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Exercise-induced Pulmonary Edema

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Exercise-induced Pulmonary Edema

Old 03-21-22, 11:11 AM
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Exercise-induced Pulmonary Edema

My second time out on roads in my town, and probably first time on a serious bike ride in 5 or 6 years. I hadn't ridden these roads yet since I moved here 2 years ago,
I live on a large hill, so there is no route I can take that won't involve a large amount of incline - maybe 180' or so with more minor inclines in between. My first time out was on my 21 speed Specialized Sirrus flatbar bike I struggled on on a 1 mile uphill but was able to make it without stopping. The total trip of 5 miles took me 30 minutes. Afterward, I had a slight catch in my breath which I chalked up to just stirring up some old congestion or something. A week or so later I did the same ride backwards on a 70's Dawes 10 speed I've been working on. I did an incline of about 160' in a 1 mile span. Without the smaller front cog of the Sirrus, I really struggled and had to admit defeat, and walked the bike up the steepest 1/4 mile, stopping again near the crest. My total trip was 4.6 miles and was very exhausting!

Afterwards I started with the catch in my breath, and coughed up a bit of a metallic taste, and went to bed that night with a wheeze in my breath. I looked up the symptoms and it's Excersize-induced Pulmonary Edema. Common with athletes who over-exert and easily recovered from. Not sure how healthy it is for a 66 year old though.
Very discouraging since, 1. I used to traverse similar inclines and go on to ride 20 miles in my 40's and 50's. and, 2. If I am to ride locally, this is the terrain I am facing.
Any other "older" folks out there with similar limitations and how have you overcome it?
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Old 03-21-22, 11:55 AM
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I have gradually adopted lower gearing and a slower climbing pace, which hurts psychologically, because climbing was the one thing I used to pretty decently.
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Old 03-21-22, 11:57 AM
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I'm neither a Dr nor an expert, but I've had it in the past. But here's my advice.

Rest until you heal up. Took a day or two off a few years ago. That was sufficient.

Can you start slower? Lower gear on the uphill? Worst case walk up the hill for a bit?

See a Dr anyways just in case.
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Old 03-21-22, 12:18 PM
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Originally Posted by locolobo13
I'm neither a Dr nor an expert, but I've had it in the past. But here's my advice.

Rest until you heal up. Took a day or two off a few years ago. That was sufficient.

Can you start slower? Lower gear on the uphill? Worst case walk up the hill for a bit?

See a Dr anyways just in case.
The start of my ride involves a downhill pretty much in every direction. Getting home is all a very daunting uphill slog. Doable on the 21 speeder, but even on the lowest gearset on the Dawes it was tough. And, yes, much to my mortification, I walked it up part of the hill, and had to stop and rest again close to the top.
Having in my 40's and 50's having a dedicated fitness regimen (only slowing down at age 61, and halting altogether due to COVID closing the gym), my doctor gives me nothing but green lights.
I will give it a few days off and may resort to traversing a more level track, even if it's an out-and-back rather than a circle route.
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Old 03-21-22, 04:24 PM
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You should probably ask a healthcare professional. However it might well be somewhat normal for a person that hasn't been doing high cardio activity regularly. Took me most of a year back in my early 50's to be able to ride hard without getting too much complaints from my body and weird stuff happening. 10 miles back then was a big effort and took a lot out of me. 13 years later 50 miles isn't anything..

If your doctor says you are good to go, then just keep going. As your body gets stronger and use to it you'll see the weird issues go away and you'll feel better in general. Though you'll probably just get another set of weird issues as you progress. <grin>

Just finished a 42 mile ride and might have to go walk with my spouse. So eventually things get better.
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Old 03-21-22, 04:35 PM
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I have been doing serious riding for the past 55 years and I have always found that I needed to warm up by riding the first 10 minutes at a moderate pace. I need to give my body time to adjust and increase circulation, including that in my lungs.

You probably have some level of asthma and doubtful it is an edema, despite what you read on the internet. I was first diagnosed with asthma as an infant but I have never experienced stress induced asthma which is what you described. It took me decades to accidentally realize that when I traveled my sinus congestion went away and with no nasal drip there was no irritation of my lungs, particularly when sleeping. I realized that I was allergic to wheat and if I avoid any foods with wheat then no sinus congestion. Doctors were happy to proscribe corticosteriods which is a bit like using a machete to remove a splinter from a finger.

A bicycle requires 15% as much energy as walking but if you use too high a gear that benefit is negated. I like to have one "granny" gear that is low enough that I can go up anything, regardless of how steep or how far to get to the top. For me this is a 39/28 or 36 inches for my low gear. It is a little more than two rotations of the pedals for every tire rotation. Today there are rear derailleurs that will handle a 50 tooth cog and so having a low enough gear is not a problem.

Most doctors know nothing about nutrition and nothing about advising people engaged in physical activity. They know how to read the numbers for tests and so they treat the numbers and not the person. My life is too valuable to me to entrust it blindly to any doctor.
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Old 03-21-22, 05:23 PM
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Originally Posted by Calsun
I have been doing serious riding for the past 55 years and I have always found that I needed to warm up by riding the first 10 minutes at a moderate pace. I need to give my body time to adjust and increase circulation, including that in my lungs.

You probably have some level of asthma and doubtful it is an edema, despite what you read on the internet. I was first diagnosed with asthma as an infant but I have never experienced stress induced asthma which is what you described. It took me decades to accidentally realize that when I traveled my sinus congestion went away and with no nasal drip there was no irritation of my lungs, particularly when sleeping. I realized that I was allergic to wheat and if I avoid any foods with wheat then no sinus congestion. Doctors were happy to proscribe corticosteriods which is a bit like using a machete to remove a splinter from a finger.

A bicycle requires 15% as much energy as walking but if you use too high a gear that benefit is negated. I like to have one "granny" gear that is low enough that I can go up anything, regardless of how steep or how far to get to the top. For me this is a 39/28 or 36 inches for my low gear. It is a little more than two rotations of the pedals for every tire rotation. Today there are rear derailleurs that will handle a 50 tooth cog and so having a low enough gear is not a problem.

Most doctors know nothing about nutrition and nothing about advising people engaged in physical activity. They know how to read the numbers for tests and so they treat the numbers and not the person. My life is too valuable to me to entrust it blindly to any doctor.
My wife has the same wheat allergy you describe and is prone to asthma. She has had excerise-induced asthma as well. She says thats what my breathing sounded like. I do have a mild inhaler left over from some some bronchial stuff I went to the Dr. for once.
I'm looking into either re-gearing the small cog from 42. What would be a good step down for a hill climb gear? 39, or smaller? I suppose I could look at my Specialized to see what the lowest ratio is, and try to get close to that. And the rest is just going to include conditioning and getting past the discouragement.
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Old 03-21-22, 06:15 PM
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There’s a bit of a difference between exercise-induced asthma and pulmonary edema. Sometimes this kind of stuff is an angina equivalent. You really need to get checked out by a doctor.
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Old 03-21-22, 07:55 PM
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Those are at best 3% inclines so without knowing your measurables like height, weight, current conditioning; I would strongly consider a PE especially if there is a family Hx of heart disease.
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Old 03-21-22, 08:04 PM
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With asthma and allergies, for me being turned into a snot-machine is well within the range of normal. Some congestion and wheezing sounds a lot more like asthma/allergies to me than pulmonary edema, which I associate with being carried down Mt. Everest while desperately ill, because it's the only cure possible.

I'm not a doctor.
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Old 03-22-22, 08:38 AM
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Exercised - induced Pulmonary Edema

I have ridden pretty consistently for 40 years and get exercised induced asthma when it is cold and dry or after a hard time trial; my lungs gurgle for at least a few hours which I guess is edema. I don't like it but it is just another price we pay to be on the bike.
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Old 03-22-22, 09:14 AM
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Originally Posted by CAT7RDR
Those are at best 3% inclines so without knowing your measurables like height, weight, current conditioning; I would strongly consider a PE especially if there is a family Hx of heart disease.
3% is about right, although the section I pooped out on was a stretch of 8% grade. No history of heart disease ad the last time I had a PE that included an EKG was about 6 months ago. I am on a mild BP med but nothing drastic. I'm 5'8" and weigh 190, I've always been into fitness but have slowed down a bit the last 4 years, and altogether halted when the gyms closed during the height of COVID. I may find a more level stretch and see how I feel, and if good, start trying to get into condition from there. Turning 66 in a couple months so I have to expect to slow down a bit, right?
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Old 03-22-22, 09:44 AM
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So how many rides do you have behind you? For what total distance?

As you do more you get better. It's way too easy to overexert yourself when you are just starting out as not all of your body is in the right shape to handle what the rest of your body is throwing at it. So take it easier and don't quit.

Also, ask a doctor about anything that concerns you to make sure it's not some red flag for serious health related issue. But as Calsun said, doctors don't always know the particulars of how to discuss sports related issues with their patients. I never got a realistic answer about exercising at very high heart rates until I got a heart doctor. All the others just gave oblique answers.
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Old 03-22-22, 10:04 AM
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Originally Posted by Iride01
So how many rides do you have behind you? For what total distance?

As you do more you get better. It's way too easy to overexert yourself when you are just starting out as not all of your body is in the right shape to handle what the rest of your body is throwing at it. So take it easier and don't quit.

Also, ask a doctor about anything that concerns you to make sure it's not some red flag for serious health related issue. But as Calsun said, doctors don't always know the particulars of how to discuss sports related issues with their patients. I never got a realistic answer about exercising at very high heart rates until I got a heart doctor. All the others just gave oblique answers.
It was only my second ride out for the year. I think the last time out was on a pretty level bike path last summer. Prior to that it was 3 years ago when I lived in a much flatter area.
So yeah, I may just be expecting too much after such a long off-period. I have been to a heart dioctor a couple times in the last 10 years and each time was given a clean bill of health and ok for the fitness program I was doing at the time.
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Old 03-22-22, 12:18 PM
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I know that taste. had a ride this winter & got a nose bleed. at one point, so much blood was in my throat, that I coughed up & spit out a big darn clot. funny thing is, the nose bleed let up while I was climbing hills to get back home. when the strain eased up, the blood flowed more. weird, but welcome
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Old 03-22-22, 05:58 PM
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Moved to Pills and Ills.
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Old 03-22-22, 11:21 PM
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Check with a doctor. But pulmonary edema usually won't clear up that quickly.

Sounds more like asthma. Or it might be complications from the ever-mutating SARS virus. While SARS has diminished in ferocity in most regions, some variants are far more infectious, with symptoms sorta like the flu. For better or worse we'll have to live with it for awhile. I'm at the point where I regard the vaccines more as immune system boosters rather than lifetime insurance policies. But recently I found my childhood shot record from the 1950s-'60s, and it turns out we got four or more immunizations for polio and other diseases back then too. And I got another dozen or more in military service in the 1970s, including immune globulin (then called gamma globulin) for hepatitis exposure -- I was a Navy Corpsman working in a high risk environment with patients who had kidney failure, hepatitis, etc. I realized decades ago viruses often carry complications beyond the face value. So the SARS virus isn't just a "respiratory bug." The lungs are just the entry point.

Recently I had to switch from albuterol (not a true rescue inhaler, no matter what the makers claim) to Primatene Mist with epinephrine for my worst asthma attacks. And I have Asmanex, a preventive inhaler that I often forget to use.

When I resumed cycling in 2015 after a 30+ year hiatus it seemed to take forever to regain my aerobic fitness. I wheezed and gasped on every hillette in my part of Texas. We don't have any mountains but the terrain in my area has lots of short, steep climbs, typically 5%-12% for 100 yards, then downhill, flat, up, down, lather, rinse, repeat until passed out. I was 57 then but after about a year was doing pretty well.

Unfortunately I've been mostly off the bike since last autumn when I caught the Super Cooties despite the vaccines (although at least the jab kept me out of the ER and ICU, unlike some friends). No lower respiratory complications, but I'm still having intermittent upper respiratory inflammation, vertigo, joint and muscle pain and fatigue. I was worried about crashing -- my dizziness really was that bad -- so I switched to mostly running on good days, jogging slowly on meh days, walking even on bad days. I figure if I get dizzy and fall it'll hurt less.

And I've experienced the metallic taste and odor thing. In my case it's from blood due to an upper respiratory inflammation that was so bad I had frequent nose bleeds and had blood clots in my nasal drainage for weeks. I had to use saline water nasal irrigation to avoid straining the mucosa and making it worse. The bloody drainage persisted from October until just a few weeks ago, late February or early March. And I needed a couple of courses of oral Prednisone to knock down the inflammation.

TBH, by September 2021 I was getting careless with with whole tiresome pandemic hoohah and didn't always mask up in places like grocery stores since I usually shop late at night when the stores are nearly empty. And I had to take the city bus or Uber often to medical appointments. So it's possible I let my guard down and caught the Super Cooties. Although to be realistic, there's no way to avoid it. We'll just have to live with it and do the best we can to avoid severe complications.

I put in the same hours per week, but a fraction of the mileage, and I'm still at only about one-third of my former workout intensity. Per Strava's gauge for workout intensity, I'm down from about 1,000 per week to around 350 on a good week, often lower. That's still better than most guys my age. I'm just fortunate that I was in exceptionally good shape from around 2016-2019, but it took a lot of hard work and tackling our roller coaster terrain hills over and over until my chest burned.

I've used the indoor trainer a couple of times and can tell it'll take me awhile to regain my cycling legs and lungs. And I have to disagree with the young Greg LeMond's statement "It doesn't get easier, you just go faster." I'm sure nowadays he'd agree that it doesn't get easier and you just get slower.

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Old 03-23-22, 06:15 AM
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Originally Posted by canklecat
Check with a doctor. But pulmonary edema usually won't clear up that quickly.

Sounds more like asthma. Or it might be complications from the ever-mutating SARS virus. While SARS has diminished in ferocity in most regions, some variants are far more infectious, with symptoms sorta like the flu. For better or worse we'll have to live with it for awhile. I'm at the point where I regard the vaccines more as immune system boosters rather than lifetime insurance policies. But recently I found my childhood shot record from the 1950s-'60s, and it turns out we got four or more immunizations for polio and other diseases back then too. And I got another dozen or more in military service in the 1970s, including immune globulin (then called gamma globulin) for hepatitis exposure -- I was a Navy Corpsman working in a high risk environment with patients who had kidney failure, hepatitis, etc. I realized decades ago viruses often carry complications beyond the face value. So the SARS virus isn't just a "respiratory bug." The lungs are just the entry point.
I too, had the virus in mid-January, despite the shots. It wasn't to the extent that you hear about, but still took about 3 weeks to clear out of my lungs. I've never been asthmatic or allergy-prone and never needed an inhaler. I was prescribed one as part of recovery from COVID but never rally used it. I've used it a couple times after my cycling exploits recently.
I've been mapping out 4 - 5 mile routes on Google maps - when you select cycling as the mode of transport it will show a graph of the elevations along the route. I looked for a route with as a mild an incline as possible, which still includes about a 175 foot elevation change but not as long of a stretch. I hope to try that out this aft on the 21 speeder. If I have to do the walk of shame, so be it. It may take a bit to work up to it.
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Old 03-23-22, 06:25 AM
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If I do not warm up really well, a hill like that will have me tasting blood.

No Doc could ever explain that to me or really shown any interest in troubleshooting it.

I do have seasonal allergies.

Sounds like asthma to me, see a Pulmo Doc
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Old 03-23-22, 08:41 AM
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Originally Posted by Hermes
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Old 03-23-22, 09:13 AM
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@swampyankee2 At your age, if you do not already have a pulse oximeter, you need one. I also turn 66 in a couple months.

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Old 03-23-22, 09:35 AM
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Originally Posted by FBOATSB
@swampyankee2 At your age, if you do not already have a pulse oximeter, you need one. I also turn 66 in a couple months.
Interesting you should suggest that. My ex is trying to excersize more lately and has been using a pulse-ox. to monitor her heart rate, mostly.
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Old 03-23-22, 09:54 AM
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Originally Posted by swampyankee2
Interesting you should suggest that. My ex is trying to excersize more lately and has been using a pulse-ox. to monitor her heart rate, mostly.
Good. Then you know they are inexpensive and readily available
My shortness of breath started climbing stairs at work. I was taking the stairs to avoid jam packed elevators (early pandemic) and was doing OK but seemed to gradually get worse, setting off COVID alarms in my head. Long story short, negative COVID tests, but COPD.
I learned if your SpO2 is below a certain number, you will NOT be allowed to leave the hospital
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Old 03-23-22, 10:30 AM
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Originally Posted by swampyankee2
My wife has the same wheat allergy you describe and is prone to asthma. She has had excerise-induced asthma as well. She says thats what my breathing sounded like. I do have a mild inhaler left over from some some bronchial stuff I went to the Dr. for once.
I'm looking into either re-gearing the small cog from 42. What would be a good step down for a hill climb gear? 39, or smaller? I suppose I could look at my Specialized to see what the lowest ratio is, and try to get close to that. And the rest is just going to include conditioning and getting past the discouragement.
A 3% grade with a 8% section is hard for your second ride!

When I got back into cycling in my 50s, I rode a mountain bike with smooth tread tires in the city. It had seriously low gearing, and I used it all. I could climb steep (for me) hills at a slow speed, without having to "mash" or "grind" the pedal strokes.

Now, I can ride long distances and climb big hills, but I still like and use quite low gearing.

Gear ratios
You should look for a lowest gear ratio near or below 1.0. If you have an older road bike with a 42 front, I'm guessing you have a 25 or 27 rear. That would be 42/27 = 1.55. This is how bikes were built "back in the day", but it's not nearly low enough.
My road bike is 34 front, 32 rear. That's 34/32 = 1.06
My gravel/adventure bike is 30 front, 34 rear. 0.88. I really like this.
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Old 03-23-22, 12:36 PM
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Wildwood 
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I empathize with @swampyankee2
My last 3km home involves ~125m elevation gain.
On my vintage bikes with smallest gear = 42/26, I walk one section of ~50m.
No shame in walking.
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