I did the ‘holiday’ guided tour version of the Trans Provence last week and on the Wednesday and Thursday suffered a combination of weird and distressing symptoms. The trip was waaaaay harder than anyone taking part had expected. Hugely physical with LOTS of climbing and hike a bike up to altitudes of 1500 to 2000 metres approx (not drastically high, but I usually live at sea level). We’re talking a couple of hours ride-climbing and an hour or so hike a bike at a time on many of the days. It was very hot and humid and I took on lots of fluid (energy drink and electrolytes) to counter the sweating. Anyway, the symptoms started with very puffy ankles at the end of the Tuesday and a tickly dry cough overnight, then on the wednesday I felt like I couldn’t get my breath very well, like my stomach was too full of food and was displacing my lungs or something. The wednesday night I kept waking breathless and couldn’t lie on my left side as I couldn’t breathe. It was a bit better when I sat up in bed. In the morning I was told I was very pale and grey looking. The Thursday I felt as if I could only take in half my lung capacity and got out of breath just going up stairs and was dry coughing a lot. The riding was excruciating, felt like I couldn’t breathe and was very weak. After the Thursday things seemed to subside and settle with the puffy ankles getting better and chest improving. The sustained efforts for climbing reduced and the days were a bit shorter.

there’s a few things I think it could be, but all seem a bit dramatic and improbable and I’m not one to make a fuss when things appear to have resolved now, but I have checked out the things that it could be and they are quite worrisome. I didn’t ask to see a doctor at the time as I thought it would be too difficult in a foreign country and might need too much investigation. Plus I thought it might just be me being not fit enough…

I’m not sure if I should go to the doc and get checked out as the acute symptoms have dissipated. What are the possible causes and should I go to the docs and explain what happened in case there’s stuff they can check out even after the acute symptoms have passed.

The symptoms you describe sound a lot like cardiac failure. There’s a couple of options: Potentially mountain sickness/ high altitude pulmonary (o)edema (HAPE) would give you those symptoms, although 2000m isn’t especially high for that. Second option is the possibility of underlying heart disease which would have been exacerbated by the altitude / exertion. I suspect option 1 is more likely based on what information you’ve given, but if it was me, I’d want to be checked out to make sure it’s not option 2.

I guess the third option is that you had a nasty flu bug or something to give you similar symptoms.

See if I was worried about my health, I would go and see my GP.

I know nothing, but if I got swollen ankles from being at low level, which 2000m is, then I would certainly see a GP. Swollen ankles isn’t normally a good sign

I agree with Superficial. Ankle swelling and breathlessness worse on lying flat sounds like cardiac failure and pulmonary oedema to me.

Could have been exacerbated by altitude or extreme exertion, either way you should see your GP even if it has all improved now.

Hope things settle down quickly for you fella

Were you sleeping at 2,000m?

I concur with the above posters. Needs a look by your GP, who might think about requesting an echo (ultrasound scan) of your heart. It sounds a bit like HAPE, although I agree that 2000m is a bit low for it (although not unheard of).

Hannah
Cardiologist

As above, but I would also add the possibility of a DVT and PE. Off to the GP Sir, and keep us informed.

Thanks for the feedback. I’ve made an appointment for Monday. Those were the samr things thay sprang to mind with me. I have some basic medical knowledge through the field I work in, but as its mainly the elderly ive seen these symptoms in, I thought i was being a bit neurotic.
Have also read that electrolyte imbalance can lead to cardiac problems, so wondered about the fluids I was taking in perhaps being part of it.

Hey, let us know how you get on. I have just had an ECG because I thought that I was going to die on the Wrynose pass and various rides have felt much harder than usual. Have since checked my bike and realised that the 25 tooth cog on the back of my new to me CX bike is a much higher gear than I’m used to. 😯

Still waiting for the blood test results and a double check of ECG just to be sure but feeling that I’ve just troubled the NHS for over-consumption of coffee racing pulse and er, gear issues. 😳

Clover. That’s quite good.

I can almost forgive you the triple figure costs of the NHS investigations so far 😉

Clover – thats class, perhaps JoJo should take his/her bike in to their consultation on Monday with the GP…just to make sure all the medical angles are covered 😆

They do say that women under-report heart conditions and the symptoms aren’t the same as men. So I was listening to advice. Being cautious. And it sounds like you should be too, Jojo 😕

Went to doctor yesterday and initial examinations showed nothing untoward (bp fine, lungs and heart sounding ok, urine dipped and clear). Back today for blood tests and results should be back on Friday. If bloods dont show anything, are there any other tests I can legitimately request or do I just chalk it up as some unexplained ‘something”? A bit concerned that it might happen again when I’m back out in septem er for the race. Any prophylactic meds possible to take before or during race if it’s related to altitude sensitivity? Online searches suggest acclimatisation, but that’s not possible.

At a guess it sounds a lot like HAPE but as others have said it sounds too low altitude. I would be surprised if your results came back not showing signs of Cardiomyopathy though but as there are quite literally dozens of pathologies that could have set this off….it will be a case for doctors of differential diagnosis, not for forum users! They took the blood test to look for biomarkers of a heart attack or other conditions such as Creatine Kinase levels.

Push to see a Cardio, at the very least if the ankle swelling was imagined it might have been a strange relatively unheard of arrhythmia.

My thought is you have done funny things to your electrolyte balance with too much water / not enough salts. – or possibly to much salts.

It is possible to drink enough water to cause severe electrolyte imbalance – thats what killed leah betts

Just a thought.

I doubt cardiac myself but would still get it checked out.

My thought is you have done funny things to your electrolyte balance with too much water / not enough salts. – or possibly to much salts.

What TJ said.

Just to highlight how impossible it is to tell you anything of any real value, how hot was it that day? Could have been Heat Stroke! The only people that can work this out are the lab guys and a cardiologist being given a 12-lead reading to look at! So DO NOT rely on us!

Hope things work out! Definitely push to see a Cardio, your ticker is the one organ you REALLY don’t want to mess around with.

Finally, take it easy. Don’t worry, forget what happened and let the doctors work it out. Coming on the internet to get advice on health will set you off on anxiety trips.

Heat stroke – possible of course.

As a doctor I’d be really pissed off if a patient came in demanding tests because someone on the internet suggested they needed them, particularly with the forum user having never met you and not knowing the whole story.

Go back and see your GP for the results and their opinion. You can voice your concerns and discuss the options – if you’re not satisfied with their explanation then I think it’s reasonable to ask for a second opinion or more tests, but I would be guided by what they say.

Re: Treatment / prophylaxis for altitude sickness (HAPE is a severe form of altitude sickness), there are options. Acetazolamide (Diamox) is often used by people climbing / hiking to altitude – but it’s certainly not something I’d take until I knew my heart was OK. The drug itself works by altering the body’s acid/base balance and could quite feasibly allow you to get to a more remote place before you develop symptoms. However, if this episode was proven to be solely a result of altitude sickness, it would be an option.

Hi, thanks all for your thoughts. I’m pretty sure it was too low for HAPE, though it was on the days we were at highest altitude. I definitely didn’t imagine the puffy ankles/lower leg. There was pitting of several mm on compression.
Most likely to be electrolytes by the sound of things, Was hot, but not unbearable and not too sunny. I was concerned about dehydration and drank about 3 litres during the day, plus more at night with electrolyte tabs. Thinking this might be causing a prob with excess fluid, I did cut back on my intake later in the week and this is when the symptoms began to subside.

I’m not the type to ‘demand’ tests, but might mention things if people thought it might be worthwhile. I’m aware that GPs are by definition generalists and may not be as au-fait with possible sports related things. He was pretty shocked by what I thought was a ‘shorter’ less demanding day’s riding and couldn’t get his head round the idea that whilst I was struggling and in a great deal of discomfort, I still managed to put in a 6hr day on the bike when at my worst. I’ll not tell him about the Strathpuffer solo…

Sorry – didn’t mean to sound accusatory with the ‘demand’ thing. I just think topics with the opinions of a hundred internet doctors (real doctors or otherwise) must be very unhelpful to the GP at the other end of it. Having said that, all of the suggestions in this topic are pretty reasonable.

You’re right that GPs are generalists and perhaps not experts in the sports side of things specifically, but actually most cardiac conditions are managed for the most part by GPs these days – they ought to have a good understanding of most of the issues.

Glad to know you’re ok Jojo! I do think that once you start talking to doctors about exercise they do go a bit vague – if you’re out of the ‘lardy couch potato must talk about weight loss’ zone you’re in an uncharted realm of ok-dom where the finer shades of fitness are not distinguished.

Having thought there was nothing at all wrong once I’d blamed it all on my gears I have been told that I am struggling around on one third of the lowest acceptable level of vitamin D (also known as living in the North) and 80% of lowest acceptable levels of iron. So it has been kind of worth troubling the NHS…

Apparently they won’t prescribe EPO and a week in Majorca. Shucks. 😉

Almost all of the symptoms alone can be accounted for by a significant increase in workload in the week.

If you haven’t done multiple days of that intensity before (especially the hike-a-bike) the swollen ankles could be fluid pooling. Might be related to cardiac return… might not. ECG and a stress test may help clear that up.

Bloated Stomach pressing on lungs. Did you start taking a different form of gels, energy bars, isotonic drink? Did you use much more than you are used to? Did your diet differ significantly from home? All could explain that feeling. I totally stopped using gels, isotonic drinks etc for about a year after the TP because my stomach just couldn’t handle them any more.

Were you working at an intensity higher than you are usually used to for the length of the days involved? The volume of air you breathed in that week would be a lot more than you are used to. Any particles of dust, polen or anything else in the air could have caused your throat to go a bit raw (Dry Cough)

Tie all that in with Fatigue of doing multiple 1500-2200m altitude gain days if you are not used to it wouldn’t surprise me.

Our bodies all react differently and with different severity to fatigue I’d say it played a role.

you spend so little time over 2000m and never sleep much over 1000m that I think HAPE is almost impossible.

Get your doc to rule out any serious pathology and then make sure you take the things I mentioned above into account before you go back in Autumn.

Dave, Sports Scientist and TP finisher 2009.

Feel compelled to list afflictions foisted on me by end of Trans Provence 2010. Both ankles swollen, cuts bruises all over both legs, right wrist and arm to elbow swollen and bone creaking yes creaking,white finger, biggest rash of cold sores you ever saw and a frozen shoulder that still hurts now. Oh yes.

I know someone who’s a food scientist; when faced with a fridge full of isotonic and electrolytonic (and so on) drinks he glanced at the labels, said “no way” and bought a full fat coke. He reckons these sport nutrition manufacturers are packing all the extra chalk and uranium and whatnot in to make a selling point, not because you need it.

If the doc says he can’t find anything (fingers crossed) you’ll still want an explanation – the weird minerals might be it.?

(Just out of interest – anyone ever seen a sherpa drinking pukeozade sport or the like..?)