absolutely hate quitting a race! The hardest thing was to make the decision to get out of the water. However, it saved my life. The EMS in the boat could tell I was having issues and took me to the on-shore EMT. They determined that I needed to go to the emergency room where I was admitted to the hospital to remove the fluid from my lungs and get my oxygen levels back up. It was explained to me that acute pulmonary edema (or in my situation, SIPE: Swim Induced Pulmonary Edema) typically continues to get worse before it begins to get better, so it was important to keep me on the breathing machines and under observation overnight. The good news is that 48 hours later I felt fine again. Amazing how quickly our bodies can go from life threatening to normal again!
Amazing! Since this event, what have you learned about yourself and about SIPE (Swim Induced Pulmonary Edema)?
Heidi: I have learned a couple of important things. The first is that I now have experienced the "worst case scenario" of a swim leg and I don't need to worry any more. The on-water safety teams at the 70.3 events are wonderful and they really are there to make sure we athletes are safe. The second is that it is really important to know your body. My initial thoughts were that I was just short of breath because of race nerves. So, I just kept pushing and I almost didn't make the right decision to get out of the water because I really, really wanted to complete the race. As I became more oxygen deficient, my ability to make good choices was also impacted. If I have another SIPE issue in the future I will know what the symptoms are and take action more quickly. In preparation I won't do as much pre-race hydration because my heart issues put me a risk for SIPE.
What would you recommend for other athletes out there?
Heidi: My recommendation for triathlon athletes is to be aware of the signals our bodies provide and take action. It is easy to be in denial and then make bad decisions which can become life threatening.
And are you still planning on racing IRONMAN Arizona on November 24? (I know the answer :)
Heidi: Ha! Yes!!! I am also working with a sports cardiologist to understand how to prevent another SIPE event. I am taking my own advice working with my doctors to learn what body signals can help me stay out of trouble.
Thank you so much for sharing your experience. I’m sure this will help those that may experience the same symptoms make the right decision in the water! You are AMAZING! See you in Arizona!