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By Tom Demerly for tomdemerly.com.

Three participants died in the swim leg of two different triathlons within seven days in Wisconsin this June. It’s an ominous start to the 2019 Midwest triathlon race season, raising questions about athlete safety, fitness and medical screening prior to participation in long distance triathlons such as Ironman and even shorter distance beginner events, where one of this month’s swim fatalities occurred.

Todd Mahoney, 38, and Michael McCulloch, 61, died during the 1.2-mile open water swim of the Ironman 70.3 Wisconsin, Madison triathlon on Sunday, June 9. The race is commonly referred to as a “half-Ironman” for its total distance of 70.3 miles. The event is half the total distance of a “full-Ironman” or 140.6-mile combined swim/bike/run distance event. The week before on Sunday, June 2, 59-year old Scott Beatse died in the Lake Mills Triathlon, also in Wisconsin. The Lake Mills Triathlon was a short-distance triathlon with a 400-meter (1/4 mile) swim, 16-mile bike and 3.1 mile run. The specific cause of death for each participant has not been released.

A September, 2017 report on triathlon swim deaths published in Reuters Health News by journalist Lisa Rapaport revealed that, “A study of more than 9 million participants over three decades found that deaths and cardiac arrests struck 1.74 out of every 100,000 competitors.”

While Rapaport’s story makes the chances of dying in a triathlon swim seem low, the 30-year duration of the study and the method of data collection may miss some key changes in current triathlon demographics. During the last decade, triathlon events have “filled from the bottom” with most participants coming from the beginner demographic. Beginner participants may- or may not– have adequate fitness or pre-existing medical conditions that go undetected until they experience the physical and mental stress of triathlon participation.

The question of whether athletes should be required to have mandatory pre-race medical screenings has been an unpopular one in U.S. triathlon events. In general, race organizers and participants are opposed to the idea of mandatory medical screenings prior to participation. But in endurance events outside the U.S. like the 156-mile Marathon des Sables, an ultra-distance running stage race in the Sahara Desert, all citizen-participants are required to have a cardiac EKG and basic medical health check certified by a medical doctor in their home country prior to entry. In the professional Tour de France bicycle race, cyclists receive a comprehensive medical exam prior to participation not only to screen for performance enhancing drugs, but also to detect any pre-existing conditions that may pose a health risk during the race. In the long distance Raid Gauloises adventure race, pre-race medical checks were also required.

There are reasons to question the effectiveness of pre-event medical screening in reducing fatalities among recreational participants. Basic pre-race medical exams such as an electro-cardiogram, blood pressure measurement and medical history may not reveal common athlete killers such as a “Patent Foramen Ovale” or PFO. The PFO, a cardiac defect, is present in “about 25 percent in the general population” according to the American Heart Association. A PFO can result in a cryptogenic stroke, which can be fatal, especially if suffered during an open water swim where even a mild PFO-induced stroke can lead to disorientation that may contribute to drowning.

PFOs are difficult to detect in a routine medical examination. They commonly require a color flow Doppler echocardiogram or transthoracic echocardiographic (TTE) imaging test to detect. These tests are not routine in general medical examinations and usually only administered after a patient has suffered a stroke as a diagnostic tool to discover the cause of the stroke. PFOs can be treated with a small cardiac implant to prevent their return.

Other factors that could contribute to athlete mortality and medical risk include participating in triathlons while being overweight. As special categories for participants categorized by weight have been introduced in triathlons, called “Clydesdale” and “Athena” categories, there may be more overweight participants in triathlons. While there appear to be no published metrics on risk factors for overweight participants compared to non-overweight participants in triathlons, overwhelming exercise research verifies that being overweight is a general health risk. It’s unlikely, however, that any endurance event would begin excluding participants based on health-based risk factors such as weight or family medical history.

Similar, documented risk factors exist for older athletes. As the general demographic of triathlon participations is likely growing older, common age-related health risks are increasing in the general triathlon population. Although participating in triathlons at older ages presents additional risk commonly associated with general aging, older participants are often celebrated as exceptional in triathlon. In fact, regular, moderate aerobic exercise- although usually less strenuous than triathlon distances and not in a competitive setting- have been commonly cited as beneficial to reducing age-induced health risks, especially obesity, in many credible medical findings. While risks for aging endurance athletes remain and even increase, the benefits may be worth it when spread across the broader population if participation is approached with moderation and medical monitoring.

Ultimately it is difficult to make a case for any one set of common medical diagnosis to predict athlete risk factors in triathlons except for obesity and aging. It is common knowledge that overweight athletes are at greater risk than non-overweight athletes. Those risk factors themselves are part of the reasons overweight people begin to exercise- to moderate the health risks of obesity by losing weight through exercise and diet. It’s also common knowledge that older people have more health risks than younger people. It doesn’t require a medical screening to reveal any of those realities.

Perhaps the greater question is why participants who know they have risk factors would participate in triathlons when a more moderate approach to managing risk factors such as weight loss may be safer? This is especially true for long-distance triathlons. Using less strenuous exercise as managed by a health care provider over time to moderate risk factors such as obesity before participating in triathlons makes sense. This approach addresses the risks faced by participants with conspicuous pre-existing exercise risks like age and being overweight. It does nothing to predict the mortality of participants with difficult to detect medical problems like PFOs. Unfortunately, as the triathlon community has learned so far in 2019, these may be undetectable killers.


 

Author Tom Demerly has competed in well over a hundred triathlons including the Ironman Triathlon World Championship in Kona, Hawaii and five other Ironman triathlons around the world. He is a four-time state cycling champion and has participated in endurance events on all seven continents including the Marathon des Sables, the Eco-Challenge and the Raid Gauloises. He has also climbed the highest mountains on three continents and the highest mountain in the western hemisphere. Demerly is a stroke survivor who suffered a stroke while running in October, 2006 from a Patent Foramen Ovale. He had heart surgery to correct a cardiac birth defect that caused the stroke. He was also a member of an elite Army National Guard Long Range Surveillance Unit (LRSU), Co. “F”, 425th INF. (AIRBORNE), Michigan National Guard.

 

 

 

 

 

 

 

 

 

 

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By Tom Demerly for tomdemerly.com

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Your chest is tight, your wetsuit is gagging you, you can’t breath, you’re sinking, you can’t see a lifeguard. You are drowning…

It’s your responsibility if your triathlon open water swims are terrifying- and dangerous, and that is good.

Since it is your responsibility, you can do something about it.

Following the death of U.S. Army Col. Gene Montague in the swim at the Chattanooga Ironman 70.3 triathlon on Sunday, May 22, 2016 here are five things to do now to prevent another potential swim accident:

  1. Yes- You Should Get a Medical Check. Even You 

In 2008 I had a stroke while running as a result of a common cardiac birth defect I never knew I had, a Patent Foramen Ovale or “PFO”. If I had the same stroke during an open water swim the likelihood is I would have drowned. Before that day I did hundreds of events without a single cardiac problem. One day, it just showed up out of the blue.

And it nearly killed me.

There are a number of pre-existing medical problems that may be minor if they present themselves on land, but could be deadly if they show up in an open water swim. Many of these are easy to detect with an EKG or other medical tests.

Take the responsibility to have these tests done yourself, because race organizers have not taken the responsibility to require them.

The harsh reality for triathletes is that, if one of these easily detectible conditions strikes during the swim, it is our own fault. We could have detected and prevented the accident prior to race day.

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Cardiac fitness certificates from a physician are common in ultra-distance running races and some ultra-distance adventure races like the Marathon des Sables and the long course Raid Gauloises. But they are oddly absent from Ironman and triathlon, where the numbers of participants and the lack of preparation make them more relevant.

This is our responsibility, so go to the doctor and have a cardiac check-up and an overall physical to assess your risk to having a serious open water swim medical problem.

  1. Own It: Proactively Manage Thoughts, and Preparation.

Practice Mental Rehearsals and Visualization to Manage Fear. Take control of your pre-race thoughts before they take control of you.

Make a conscious decision to replace destructive fear with constructive mental preparation. Proactively eliminate fear using conscious thought.

If you do not have a purposeful approach to mental preparation for open water swimming then involuntary and subconscious fear will surface. Don’t let it. It is your decision.

Your cognitive brain has a given processing capacity. If you use all of your brain’s processing capacity for purposeful, constructive thought you won’t have any remaining cognitive capacity for fear. You won’t have time to be scared.

You’ll be too consciously occupied visualizing a positive outcome to have fear of a negative outcome affect your performance.

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Four to eight weeks before your first race find a quiet place to sit without distractions for 15 minutes. Close your eyes and visualize what you think the transition area might look like on race day. Look for photos of the race venue on line to assist with this preparation.

Imagine yourself racking your bike in the transition area; chatting with other athletes, feeling the cool morning air before the sun rises. Think about pulling your wetsuit on, adjusting it into place. Go over the actions again and again in your head.

Focus on concentration- it isn’t easy to concentrate this purposefully. Visualize walking to the water’s edge, having your goggles with you, stretching your swim cap on and pushing in your earplugs. What will the race announcer be saying over the loudspeaker? What wave will you be in for the start? How many people will you be swimming with? Answer these questions in advance using the race website resources and information about last year’s race.

Occupy your brain purposefully and teach yourself to think calmly and in an orderly manner about controllable factors. Use all of your brain on things you can control and let the rest go.

  1. Practice Swimming In Open Water Before Race Day.

Seems obvious, frequently ignored.

Especially in inland fresh water lakes in the Midwest underwater visibility is poor. Add glare from a rising sun on the horizon and you are swimming blind in the open water in a group of people kicking you with no idea where you’re headed.

That’s scary if you aren’t accustomed to it. Get used to the open water swim environment gradually and in increments before race day.

To moderate your open water anxiety, practice swimming straight and parallel to the shore in shallow, open water prior to race day. This will teach you straighter swimming, sighting strategies and get you mentally acclimated to swimming in poor underwater and surface visibility.

Get used to mucky, sandy and weed-covered lake and ocean bottoms you never encounter in pools.

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Ramp your pace up to the speed you’ll swim in a race. Bring a friend to swim with- never swim open water alone- and practice swimming close to each other with occasional bumps. This will get you ready for rough and tumble swim starts.

As your comfort and proficiency swimming parallel to shore increases then practice swimming toward a landmark into deep water with your swim buddy. Always use an area free of boat and watercraft traffic. Try to navigate straight out toward an object on the horizon like a water tower, tall tree or other visible, stationary landmark on the horizon, and then reverse your course back to shore. Keep it short and comfortable and repeat several times to improve your comfort, confidence and proficiency.

  1. Swim More Before Race Day. Way More.

Also Pretty obvious.

Except in competitive swim, surf and lifeguard circles swimming is the event people like the least and practice the least. Change that.

If you increase your swim volume before race day you will get slightly faster , slightly more fit but significantly more comfortable in the water.

This is a simple fix, but since swimming is less convenient than going for run or a bike ride and more people are afraid of it, it usually gets relegated to the thing we train for the least. Most people simply train enough to “get through” the swim. That makes an event less enjoyable and more frightening.

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Too late you say? You’re big race is a month away and you’ve only been to the pool twice? They will have the same race again next year, and there is wisdom in picking your battles, taking time to competently prepare and coming back in a year.

  1. Get Comfortable With Your Wetsuit and Swim Gear Early. 

I’ve sold triathlon wetsuits since they were invented in the 1980’s. To this day people will buy a wetsuit on Thursday and try to race in it on Saturday.

Don’t do that.

Buy your wetsuit at least a month before race day. Do a dry-land try-on and make sure it fits precisely (read: tight) enough so no excess water enters the suit. Learn to pull the legs and torso up without tearing the outer surface of your suit with your fingernails. Practice getting the torso and arms pulled up so the suit is not restrictive.

New wetsuits usually feel uncomfortably tight and restrictive when you’re doing a dry land fitting. That’s normal.

Follow-up the dry land fitting with a pool and an open water practice swim in the wetsuit and race clothing you’ll use on race day.

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Tip: Triathletes who say it is easier to swim in a sleeveless suit than a full sleeve suit usually didn’t have their full suit on correctly- that is why they had problems swimming in it. Full suits are faster, warmer, more buoyant and you travel farther per stroke making them more efficient. But you have to put them on correctly. If a a suit is not pulled up high enough in the upper torso and the arms aren’t pulled up high enough excess neoprene in the underarm will make swimming more difficult. It isn’t the suit- it’s a poor job of donning the suit.

Few triathletes go to an open water swim venue with their equipment and practice. This is a key error.

Put on your wetsuit, get it adjusted correctly, enter the water, get used to the suit in the water well before race day. Then do some shallow water, slow, controlled swimming to get used to the new sensations.

Take all your race day gear and do a test swim at low speed in waist-deep water. Take time to stop, stand up, adjust your wetsuit, your goggles, and your earplugs. Get used to how all your equipment feels well before race day. Do this in a controlled, non-pressured situation.

If you practice these five proactive behaviors before race day your open water swim will be safer, you will be a more responsible, better-prepared athlete and you’ll have a better performance and enjoy your event more.

Take responsibility for your own performance.

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Author Tom Demerly has raced endurance events on all 7 continents, written for numerous triathlon publications including the official USA Triathlon newsletter, Inside Triathlon and many others. He’s done Ironmans around the world Including the Ironman World Championship in Kona, Hawaii and the Discovery Channel Eco-Challenge, The Raid Gauloises, The Marathon des Sables and the Jordan Telecom Desert Cup in Jordan. He is a former member of a U.S. Army Long Range Surveillance Team and a certified Advanced Open Water SCUBA Diver. Demerly also worked with athletes at Doug Stern’s Open Water Swim Camp in Curacao, Dutch Antilles for three years. Most importantly, Demerly loves the water.

 

By Jan Mack and Tom Demerly.

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Today is Trish Morgan’s first triathlon.

It’s a beginner triathlon with a ¼-mile swim, 10-mile bike and a 3-mile run.

Trish has run a few 10K’s, a half marathon (she has a “13.1” sticker on her Honda), did a three-day charity bike ride and swam on the intra-mural swim team in junior high school. She followed a “Ten Weeks To Your First Triathlon” program on line.

So Trish is ready.

She’s at the swim start. The loudspeaker says something important. She catches every third word. Her swim cap feels too tight. It’s her first time swimming in this new wetsuit. It feels too tight. She can barely take a full breath. The salesman said that was OK. Her goggles feel so tight they are making her eyes pop out. They keep fogging up. She won’t be able to see where she’s swimming. In the middle of Mud Lake, with foggy goggles and a new wetsuit choking you, what are you supposed to do?

She can’t see where the lifeguard kids on the paddleboards are. How is a kid on a paddleboard supposed to save you anyway? She can’t see the swim buoys that mark course. The loudspeaker keeps saying something. The wetsuit is too tight. They said this was the right size…

It’s too late to worry. Like a herd of lemmings her group with pink swim caps is moving… into the lake. The dark, weed-filled lake. They are like people trying to escape a fire. Trish moves with them, swept along in the crowd. A rising voice inside her begs attention. It begins as a whisper but gathers volume and urgency.

The rush of cold thickness in the water at her thighs makes it hard to move forward. When do you start swimming? It gets deeper. Quickly. The bottom is giving way- sandy and mucky. She feels something touch her foot… A weed? It grabs at her toes, sending a spike of panic. The water is too deep to stand now. Everyone is still moving forward. She has to swim. There is no choice now.

Her first few strokes are desperate churns of the water that now feels too thin to grab or support her weight. At least the wetsuit floats, and her legs seem to bob uncontrollably behind her while she tries to manage some kind of swim stroke other than a panicky dog paddle. But the wetsuit feels like a straightjacket now, binding her arms and squeezing her chest.

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“Put your face in the water and swim,” she tells herself. But the cold bite of the water on her face sends shock through her body, seeming to steal her breath. A jet of icy water shoots down her wetsuit. And through the grey water another swimmer’s heel emerges- she sees it just before it cracks into her left goggle lens. Something touches her foot, a person next to her where she can’t see bumps into her. She cannot see land behind her, she cannot see the first swim buoy, she cannot see a lifeguard. She cannot see in the murky water as the fog in her goggles begins to thicken. Sun glare bounces off the surface blinding her. She can’t see. The buoyancy of her wetsuit is replaced by a rising sensation that she can’t breathe. The voice in her head shouts one word: drowning.

Her chest tightens. She flails against the ever-thinning water. The wetsuit is her enemy now; squeezing what little breath she has out of her lungs. Another swimmer collides with her from behind. And another…

Drowning.

Trish Morgan ends her first race in tears clinging to a lifeguard’s rowboat as he slowly paddles her toward shore.

Trish is a fictional character, but her terrifying ordeal is typical of first time triathletes with no open water swim experience. This horror story is the combination of every swim disaster story I’ve heard during my 30 years in triathlons.

Ask twenty triathletes what the hardest part of a triathlon is, eighteen will tell you the swim.

This contradicts the reality of swimming. Swimming is the easiest part of a triathlon. The swim leg comes at the start when athletes are freshest. It is not weight bearing. There is no foot strike or saddle discomfort. Your body is horizontal so your blood pressure is the lowest of all three sports. It is the only part of a triathlon that is monitored every few yards by safety personnel. You are moving the slowest so risk of impact injury is lower than the bike or run. And unless the water is really rough, there are no hills on the swim course.

But despite the cognitive realities that open water swimming is safe it is consistently perceived as the most difficult and dangerous leg of triathlons, especially for new athletes.

Why do people have swim anxiety and how can they moderate it?

Like any single problem, there is no single solution. Swim anxiety emanates from many origins, some founded in rational fears of drowning, others founded in irrational fears of being attacked by sea life, entangled by weeds or sucked underwater by invisible forces.

Two common triggers are present in open water swim anxiety:

  1. Lack of experience in the open water swim environment. 
  2. Absence of a purposeful, step-by-step approach to building proficiency and competence in the open water.

You can’t just jump in the open water and expect to feel comfortable, especially in a crowded mass swim start. People often have unreasonable expectations when they enter their first triathlons. They have not adequately prepared for open water swimming, both mentally and physically.

How to Overcome Fear: A Meeting with the Sensei.

I went to California to find out how the best open water swimmers in the world, the Navy SEALs, overcome terrifying swim conditions, often at night, usually with a very real enemy trying to find- and kill them.

I’m sitting on a log at the Phil H. Bucklew Naval Special Warfare Center in Coronado, California. The man sitting at the beach with me is SO1 (SEAL Operator 1st Class) David Goggins.

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Naval Special Warfare Operator (SEAL) Dave Goggins (Left). Photo Credit: Outside Magazine.

Goggins is a legend in the Navy SEAL community, a title that most of these naval special warfare operators don’t care for with the recent flood of Navy SEAL books, movies and media attention. They prefer “Naval Special Warfare Operator”.

David Goggins is a graduate of the U.S. Navy Basic Underwater Demolition School (BUDS), SEAL Qualification Training (SQT), the U.S. Army Ranger School, The U.S. Army Airborne School, and The U.S. Air Force Special Tactics “P” School. Because of challenges he faced during his Basic Underwater Demolition School Goggins had to go through the most difficult phase of BUDs, Hell Week, almost three times. He may be the only person in history to have done so. Goggins’ Hell Week became Hell Month.

Goggins is an African-American, a demographic not populous in competitive swimming. Black Americans do not widely integrate swimming into their adolescent development. According to USA Swimming, “70% of Black-Americans cannot swim”.

Goggins also came from a broken home, has battled obesity and has a heart defect, a hole in his heart, for which he underwent surgery to correct. None of it has stopped him from being a Navy SEAL, Ironman finisher and ultra distance runner.

“How did you overcome physical and mental barriers to swim for hours in the dark?” I asked Goggins.

“You can push yourself past physical limits.” He told me. “You simply have to focus.”

“Really? It’s as simple as one word; ‘focus’?”

Goggins is right. The singular problem new triathletes have with open water swimming and the single largest cause of open water swim anxiety is the failure of athletes to systematically prepare for the specific task of swimming in the open water environment.

New swimmers practice avoidance, not focus, with learning survival in the open water.

They don’t use a step-by-step approach to open water swimming. They literally jump in all at once.

Jan Mack is a corporate executive and an Ironman finisher. She also has swim anxiety. Or, more correctly, had swim anxiety.

In only eight weeks Mack went from terrified of open water swimming to being a competent open water competitor and SCUBA diver. Previously she stood on the beach crying in fear at the start of a race, her friend pulling her by the arm into the water. Now she is a certified PADI Expert Open Water SCUBA diver who swam through underwater caves at 60-feet depth, explored sunken shipwrecks, swam in the open ocean in 5-foot waves three miles offshore and dove in a school of 6-9 foot sharks without an anti-shark cage.

How?

“Crawl, walk, run.” “Slow is smooth, and smooth is fast”.

Learning any new skill is best done in a systematic process broken into steps.

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This is especially true of skills that require confronting fear. The most common reason for open water swim anxiety is the failure of the athlete to engage in a step-by-step process for acclimating to the open water.

It’s a Sunday morning, eight weeks ago and I am at the Ford Community and Performing Arts Center pool in Dearborn, Michigan with Jan Mack.

We are in three-feet of water, about knee-deep, and she is learning to flood her snorkeling mask of water and then clear it underwater without panic.

She’s having trouble.

When Jan’s swim mask is flooded she must continue to breath through her snorkel underwater, but only through her mouth, and she cannot see clearly since her mask is now filled with pool water. When she tries to inhale through the snorkel some of the water inside her flooded mask goes up her nose, producing a drowning sensation. It is terrifying, the same sensation suspected terrorist detainees at Guantanamo Bay experienced when they were waterboarded. According to most international watchdog organizations, what Jan is subjecting herself to in preparation for open water swimming could be considered “torture”.

In repeated evolutions I explain and demonstrate the process to Jan. Slowly, smoothly, repeatedly. Slow is smooth. Explanation, demonstration. Then Jan tries a practical application by ducking underwater on her knees, flooding her mask, panicking and surfacing. And we start over. Slow is smooth, smooth is fast. Explanation, demonstration, practical application. Crawl, walk, run.

There is no time limit, no starting gun, no dark water, no pressure.

Jan tries her fifth or sixth time. It works. There is coughing and sputtering and spitting, but it works. She did it. In three feet of clear, warm pool water Jan Mack has become a “Go” at task number 1, clear your mask of water in a pool without showing undue signs of panic and continue breathing through your snorkel underwater.

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Jan Mack advances to the next phase of basic open water training. And the next. And the next.

At each step Jan receives an explanation, demonstration and then performs a practical application of her assigned new skill; using swim fins, wearing a SCUBA tank, maintaining neutral buoyancy… The skills build upon one another. And so does her confidence.

At the same time she is assigned bookwork on open water diving and must take graded tests. Her knowledge about ocean conditions, the sea, her equipment and open water physiology increase. She learns a checklist mentality. She is focused. The new knowledge combined with the skills she practiced beginning in the kiddy pool and advancing to the deep end has built on each other.

Crawl, walk, run. Slow is smooth, smooth is fast.

She has learned through deliberate progression. Jan Mack focused- exactly like Navy SEAL David Goggins, on specific intermediate goals on the way to a bigger goal.

It’s seven weeks later, Friday, February 19, 2016. Jan Mack and I are in a small boat bouncing through big waves three miles off the coast of Roatan Island, Honduras. 70-feet below us a school of sharks, big sharks, circles. I’m fighting seasickness and Jan is fighting fear. But we have our dive instructor, Russ Nicholson, with us and we have our training and experience up until this moment.

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There are 20 big Caribbean reef sharks (Carcharhinus perezii) swimming below us.

For the next hour Jan swims with the sharks, no shark cage, no protection. She learns the sharks are like any animal in wild; commanding of respect but not aggressive toward people if unprovoked.

“I don’t know why I was ever afraid” she says after her dive training and open water experience.

Jan Mack has systematically ascended the open water swimming learning curve. She knows the open water environment, from top to bottom. She’s experienced every corner of it, from the shallow end of the local kiddy pool to the open ocean with a school of sharks. Whatever frightened her before, known and unknown, has been systematically broken down into smaller tasks, defeated, and resolved.

The open water environment still commands respect, and being three miles off shore, 70-feet down rough water in a school of large sharks only reinforces the need for that respect. But the process of Jan Mack’s indoctrination into the open water environment has also taught familiarity. And competence.

Unlike the fictional Trish Morgan who panicked in her triathlon swim, Jan Mack prepared in a step-by-step process to get acclimated to the open water environment. Now her fear of the water is converted to a learned respect of the objective risks and a significant level of competence in moderating them.