In my first triathlon about 15 years ago, I was in a huddle of wet-suited men about to wade into a lake in Maryland when an acquaintance next to me offered a singularly useful piece of information.
He said it was common for people to have panic attacks in the swim leg of triathlons, which are races that consist of swimming, cycling and running various distances, in that order. He’d done a few. We knew each other from training three mornings a week in a bright, clear Olympic-size pool.
“You’ll see. Within the first hundred yards or so, a couple people will swim right to the shore. They’ll be freaked out. The race will be over for them.”
In a minute, we were standing in water so dark you couldn’t see anything a foot below the surface. The bottom was squishy underfoot. It was not yet 8 o’clock in the morning. The wet suit, which I’d put on only a few times before, was tight around my chest and cold as the water seeped in.
The starting horn screeched.
Fifty or 60 of us, all wearing identical swim caps whose color denoted the age and sex of our starting group, began to swim. We collided and had our faces bumped and kicked as we made our way into open water. Within a few minutes my heart was racing, I was breathing fast and I was scared to death, although I wasn’t exactly sure why.
I rolled onto my back to calm down and let the pack move on. As I sculled slowly, I looked to the shore. Two men were climbing out on all fours.
Something in the water?
I think of that day each time I hear that someone has died in a triathlon.
This past summer, at least nine people in the United States died, a number that appears to be a record in a sport experiencing a boom similar to what occurred with running in the 1970s. More than 243,000 people competed in 2,500 triathlons in 2010. USA Triathlon, an organization of competitors, race directors and coaches, has 150,000 members; in 2000 it had 21,300.
Whether nine is a complete count of fatalities isn’t known. USA Triathlon, which keeps track of deaths in the 2,500 races it sanctions, won’t provide the numbers. It has, however, recently appointed a panel of three physicians and two race directors to look into them.
All but one of the nine deaths occurred in the swim portion of the races. The one exception was a 59-year-old Arlington man, John Park, who collapsed shortly after starting the bike event in the Nation’s Triathlon, which was held in the District on Sept. 11. A similar preponderance was seen in the only rigorous analysis of triathlon deaths, which appeared last year in the Journal of the American Medical Association. Researchers at the University of Minnesota found 14 deaths from 2006 through 2008. Thirteen occurred in the water.
In most of those cases, as in this year’s, drowning was the official cause of death. In about half, some minor heart abnormality was found and cited as a possible contributor. The most common was thickening of the heart muscle, which can be a normal consequence of training, and atherosclerosis, which is present in virtually all adults.
Damaged heart tissue — evidence of a myocardial infarction, or heart attack — has never been found in these cases, nor have any of the rare molecular defects of heart muscle occasionally associated with drowning. Nevertheless, news reports usually give “cardiac arrest” as the inciting event, leaving the impression they’re the consequence of heart disease.
In all, an air of fatalism and mystery surrounds these tragedies. But are they mysterious and unavoidable?
I don’t think so.
My hypothesis is these athletes suffer panic attacks, a state characterized by a racing heart, sensation of breathlessness or choking, and a feeling of lost control.
In the swim event, a combination of stresses can lead to a panic attack (or something like it): the excitement of the moment, the chaos of swimming into and over other people, the chest constriction of the wet suit, the darkness and coldness of the water, competitiveness and the desire not to quit when friends and family are watching. On rare occasions this leads to drowning.
Discussion threads on blogs suggest that panic attacks are common even among experienced athletes, although apparently nobody in the triathlon industry has attempted to learn how common they are. Some coaches mention them, but many triathletes train without coaches. Race directors in general don’t name panic attacks as potentially lethal but manageable hazards, though they do warn about wet roads for cyclists and high temperatures for runners.
Perhaps the biggest problem is that panic attacks leave no trace, making it hard to make them a contributing cause of death.