The TriDoc Podcast, triathlon and health in one place · Dr. Jeff Sankoff

Ep. 192-Swimming Induced Pulmonary Edema & How to Lighten Your Mental Load Before the Race Begins

·1 hr 13 min·4 clips

Jeff tells athletes to swim the first one or two buoys calmly, with full exhalations and no race pace.

1. The TriDoc Podcast on March 6, 2026 focuses on swimming-induced pulmonary edema and race-day mental load. 2. Host Jeff Zankoff is an emergency physician, triathlete, triathlon coach, and multiple Ironman finisher, and guest Dr. Jim Taylor is a psychologist who works with athletes and other high performers. 3. The episode asks what athletes can actually control before a race starts when cold water, anxiety, and breathing all matter. 4. Jeff and Juliette Hockman return to swimming-induced pulmonary edema, which Jeff describes as fluid in the lungs and a subject he keeps getting asked about by triathletes. 5. Jeff says deaths in the swim portion of triathlons are difficult to attribute because autopsies can also show water from partial drowning, CPR, or a primary cardiac event. 6. Jeff explains the core mechanism as a mismatch between right-heart output and left-heart output, using a 4.5 liters per minute versus 4.4 liters per minute example. 7. He says the extra fluid first fills the interstitium of the lungs and then the air sacs, making the swimmer feel short of breath from within. 8. Jeff identifies cold water as the main trigger because peripheral vasoconstriction can shift 400 to 600 cc of blood from the legs back to the torso. 9. He adds that a tight wetsuit, pre-race adrenaline, and forceful inspirations can further increase venous return and overload the heart. 10. Jeff and Juliette also note that older athletes with hypertension, prior myocardial infarction, or other cardiac dysfunction appear more vulnerable. 11. Jeff cites Swedish open-water river swims from 2016 to 2019 and says ultrasound found pulmonary edema in 64% of swimmers, although most cases were not symptomatic. 12. The same Swedish data showed a much higher rate in women than in men, with Jeff citing examples such as 0.6% versus 0.1% and 1.0% versus 0.15% in different years. 13. The age graph rose sharply as athletes got older, with the youngest groups near zero and the over-60 groups reaching around 0.8% or more in several years. 14. Jeff says the sex difference may reflect smaller lung and airway volumes in women, which could mean less fluid is needed before symptoms appear. 15. He emphasizes that the practical warning sign is shortness of breath that does not improve after stopping, which should prompt help, oxygen, and getting out of the wetsuit. 16. Jeff distinguishes that pattern from ordinary cold-water panic, where stopping and settling usually makes the breathlessness go away. 17. The style is a conversational medical segment with Jeff and Juliette trading examples, then a separate interview with Dr. Jim Taylor about sports psychology. 18. The tone is practical and advisory, with Jeff repeatedly telling athletes to control effort, breathing, and anxiety rather than obsessing over uncontrollable risks. 19. Athletes anxious about cold-water swims and listeners who want concrete race-start tactics will get the most from this episode. 20. Listeners who want a short, purely technical physiology segment without psychology or race advice may skip it.

As heard by us

A calm start guide for athletes who race better with less chaos.

TriDoc stays centered on race-day anxiety and practical open-water control, with Jeff Zankoff and Dr. Jim Taylor keeping the tone athlete-to-athlete.

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Why you'd press play

You want a calmer swim start and a quieter head when the race goes from theory to water.

Read the full recommendation in PlayNext →

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