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Thursday, April 9, 2015

Checking Up And Checking In For An Ice Swim

Courtesy of Nuala Moore with upper photo of Paolo Chiarino.

Nuala Moore talks about preparing for an Ice Swim in less than 5°C, either for a competitive 1 km ice swim or the ultimate Ice Mile.

Daily News of Open Water Swimming: I can swim both a kilometer and a mile. Why are medical check-ups required to compete in an Ice Swim?

Nuala Moore: No one would doubt your ability if you say you can. Having a medical is not about the distance. It is about is the impact of the temperature of the water and your body’s physical and emotional response to below 5°C. The question of a medical or medical fitness poses a challenge to ice swimmers [with a threat of hypothermia], but it is also an equal challenge to swimmers who for the first time get into water temperatures 10-15°C over their normal training temperatures [with a threat of hyperthermia].

Racing in hot water can be equally as dangerous; the same as racing in wetsuits in hot weather for long periods. All swims have challenges to the body. Therefore, if you want to swim a mile in ice water, then it’s good to understand the possible medical and physical ramifications to swimming often at speed, at these temperatures. I focus on those swimming at speed and intensity.

Excuses such as ‘Do I need a medical?’ or ‘The cost of the ECG is prohibitive’ or ‘I can’t get an appointment’ often make me shudder.

Daily News of Open Water Swimming: How recent should the check-up be?

Nuala Moore: A medical and an ECG are as basic a requirement to an ice swimmer as are the essentials of swimming such as togs, goggles and a swim cap. The reasoning that ice swim insists on a ‘fit-to-swim’ medical are multi-factorial. Hypothermia is certainly a great challenge although, I don’t believe it is the biggest challenge.

I have asked our doctors and the ones tested me about the ECG and medical. They, typical scientists, always stuck to the claim that no medical check-up can prevent death 100% of the time.

Some recommended a stress ECG at least once a year if you above the age of 40 to 45 years old.

The biggest debate is about the relevance of the ECG: is one month good? What about three months? Or 6 months? There is no best answer. But the doctors say, “Better safe than sorry” (meaning dead) so the more recent the ECG, the better you are.

Daily News of Open Water Swimming: What exactly is checked at an ice swim under 5°C?

Nuala Moore: I was fascinated on my first outing to Tyumen [Russia] when Dr Nataliya Fatyanova and Dr. Irina Zhidkova digitally recorded images of our hearts before we entered the ice [water]. I continued on each trip to 0°C observing and documenting, all in support of the facts that ice swimming can a safe extreme sport.

Anne Marie Ward and I travelled with our blood pressure monitors and are amazed at the changes to our cardiovascular systems. In all the events that I have competed in, all had maximum blood pressure cutoffs. On my first outing with a ‘fit-to-swim’, I presented a medical textbook blood pressure of 120/80 with a heartrate of 60, but my physical reaction to 0°C was terrible, albeit it was purely anxiety based. The cold [water] had a real impact which stunned me

Daily News of Open Water Swimming: What are some of your other recommendations?

Nuala Moore: On the morning of our ice swim, many of us were sent away to a quiet room to calm ourselves as our blood pressures were rasied. They were too high for the organisers to accept the risk of us swimming.

This type of monitoring has helped affirm that we can be too liberal with our own personal responsibility to the Ice. One cannot blame the ice if one is not prepared for its impact. One cannot guess what it feels like. One cannot blame the mountain if one falls. A medical is something we can manage and should have. If we fail a medical check before a swim, it is a failure for a reason – the body is not prepared and this may save a life and maintain the safety of the event. So when people say “Do I need a medical?’, I often reply “I don’t know. Check with your family.” This can highlight its importance to the swimmer.

Elite athletes are subkect to medical tests all the time. However, extreme sports people – English Channel or North Channel swimmers and Ice swimmers are not elite swimmers. Therefore, we are not used to regular medicals. People like us should have a full medical every six months. The extreme we expose ourselves to needs a very early warning. Those of us who swim often have a medical sometimes 4 times a year.

Daily News of Open Water Swimming: When did this begin for you?

Nuala Moore: When I met Ram Barkai in 2011 in New York [at the Global Open Water Swimming Conference], I had already developed a huge interest in the body’s responses to extreme having monitored a lot of the Round Ireland Swim responses. I watched their South African Ice Miles. I watched when Ram presented his videos of the team swims in Chile and Argentina. I noted that despite their super human extreme adventures, their bravery in the vision of danger, the external physical reactions of their bodies, and their responses were human. They shivered, they screamed; these were all very normal behaviours. What they were showing me was an extreme level of pain management and an insight into the power of the mind and a willingness to learn.

Daily News of Open Water Swimming: This sounds superhuman…

Nuala Moore: [After Ram’s talks], I immediately turned to Anne Marie [Ward] and said “We’re in”. I have always had a huge interest in the medical workings of the body because I was a very young medical carer for my mother with a cardiology history and was a full-time carer for my father. I’ve spent my years trying to work medical things out for myself, seeking knowledge for experts in their fields. Risk identification and management and the sea have been my life so what a niche this was – I was able to incorporate all this knowledge and apply it to the ice.

Daily News of Open Water Swimming: What do you see in the future?

Nuala Moore: My contribution to the future of ice swimming would be to further my understanding of it, to make the journey a little easier for those new to the sport, and to protect the sport’s history including the identification of the controlled risks taken so as to understand and see the path of development and change. And finally, to keep the swimmers medical presentation a priority.

Daily News of Open Water Swimming: You have had quite a history in the sport…

Nuala Moore: The journeys to Tyumen in 2012, Murmansk in2013, Bering Strait Relay in 2013 and Tyumen in 2013 involved me working closely with two of our medical doctors. I documented and monitored all my own responses, blood pressure, heart rate, and ECG, and where permission was given, the results of other swimmers. I was watching pre- and post- swim medical results which interested me more than hypothermia. Dr Nataliya Fatyanova presented an amazing report on how the body responded to the challenge.

Daily News of Open Water Swimming: What are some of the biggest challenges?

Nuala Moore: Exposure to the cold is a colossal challenge to the body. Swimming any distance at speed into 5°C, 4°C, 3°C, 2°C, 1°C and 0°C water gives your body many great internal challenges. Your heart may stop long before the body succumbs to hypothermia as often the effects of cold exposure are secondary to the impact on your internal system.

For me, there are 2 ways of looking at swimming in ice water or water under 5°C: What you feel and what is happening. From 10°C, and particularly from 5°C, each degree down to 0°C has a different impact and challenge.

Daily News of Open Water Swimming: Can you explain a little more?

Nuala Moore: The body is a simple system and has fairly simple responses to external stresses. In learning often, we get the results and work backwards so as to try and understand how the results were arrived at. The body is logical in that - to a point. The body has roughly 5 litres of blood . This blood travels around the body in our daily activity pumped by the heart when a swimmer stresses this system, the cardiovascular system responds by increasing the blood flow to deliver the oxygen around the body faster to the muscles. A fast cold water swimmer has the same requirement for oxygen as when swimming in tepid or warm water, but there are more challenging problems when cold is added. Peripheral circulation is immediately restricted by the cold water. The capillaries close and the blood flow to the hands and feet is slowed to near a stop. This occurs after a minute or so; pain is felt in the hands and feet. This is a survival mechanism of the body to divert the blood to the core.

The body does not have any “overflow” system as in household plumbing for example so when water/gas pressure builds up inside, systems allow the overflow to exit or it will burst a pipe or blow a gasket. So, as the capillaries close off, the blood is now channelled into a smaller area and the response reaction is an absolute mechanical increased blood pressure. This is engineering an autonomic response, same blood volume, less space, increasing the workings of the heart all leading to increased dystolic and systolic pressure. We have absolute evidence on this where we have recordings of blood pressure scales post ice swims.

Professor Tipton wrote a lot about it. Autonominic conflict of submerging in icy waters.

With changes in blood pressure, it is also important to factor in that before and during the swim, the heart rate increase with aerobic activity, and event-led adrenaline production connected to the fight of flight response. Many swimmers will report a heart flutter prior to or during their swim as an indication of feeling the pain or the cold or the need to escape both

Daily News of Open Water Swimming: Are there any exceptions?

Nuala Moore: Yes, swimmers like Henri Kaarma, Alexander Brylin and all those who live, train and swim at these extreme temperatures regularly so their cardiovascular responses are not the same as ours. Who I refer to are regular swimmers who do not have possible exposure to exertion at 0°C to make “normal” our responses. Experience reduces anxiety and this is obviously a benefit. If we look at those who train regularly, they seem to be the most responsible in their medical knowledge. They are mainly those who understand that fun and calm are priorities.

But I am yet to be convinced that these guys have an advantage because they live there. We haven’t tested people from other places against them, but we see more and more superhumans coming out from countries that are not mostly Icy. I think they have a lot of experince.

As blood pressure increases, the body’s vascular system responds to facilitating the increase volume. The walls of the arteries and the veins have to harden to make room for the extra volume of blood and the walls become thin.

I feel this is possibly where many of our risks could be in racing in Ice. If the swimmer who is not acclimatised pushes past the point in exertion, leg kicking, sprinting and has not had the cardiovascular system tested, there is a possible risk of embolism. There is risk that the walls of the arteries and veins become so tight and stretched with the increased blood flow that this can weaken and leak.

Daily News of Open Water Swimming: What else is there?

Nuala Moore: This can apply to any race. There are people dying in marathons and cycle marathions from similar effects. Of course, Ice swimming is more extreme.

But acclimatisation and responsibility can reduce this.

If an athlete has a chink in your armour and don’t know yourself as a swimmer, don’t know your responses, don’t recognise the symptoms of increased heart rate and blood pressure of stress, and don’t know when to slow, you pose a challenge to your own life. Similarly, by not knowing the challenges, by not know what 0°C is, you can increase your blood pressure. Learn and get to know who you are as a swimmer and by knowing how you will react, you can keep yourself and the sport safe.

Daily News of Open Water Swimming: What can be compared with extreme warm water temperatures?

Nuala Moore: I think that in the ice, the exterme cold can be safer than having similir stresses in a hot environment. Some people after ice and cold swims are in bad shape. But they all have recovered better than once in heat situations. The cold has some preservation mechanism. All is good unless you have a cardiac arrest. The real question is: Are people who die in these situations, die because of the swim, or were they an accident waiting to happen. I don’t know.

So I guess it is safe to say that Yes.. ECGs and medicals are crucial to all our safety in the sport and yes I would definitely say keep up-to-date on your personal medicals. I don’t think medicals are guarantee to anything, but they reduce the odds of issues significantly

Daily News of Open Water Swimming: Anything else?

Nuala Moore: I still belive that the mind has a huge role to play event in safety. But I still have a lot to learn.

Copyright © 2015 by World Open Water Swimming Association

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