Miller School Team Supports Diana Nyad’s Marathon Swim

When Diana Nyad stepped onto the beach at Key West on the afternoon of September 2 after completing her historic 53-hour swim from Cuba, few were cheering harder than her volunteer medical team from the Miller School of Medicine.

“We were all ready in case Diana passed out, but she stood up and gave a ‘V for victory’ sign as everyone cheered her remarkable achievement,” said John Kot, M.D., voluntary assistant professor of anesthesiology, who accompanied Nyad on her escort boat with Derek B. Covington, M.D., third-year anesthesiology resident. “She is an amazing woman.”

That afternoon, Nyad spent a few minutes celebrating her 111-mile swim across the Strait of Florida – a feat she had been told was impossible after her first attempt in 1978, and which she attempted unsuccessfully three more times. The two physicians gave Nyad intravenous fluids for dehydration, and she was taken to Lower Keys Medical Center in Key West for observation and released after several hours.

“The next day, Diana was on ‘Good Morning America’ and looked like her usual self,” said Covington. “It was a truly remarkable swimming achievement – especially at age 64.”

It was also a special moment for the Miller School’s medical professionals and support staff who have been part of Nyad’s support team for the past three years. In 2011, Nyad’s West Coast-based training team contacted Lee Kaplan, M.D., Chief of UHealth Sports Medicine, to arrange for volunteer medical support here in South Florida.

“Our involvement began on Diana’s third attempt at the Havana-Key West swim,” said UHealth Sports Medicine specialist Clifton L. Page, M.D., assistant professor of orthopaedics and team physician for UM Athletics and the Miami Marlins. “We looked at the issues and prepared the medical protocols and a game plan for support.”

For Nyad’s marathon swim, a wide range of medical concerns needed to be addressed, including adequate intake of water and nutrients, loss of body heat (hypothermia) from exposure to sea water more than 10 degrees colder than normal body temperature, prolonged lack of sleep leading to possible disorientation and hallucinations, tired muscles, breathing difficulties, possible shark attacks, and allergic reactions to jellyfish stings.

When Nyad was ready for her third attempt in September 2011, Page and Michael Letter, P.A. with UHealth Sports Medicine, joined her team on the escort boat, while University of Miami Hospital provided the medical supplies. Despite suffering severe box jellyfish stings when leaving Havana, Nyad kept on swimming for another day. “Diana needed a lot of medical care on that attempt,” Page said. “She had an allergic reaction to multiple box jellyfish stings and we had to pull her out of the water for her safety.”

Learning from that experience, Page said the UHealth Sports Medicine team adjusted the medical protocol to include more oxygen, IV fluids and anti-inflammatories to reduce Nyad’s reaction to jellyfish stings, with an anesthesiologist on hand to provide acute care if necessary.

On Nyad’s fourth try in August 2012, three Miller School volunteers – E. Willis Weyers, M.D., fellow in anesthesiology and critical care, Gabriel Sarah, M.D., senior resident in anesthesiology, and Letter – accompanied Nyad on her escort boats. Again, Nyad suffered from multiple jellyfish stings, bad weather and severe eddies in the Gulf Stream that pushed her off course and ended her attempt.

But again, the Miller School team took a close look at the medical obstacles and came up with some potential solutions. “To prevent hypothermia, Diana ate warm soup and had warm shower baths during her feedings,” said Letter. “We encouraged shorter feeding times so her core temperature didn’t drop during extended feeding times. It was better for Diana to continue moving and keep warm.”

On the morning of August 31, Nyad began swimming from Havana on her fifth attempt, wearing a silicone mask, a full bodysuit, gloves and booties to protect her from jellyfish stings. She was accompanied by a 35-person support team that included her handler, Bonnie Stoll, as well as UM’s Kot and Covington. Kayakers helped keep sharks away and pushed jellyfish out of her path.

During the swim, Nyad suffered from nausea from swallowing sea water, Kot said. The silicone mask irritated her mouth and the sun and water caused her lips and tongue to swell up, but she was still able to swim, talk and breathe without any serious problems.

“This time, we had very little to do,” said Covington. “Diana did all the work, and everything worked out perfectly. It was really a thrill for all of us at the Miller School to be part of her historic achievement.”

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