We Dolphins tend to call all physical distress related to cold water swimming "hypothermia." Hypothermia is the condition of having an abnormally low body temperature. It is characterized by shivering, slurred speech, fumbling hands, and confusion. According to the Mayo Clinic, "Shivering is likely the first thing you'll notice as the body temperature starts to drop because it's your body's automatic defense against cold temperature--an attempt to warm itself." In contrast, syncope (sink' o pee) is a medical term for loss of consciousness for a short period of time. In its most severe incarnation, the person will collapse and fall.
This happens to Dolphins from time to time. A brutal post-swim episode is the recent collapse of Joe Illick. Daniel Handler describes it this way. "When I came down to swim Joe was climbing up the short staircase from the beach and he looked in a bad way. He moved slowly and awkwardly as if in a daze, and his facial expression looked like he was searching for something. A woman at the deck showers immediately thought something was wrong and asked him if he was OK. He said yes, faintly and unconvincingly. I said hello to him and he said hello to me--in a way that felt more like social instinct than really being aware, although he did use my name. Then he started to tilt and you could see his entire body didn't know what to do. He grabbed wrongly, he turned around and then seemed to change his mind--it was all a mess of limbs and slow decisions. And then he fell, the worst way he could have. Something was wrong when he got out of the water, and there was no time to make it right."
Recently, it also happened to accomplished marathon swimmer Catherine Breed. She had just returned from an international trip and went for a "shake-out" swim for about 25 minutes. Recounting her experience, she says "When I got into the shower, I started feeling very heavy and dizzy. I sat down on a chair for a bit in the shower and thought, 'I need to get myself into the sauna and lay down because I'm about to pass out.' When I walked into the sauna, I felt very dizzy and said to the women there, 'I don't feel well' and that's all I remember until I woke up on the ground." The paramedics measured her blood pressure at 80/40 in the ambulance about 15 minutes after the syncope. She swam the next day with no problems and has returned to her full athletic schedule.
The loss of consciousness doesn't necessarily always lead to a complete collapse. This happened to Andy Greer when he returned to the water after a long layoff. He was sitting in the sauna when he started feeling "really hot" and moved to the lower bench. At this point, he began to lose his eyesight and wound up sitting immobile on the lower bench in an unresponsive stupor. Bobby Tandler noticed Andy's distress and waved a hand vigorously inches from his face without a reaction. When told the name, Bobby began shouting, "ANDY!! ANDY!" at which point Andy said in a vague, distracted way, "I can hear!" But he still couldn't see. Given a drink of warm tea, he almost immediately smiled and said, "I can see now!" Although he recovered, he went home and stayed on the couch the rest of the day feeling ill. Now, he only stays on the lower deck of the sauna for five minutes and then leaves, dons warm clothes, sits by the heater in the Staib room and suffers no ill effects other than missing the camaraderie and myriad "true facts" of the sauna.
Syncope doesn't always happen on dry land. Naphtali Offen was completing a long training swim outside the cove. When he got to the Opening, his pilot, Adam Goldberg, noticed that he was moving his arms but going nowhere. He was bobbing almost vertically in the water. The pilots in a motorized craft pulled Hal into the boat and brought him to shore. Adam helped him up the stairs and into the sauna. The first thing he remembers is five or six men coming up to him in the shower afterwards and asking him how he was feeling. He told them all that he felt fine and as they left, he puzzled over their solicitude. Then Adam came to him and said, "You do know you were pulled, don't you?" Naphtali indignantly refused to believe this until Adam said, "Let me ask you this. Do you remember getting to shore?" The answer, of course, was "Noooo?!!"
Duke Dahlin was taking a lesson when he was training for the Manhattan Island Marathon Swim. The swim lesson involved stopping periodically and treading water to listen to the instructor's suggestions. When the lesson was over, Duke decided to swim once more to the flag even though his instincts told him it was too much. He walked up the stairs under his own power, waving at people, went to the shower and collapsed. When the paramedics arrived, they immediately took him out of the sauna. In the ambulance, they told him that he was dehydrated and administered an IV drip. Since then, Duke has paid closer attention to his instincts and avoided any subsequent episodes.
In the preceding examples, the syncope was unaccompanied by shivering. In fact, swimmers regularly reported starting to feel much better when they eventually did begin to tremble. This is consistent with a case report entitled "Near-syncope after swimming in cold water." Lead author and Dolphin Club member Dr. Tom Nuckton reports that the 60 year-old swimmer in the case study did not have signs of clinically-related hypothermia when brought to the sauna after swimming and sinking to the floor. "Clinical improvement was noted when the patient started shivering after being removed from the sauna and all symptoms resolved after the administration of 1 liter of normal saline." The case report concludes "Careful consideration should be given to the differential diagnosis [between hypothermia and syncope] in all cases. Depending on the presentation, the priority of treatment may be the correction of volume depletion and orthostatic hypotension rather than active rewarming."
It's easy to determine what causes hypothermia: swimming in cold water. Getting warm by using the sauna, using the shower, exercising, wearing warm clothes (or some combination) reliably treats the symptoms. Syncope, on the other hand, has a very long list of potential causes. In his case report, Dr. Nuckton puts it this way. "While we speculate that orthostatic hypotension is a common etiology of syncope and near-syncope after swimming in cold water, other causes must be considered. Dysrhythmias, including those related to long QT syndrome, have been associated with swimming and other forms of exercise. Myocardial infarction, structural heart disease, vasovagal syncope, cold urticaria or anaphylaxis, and other possibilities should be considered." Medical tests such as ECG are the most dependable way to rule out the more serious causes that could indicate underlying, persistent health problems. And drinking water, or tea, or Gatorade will not necessarily treat a severe case of dehydration and/or hypovolemia (decreased volume of circulating blood). Administering a liter of IV normal saline did the trick immediately for Duke and the patient in the case report.
Of course, these interventions require a trip to the hospital and some people will adamantly resist "the ride" in the ambulance. Many Dolphins are quite independent and strong-willed. For some, the ride is too embarrassing and expensive--not to mention the hassle of getting back to the parked car and possible parking fees. However, many physicians will tell you that no amount of bravado is worth missing a serious underlying issue. Additionally, it's very much worth noting that if the distressed person is not shivering, getting them to the sauna or shower may not be wisest approach. It could easily be that letting the person rest until the body's automatic defenses decide to kick in could, counter-intuitively, be the best practice--whether or not you call 911.
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