Eric is joined by Dr. Mike Fields, a pediatric pulmonologist. Mike has swimmers as patients with lung issues and breathing problems due to swimming indoors. The discussion touches on indoor pool air quality, and the similarities between blood and water chemistry.
00:00 - Introduction
01:01 - Why Dr. Fields contacted us
04:58 - Indoor pools and HVAC design
09:59 - What are weezing and asthma?
14:25 - Medications for breathing issues
20:22 - What is a pulmonologist?
22:37 - Explaining chloramines and the pool smell
32:13 - Contamination Sources
34:56 - Blood and water chemistry
42:55 - Closing
[00:00:00] Eric Knight: Hey everybody and welcome back to the Rule Your Pool podcast. This is episode 149. I'm your host Eric Knight with Orenda, and I would say I'm doing this alone but we do have a very cool guest.
[00:00:09] If you remember we had Dr. Paul Cagle on here, a shoulder surgeon, to talk about lifting heavy chemicals in and out of a truck. We just had Rowdy Gaines on. I've got a few more guests lined up. But I've been looking for this specialty for a very long time. And as luck would have it, he reached out to me about indoor air quality in indoor pools.
[00:00:28] Today we have on the show Dr. Mike Fields, a pediatric pulmonologist.
[00:00:34] I've been wanting to get a pulmonologist on here, not only to talk about the indoor air quality problem, which as the listeners know, is deeply personal to me because I got very sick swimming indoors. And that's why I'm in this industry. But also to talk about water chemistry in general and how it is very similar in the body as it is in swimming pools.
[00:00:52] So Dr. Fields, thank you so much for being here.
[00:00:54] Mike Fields, MD: Thank you for having me.
[00:00:56] Eric Knight: It is an honor to have you here, and This is episode 149 of the Rule Your Pool podcast.
[00:01:01] Eric Knight: You reached out to me and, uh, I'd like you to just tell the audience what caused you to email me.
[00:01:29] Mike Fields, MD: Yeah, it's interesting. I'm a pediatric pulmonologist. I've been in practice for about 18 years now. And I've noticed over the years that I've had a lot of patients who are swimmers. High level swimmers. Who spend a lot of time, obviously, not only in the pool, but in the indoor pool environment. And they come to me with breathing problems that have been related to under the umbrella term of asthma, which we can talk about later. Shortness of breath, difficulty breathing, coughing, wheezing, having a hard time.
[00:01:58] And in talking about it, it became apparent to me that this was much more of a problem indoors than outdoors. And it was also much more of a problem in certain indoor environments than it was in others. Certain pools, when they went to that pool, they had a lot of breathing troubles. When they went to that one, there was really no troubles.
[00:02:15] And so it's got me interested in thinking about why this is. And over the years, periodically, I, I've never had the time to delve into it the way I wished, but I've periodically started searching and Googling and digging around and trying to understand it. I had my own kind of pet project in the back of my head, which I've subsequently learned from Eric is not a good idea, but I
[00:02:36] Eric Knight: We'll discuss it.
[00:02:36] Mike Fields, MD: We'll discuss it. Um, but I didn't want, I wanted to put fans on there to blow the bad air away, but I, what I've learned from Eric is that that'll mess up a lot of other things.
[00:02:43] Anyway, so I was researching a few weeks ago and I was looking up chloramines and stumbled upon Chloramine Consulting, and started reading about this guy who was a big time swimmer doing exactly the stuff that I had been wondering about in a informal way. I was wondering about it in an informal way for a bunch of years.
[00:03:05] Eric Knight: For those listeners who don't understand this, um, my full time job is Orenda and HASA.
[00:03:10] You know, me from this, I do water chemistry. But I was in the HVAC side of the business before Orenda. I happen to be bilingual that I can speak HVAC and water. And in those two trades, something like the word return is the exact opposite. So in the pool business, we think of the return as returning water to the pool.
[00:03:31] It's the exact opposite in air. You're actually not returning air to the room. You're returning air to the system to be treated. And so a lot of times in indoor pool design, people talk right past each other. And the result is people get sick like me, because there wasn't a lot of communication, the air system was not designed for the pool. Nobody knows what they don't know.
[00:03:51] And I'm in a unique position in that I understand both sides of this equation very well. And when there are facilities that need help with indoor air quality, that is a service that I've been happy to provide. It was one of the conditions for my employment at Orenda and HASA as well. And it is why I'm in this industry.
[00:04:08] I understand that like most of what I do is probably dealing with plaster problems, which is frankly annoying to me. But, that's not what makes me stay in this industry. I'm in here to fix the indoor air quality problem. That's what I'm passionate about. And that's what you reached out to me for.
[00:04:23] Things have come full circle. Because I was looking for a pulmonologist for the last about 18 months. And you'd be amazed at how hard it is to find one that's willing to go on a podcast. And nobody really had any interest in the indoor air quality thing. Uh, I guess everybody's busy.
[00:04:40] But I'm so grateful you reached out. I just recently had a shoulder surgeon on. I have a few other doctors lined up for the rest of the summer, and this is an interesting profession that you're in. Because there are two distinct, unrelated topics that I hope to discuss in today's episode.
[00:04:58] Eric Knight: We'll start with the indoor air quality, and then we'll get into blood chemistry.
[00:05:02] So indoor air quality, as you said, you've been dealing with a lot of patients. I was one of them. Not one of yours, but I grew up in Northern Virginia and I understand that you were in that same area, literally a few miles from where I was living.
[00:05:15] I'm sure a lot of the people that got sick were swimming in pools that I also swam in. Because I got sick in those same pools. I'm very familiar with what you're talking about. So when patients come to you, what are you seeing? You're the doctor, please just lay it all out there.
[00:05:30] Mike Fields, MD: Sure. Um, first I'm honored to be following Rowdy Gaines. Uh, it's quite daunting to think about that. And second, if I wasn't supposed to mention Chloramine Consulting, my apologies, you can just,
[00:05:41] Eric Knight: No, it's totally fine. Most people don't know about it because I don't promote it here, and I don't have any problem. I'm open about My employers know about it. It's part of what I do in this industry and it's important to me.
[00:05:52] Mike Fields, MD: It's great. No, I think it's fantastic. So what do I do?
[00:05:56] What I do is I see patients with a variety of breathing problems from infants to adults, and the ones that are relevant to this discussion are classically the teenager who's big into swimming and is a very good swimmer. And rather than kind of running into the, the natural physiologic limit that I think all of us have, um, for me, it was not a very big limit. And for you, it was much, much better. For a lot of these guys, they're trying to be like you and they're having troubles and being like me.
[00:06:27] And so they come in, they, you know, they're coughing, they're wheezing, they're feeling short of breath. They're not able to finish their workouts the way they want to. They get to the end of the lap and they're coughing and wheezing and having a hard time breathing. Very, very uncomfortable. And it really impacts negatively their ability to participate in their sport.
[00:06:45] One of the things that I say to my patients all the time is that if you have asthma, we should still have you being able to do everything you want to do just like anybody else. Maybe you need medicine, fine. We should be able to have you out there performing in whatever field it is you want to perform in. I can't make somebody into an Olympic level athlete, but I can certainly at least help them to not be held back by something is a medical problem that can be treated.
[00:07:11] Eric Knight: Wow. This hits so close to home, Mike. When I was in college, my first two years, it was a bromine pool. I did an episode on this show about bromine. Bromine has a different smell than chlorine and to me, it wasn't as bad of an issue. I was okay with it. I didn't have any breathing issues. A lot of people did though. A lot of people did.
[00:07:32] And so they decided because of this air quality thing and perhaps cost as well, they switched to calcium hypochlorite. Now the water went from a tinge of green to beautiful blue because that's the difference in a bromine pool and a chlorine pool is seen in the tint of the water.
[00:07:48] So right off the bat, everyone's like, Oh yeah, this water looks so good. Except we started getting sick. And I particularly got sick and it wasn't as bad in the Mason pool, because there's a very large natatorium, it wasn't a huge deal. But when you'd get into those sets where you're doing 40x100's on a tight interval and you're just pounding, and you're breathing because swimmers aren't breathing like you're walking around or even jogging. We're gasping for air, holding air, breathing out slowly, gasping in again, right at the water surface.
[00:08:22] And I started developing asthma. At least that's what the doctor told me I was developing. And it got really bad when we would go to any other pools. One pool in particular, I will not name it, I was racing in 2009 and I had an asthma attack in the middle of the race. And I never had an asthma attack. Didn't know what that was. All I knew was I was suffocating in the middle of a race and I had to get out. And I hopped out and went out and there was like an inch of snow on the ground.
[00:08:46] And I just remember fresh air. It was freezing cold, but it just felt, I just had get
[00:08:53] Mike Fields, MD: That's how breathing was, right.
[00:08:55] Eric Knight: Well, there's enough swim meets, Mike, where there's an ambulance just idling in the parking lot. Seriously. And then you look at like 2014, Junior Nationals was at a pool and you can actually see me on YouTube back then with my old company, Paddock Evacuator. We had installed a system and that system did what it was supposed to do, but there were banners and curtains that were blocking the airflow, which were not calculated into our design. They were added later. And so the system was failing because we couldn't get the chloramines to the system to evacuate out of the room.
[00:09:30] And one of the most famous swimmers on the planet, Caeleb Dressel, left in an ambulance. It was a really bad day. a really bad day.
[00:09:37] That it doesn't get worse than that. And that night he just broke the national age group record and he was a budding superstar at that time. But I will never forget that experience.
[00:09:46] And once we removed the curtains and the banners, cleared right out. You are seeing the symptoms from a medical perspective of what I already know. I know what that feels like. So I have a few questions for don't mind.
[00:09:58]
[00:09:58] Mike Fields, MD: Please, not at all.
[00:09:59] Eric Knight: Can you define wheezing?
[00:10:01] Mike Fields, MD: Wheezing, when the airways get irritated and inflamed from pretty much anything that can irritate them, they get some inflammation. When they get some inflammation, they get a little bit narrowed. But then when the inflammation gets past kind of a critical threshold, the muscles in the walls get angry and the muscles get tight.
[00:10:18] And so the way I describe it is the two lane, like a highway tunnel, two lanes, flat tile wall, smooth concrete floor, easy to go through. With that inflammation, it's like a spongy, wet, wall. And instead of having a clean concrete floor, you then have mud kind of gunk mucus all over the floor.
[00:10:35] On top of that, when you end up irritating things past that threshold, the muscles and the walls get mad and the muscles get tight. So if you imagine that highway tunnel shrinking down to one lane, that's what's going on. And wheezing is the sound that the air makes when it's squeezing through that narrow tube.
[00:10:50] Eric Knight: Oh, definitely had that. Okay. Uh, you know, people say the word wheezing, that was a real question for me. I've never actually known what it meant. I just assumed it was that difficulty of breath where it's like, Huuuuh, huuuuh, huuuh.
[00:11:03] Mike Fields, MD: Yeah. So the noise sounds a lot like, and we can all kind of generate it and fake it. But, um, there's a variety of different noises that you make with a variety of different breathing problems. And many people call all of them wheezing when they come into the doctor's office. So that's why I make funny sounds, So I can out what they're talking about.
[00:11:23] Eric Knight: Well, that's what you have the stethoscope on your desk for, right? So you can hear it. So um, you mentioned that athletes come into your office. A lot of people come into your office, but the athletes that may have asthma symptoms, what is asthma?
[00:11:39] Mike Fields, MD: So asthma is getting back to the highway tunnel. It's that airway getting inflamed and irritated. And the world is a dirty place. There's always things coming at our body, causing irritation and inflammation. Most all of us have a little bit of inflammation. But people with asthma, they just keep more of that inflammation because their bodies are essentially overreacting to those things. They keep more inflammation, they keep more swelling.
[00:12:03] So even on a good day, their tunnels are not quite as crisp and clean and smooth as they should be. And then they do get irritated by whatever the trigger. Some people have troubles with viruses or weather change, cold air, hot air, exercise, chlorine from the pool, cigarette smoke from Uncle whoever.
[00:12:22] All those different things can cause more irritation and inflammation. And when you have that going on, you're then prone to these asthma attacks where stuff gets worse. Maybe it's because you were already having some troubles and then the weather dropped 20 degrees. Maybe you were already having some troubles and you just tried to run the fastest 400 meters you could ever run and that's just pushing you over that threshold. Does that make sense?
[00:12:49] Eric Knight: It does because I was diagnosed with what they called sport-induced asthma. So I guess my trigger was being an athlete specifically swimming indoors. And it sounds like that's what you are seeing a lot of in your office.
[00:13:01] Mike Fields, MD: Yeah, and, you know, it can be any athletic endeavor. You know, it can be swimming, it can be basketball, it can be football, it can be track, it can be all of those different things. And asthma is a big umbrella word. If you put 20 pulmonologists in a room and say, what's your definition of asthma, you're going to get 20 different definitions.
[00:13:21] We don't have a great classification system for all the different subtypes that really fit under that umbrella. So it all kind of gets lumped together. We try to say, okay, you have exercise or sport induced asthma. Oh, you have viral induced asthma. Well, bottom line is it's still asthma. It's still inflammation in the airways. They're going to get tight. You need to think about the same kinds of rescue medicines or control medicines to prevent the problem. Whatever it is that's bringing you to that final common pathway.
[00:13:49] Someday will get smarter and better and be able to really know nuts and bolts inside. Why is it that this exercise pathway is different than this virus pathway? But in 2024, we definitely don't know.
[00:14:01] Eric Knight: We don't know?? Really? I I mean, think medicine is advanced enough to have a deep understanding of this and you're saying we're not there yet. That's amazing.
[00:14:08] Mike Fields, MD: We're not there yet. We're there with, we understand a lot of the chemical mediators. We understand a lot of the reasons why things happen. But why it is or how it's different subtly between one particular subset of the population versus another is not crystal clear.
[00:14:25] Mike Fields, MD: Fortunately, whatever's causing your inflammation, the inhaled steroid medications address it and make it better. So in some ways it doesn't matter. But in other ways, obviously it does. Because what if there's a better medicine or a more focused specific medicine or something that we might be able to bring to bear someday?
[00:14:43] So hopefully someday we'll have better explanations.
[00:14:47] Eric Knight: That's interesting because now we're going to take a little bit of a segue because I wasn't, thinking we were going to go to this. But you just said, yeah, steroid medication. Is that right?
[00:14:56] Mike Fields, MD: yep. Inhaled steroids,
[00:14:57] Eric Knight: Okay. So two questions. What would be some examples of those? Because they prescribed albuterol for me, and that helped. And then the second question is, do you see in our future that we can defeat this without medicine?
[00:15:10] Mike Fields, MD: Let's talk about the medicines first, because that's going to be a lot easier for me. So albuterol is in a category of medicines called rescue medicines. It's not a steroid. It goes in there like a fist, and it punches open the airway. It makes those muscles relax. It kicks in in 10 or 15 minutes. It lasts a few hours and it goes away.
[00:15:29] . .
[00:15:30] it helps and it makes breathing better and it is not a banned substance. It is a banned substance at certain levels. Like there's kind of a maximum dose that they say you're allowed to take in a day. I was just looking this up last night in prep for this. There is a max dose that they would say you should be able to be allowed to take before you'd have to get some kind of special exemption from the whoever
[00:15:53] Eric Knight: USADA or WADA, yeah, the doping agencies.
[00:15:56] Mike Fields, MD: The doping agencies.. So it's not banned. It's just. You can't use gobs of it.
[00:16:01]
[00:16:01] Eric Knight: What are the steroid inhaler products?
[00:16:04] Mike Fields, MD: So the steroid inhalers, brand name is, uh, used to be Flovent, generic for that is Fluticasone, there's Beclomethazone, Mometazone, Budesonide. There's a whole variety of them that are very, very similar to each other and all work very well and very similarly. They're each slightly different molecules and it's sort of like, you talk about Zyrtec and Claritin, like they're both antihistamines. They both do the same thing, but Claritin might work great for you and terrible for me or vice versa just because your body's histamine receptors react better to one than the other. And similarly, some people might react better to one of those steroid molecules than another.
[00:16:44] The job of the steroid, just like, you know, if you have a rash and I say, put some steroid cream on it, you're going to say, okay, well, that makes total sense because there's a rash and the steroids melt it away and make things better. That's the exact same rationale for the inhaled steroids. You breathe them in with the inhaler and the spacer, they float down your airway tree. They land on those spongy, nasty, thick walls or swollen walls, and they melt it all away and calm it all down and get rid of that inflammation, get rid of the mucus and gunk on the floor.
[00:17:13] So kind of turn down the temperature of all that inflammation. So you hang out down here instead of hanging out up there. So when you get in the pool and you go up by that much, you're only going up by that much from this level. So you're not, it's not impacting your breathing. It's not
[00:17:28] Eric Knight: Your baseline is lower.
[00:17:29] Mike Fields, MD: Your baseline inflammation is lower. Your reserve is higher. You can breathe more easily and you won't get into trouble.
[00:17:36] Eric Knight: Where does the inflammation go? You said if, if it just melts away, it's got to go somewhere. Don't you cough it up? And hack it out? Or what?
[00:17:42] Mike Fields, MD: So there's a lot of secretions and you cough it up. There's a lot of mucus on the surface. Some of the stuff that's inside the cells is just fluid and other immune system mediators that get reabsorbed by your body and just go away.
[00:17:54] But yeah, absolutely. There's a lot of debris and a lot of junk. And one of the things that your, airway has is an elevator that kind of like little hairs that line your airway that brush the stuff up and out. And getting moisture in there like a neb treatment, getting albuterol in there can make the hairs work a little bit better. Can kind of open up the airway and help you clear stuff out, make that cough more effective.
[00:18:18] Mucinex is one of a variety of the cough medicines that help to loosen the mucus, loosen the thickness of it, because it's easier to cough out something that's thin to cough out something that's really thick and solid. Some of the cough medicines also have a medicine in them to suppress the cough, and those things go to your brain, to the cough center, and turn it off.
[00:18:41] So body says, I want to cough, and your brain says, nope, nope, not right now. And that's fine if you are an adult and you're not having troubles breathing, you're not short of breath, and you have a cold and you got drip going down your throat and it's making you cough and you want to turn off your darn cough for a few hours so you can get some sleep. That's totally fine.
[00:18:59] But if you're one of our patients and you have troubles breathing, cough is one of our warning signs that things are not going well. So we always have to use those suppressants with some caution, because we don't want to suppress a cough that's a warning sign. It doesn't mean cough medicines are bad, it just means you have to know what you're doing. You have to know why you're doing it, and how the medicine is going to work.
[00:19:19] Just like a lot of your audience knows all about whether to put this chemical or that chemical in the pool and they know it's a bad chemical but if you use it properly it's a great chemical. It's the same thing.
[00:19:28] Eric Knight: What can people do listening to this? What can people do without medicine to be proactive to avoid this sort of inflammation in the first place?
[00:19:37] Mike Fields, MD: I think that most of the things on this list are unavoidable. I can't change the weather. I can't change your allergies. I can't change the viruses you're exposed to. You can change the viruses you're exposed to by doing things like wearing a mask and things like that, but that's not how we want to live our life day in day out. You know, the big things, the easy things, the low hanging fruit, clearly, don't smoke. Don't vape.
[00:20:02] Um, because then you're inhaling these really superheated particles into your very delicate airway and vaping is a good tool to use to step off of cigarettes. They should not be an end point. And the fact that they're marketing them to kids with all these flavors is just offensive. I mean, it's just it's just wrong.
[00:20:22] Eric Knight: Well, I don't mean to cut you off, but, um, I realized I didn't actually ask probably the most important question we should have led off with. What is a pulmonologist?
[00:20:32] Mike Fields, MD: Oh, that's a good question. So a pulmonologist is a doctor who specializes in the airways and the lungs. All of the problems that you can be born with or that you can develop later, um, everything from asthma, to cystic fibrosis, to lung disease from being born early, to chronic lung problems that you get when you have troubles aspirating secretions, or problems you get from a hypersensitivity reaction to one of the things you're exposed to.
[00:20:58] Whether it's somebody who works in a a barn and is exposed to certain things there all the time, or is it somebody who swims in an indoor pool and gets exposed to those chemicals. And other Infectious particles and those things drive a lot of trouble. We take care of all of those things.
[00:21:15] We mostly work with medicines to treat the problems. We don't operate or do surgeries. Our only invasive procedure is we can look in your area with a camera, a small, flexible tube that's like the size of your typical USB cable, and look around inside the airways and take out samples, suction out some, some mucus and things like that to try to figure out what's happening or why are things inflamed?
[00:21:38] Eric Knight: I think of pulmonary, the first term that comes to mind is CPR. Cardiopulmonary resuscitation. And my first thought is blood. Is that incorrect? Because if you're a pulmonologist and you deal with lungs...
[00:21:52] Mike Fields, MD: I deal with the lungs. The blood is what is used to carry the oxygen away from the lungs and to bring the carbon dioxide back to the lungs. It's obviously pumped by the heart. And so CPR is basically taking over the functions of breathing and heart pumping to move the blood through.
[00:22:13] And, you know, we breathe so we can breathe in oxygen and breathe out the carbon dioxide. If you stop breathing, you're going to run out of oxygen pretty quickly. And that's a huge problem. It's also going to be a problem because your carbon dioxide level is going to build up and that's going to have negative effects. And so we breathe to keep those things in balance with what our bodies need for our physiology to continue humming along.
[00:22:36] Um,
[00:22:37] Eric Knight: yeah, no, that, no, That's a great answer. Uh, I want to wrap up on the air quality and the chloramines in the lungs and then we'll get into blood chemistry. I was told in college that I had an allergy to chlorine. Which is funny now because our drinking water has chlorine in it and drinking that my whole life.
[00:22:57] So I just had my water tested in my house for a filtration system and I have one part per million free chlorine in my drinking water. And I have 0.25 parts per million combined chlorine which is not good and I'm going to get an activated carbon filter to deal with that. But we drink this every day and we have been for our entire lives. Now there are filters that can remove it, but by and large, chlorine in water has saved millions and millions and millions of lives every single year from things that were killing people.
[00:23:28] And this is where Dr. Langelier, with the Langlier Saturation Index, this is more for the audience, um, he was in drinking water and he was on the cutting edge way back in the early 20th century in that chlorination and flocculation process of dealing with drinking water and wastewater.
[00:23:45] To explain to the audience the problem with indoor pools since most people on here have their own outdoor pool or they're in the pool trade. If you've ever been in an indoor pool, that pool smell is not chlorine. Okay. If you inhaled chlorine gas, you wouldn't be around to talk about it. It's very dangerous.
[00:24:03] It's chloramines. Which is a general term to describe chlorine byproducts of disinfection and primarily oxidation. Chloramines technically mean chlorine has combined with nitrogen compounds. And that's why it's called combined chlorine. But there's also organic nitrogen compounds like urea. And urea comes from urine when people pee in the pool.
[00:24:26] That's a much more complicated nitrogen compound than say inorganic ammonia, which is just NH3. Urea is a lot more complex. So as chlorine oxidizes and combines with these molecules, you start getting a lot of different by products and many of them off gas into the air.
[00:24:42] And if you go back a few episodes and, and remember that we talked about molar weights and molecular weights of substances, the molar weights of these byproducts are heavier than oxygen.
[00:24:53] Think about that for a second. They off gas out of the pool, but they're heavier than air. So what happens is you get these gases that build right on top of the pool surface, right where I'm breathing. And if you have kids on a swim team, right where the kids are breathing, and eventually it builds up to the point where the coaches are breathing it and the lifeguards are breathing it. And people who are spending a lot of time in pools are exposed to this nonstop.
[00:25:16] Mike Fields, MD: Indoor pools.
[00:25:17] Eric Knight: Indoor pools.
[00:25:18] Yes. Outdoor pools. You still have these things if you have nitrogen compounds, but because it's outdoors, you never really notice it. The wind takes it away. No problem. Um, this is what got me sick. And this is what gets thousands and thousands and thousands of swimmers sick every year, probably hundreds of thousands of them.
[00:25:34] Or at least causing irritation, long term exposure, whatever. And there's a lot of research on this. And that's the problem that Mike reached out to me about. Because his patients are breathing in the same stuff I did. And that's what we're talking about. And so I'm in this industry to fix that problem.
[00:25:49] Straight up. It's not plaster problems that brought me here. It's indoor air quality. I care deeply about the health and welfare of swimmers. I care more about it than just about anything. I've devoted my whole professional career to it. And that's why it is such an honor to have you on here, Mike ,because you're on the front lines of dealing with the consequences of this problem.
[00:26:06] I'm on the front lines of trying to eradicate the problem to begin with. And apparently I'm not doing a good enough job because it's still happening. So trying to get the word out there that this is a solvable issue. You just need to know what you're looking for.
[00:26:17] Mike Fields, MD: It should be solvable. Exactly. And the chloramines on the surface of the pool is exactly what got me thinking about this and my brainchild of putting fans along the surface. And,
[00:26:26] Eric Knight: Yeah, tell us about that.
[00:26:27] Mike Fields, MD: I was just thinking, you know, wouldn't it be interesting to have a bunch of swimmers swim, check their lung functions, breathe in all the chloramines. And then do it again, but this time have a bunch of fans blowing the chloramines away and see if that makes a difference in their breathing.
[00:26:40] And I think that it would, because the chloramines are bad, but it would cause a lot of other issues with the indoor pool environment, like you talked about, because it would increase the evaporation and it would lead to a lot of other problems in managing that space.
[00:26:53] Which comes back to what you started with a little while ago, which is you've got to have the HVAC people and the pool people working together that complex indoor space. And I, I don't know anything about that industry. I don't know anything about how that happened, but I feel like it sounds to me like somebody was building a pool and building a building over it. And the HVAC guys said, well, I don't care what's on the floor.
[00:27:14] It could be a pool or it could be a floor and I'm going to build the HVAC system for that space. And not including the fact that that pool is a living creature that is participating in this environment.
[00:27:26] Eric Knight: thankfully it's not that bad. No, they definitely know there's a pool there, but I'll give you an example of where there's a disconnect. Engineers are phenomenal at what they do. It there's, this is not a criticism of engineers at all
[00:27:38] Mike Fields, MD: And I didn't mean to offend I feel like they have to think about more than I don't know if they have nowhere to turn.
[00:27:44] Eric Knight: They're not given enough information. So it's, it's not a fair fight. They're put into an impossible situation. They don't have enough information because there are some, customized nuances to every building that you have to really know what you're looking for to know they're there. Because they're not obvious.
[00:27:58] So I'll give you an example. Uh, if I look at a pool and it's got a three and a half foot shallow end and they're saying, oh, we're going to keep this pool at 80 degrees Fahrenheit for competition. ERR. Not forever because they're going to realize the finances of that pool don't make sense unless you can do swim lessons and you have a shallow end.
[00:28:17] They're going to raise that temperature up because water aerobics are going to be in that pool. They're going to find programming to make it a financially viable facility. And they're going to crank that water temperature up to probably 86, 87, 88 degrees. And now you have a serious problem because for every degree that the water is warmer than the air, your evaporation rate goes up a lot.
[00:28:39] Like way more. And so what happens is you start overwhelming the dehumidifier, which was designed to do something very specific: keep the relative humidity in the space consistent. And by doing that, they can control the temperature.
[00:28:51] This is not the same as an air conditioner. An air conditioner is designed to control the temperature. It will dehumidify in order to do that, but it's end goal is temperature. Pool dehumidifiers, the end goal is the relative humidity. It keeps moisture at a consistent level in the air.
[00:29:06] It cannot separate bad air from good. So if you've got low return intakes, meaning vents that pull air into the machine, chloramines are going into there and you're basically chain smoking. And this is what causes rust and corrosion on evaporator coils and condensers and all this expensive equipment.
[00:29:25] And by the way, you may know how big your air conditioner is in your house. To give you an idea, a six lane lap pool's dehumidifier. Is bigger than a truck. It's bigger than an F-150. It's about the size of a U Haul. Okay. It's a big machine. I can walk into it. We'll put it that way. I can walk into there and there's doors on the sides. They're typically about seven or eight feet tall and bigger pools will have two or three of these units, depending on what it is.
[00:29:49] And they are designed for a very specific purpose. And they are phenomenal at that purpose. But they cannot separate bad air from good and that's what source capture exhaust does. Because it uses the physics of the room to take the heavy air out because it's a heavier molecule, it's going to be lower in the room, and it is.
[00:30:08] But if you take fans, Mike, and you go and stir all that up, now you've forced this mess of a cloud of chloramines going all over the place. And yes, it will be better for the swimmers in the short term. There's no doubt about that. But you will also increase the evaporation rate. And suddenly that dehumidifier that was optimally designed for that pool is completely overwhelmed.
[00:30:31] It can't handle that. You can't pull a horse trailer with a Honda Civic. And that's what happens, so it puts stress on the units and then they die prematurely. HVAC goes down and we see this all the time. It's really sad.
[00:30:44] But the worst part...
[00:30:45] Mike Fields, MD: I ask two questions?
[00:30:47] Eric Knight: No, you're out of questions, sorry Mike.
[00:30:49] Mike Fields, MD: Okay, I'll chime back in maybe tomorrow.. The first question: the dehumidifiers at the pool, do they give the water back to the pool? Or do they waste it?
[00:30:56] Eric Knight: I wish they could. I wish they could. Right now they waste it. But there is a growing argument and I am in favor of this argument because it's distilled water, it's just, it's evaporated water, right? So there's nothing in it. If you were to put that back in ahead of the filtration and disinfection system, you should be able to reclaim it because in a given year, take a guess, Mike. In an indoor pool, properly dehumidified, how much water will that dehumidifier remove from the air?
[00:31:26] Mike Fields, MD: Over the course year? Oh, I bet it'll remove way more than the volume of water in the pool.
[00:31:33] Eric Knight: It is actually about the exact same volume of water. So you're the first person who's ever thought it was more.
[00:31:39] Mike Fields, MD: Well, I thought you were leading that way too, so I was kind of reading in between saying, okay, I'm going to try and guess this one.
[00:31:45] Eric Knight: No, it's the yeah, volume of the pool.
[00:31:47] Mike Fields, MD: Holy cow!
[00:31:48] Eric Knight: So if you've got an Olympic pool at 1.2 million gallons. That's 1.2 million gallons of water you're pulling out of the air year. And that's proper dehumidification. So I would like to you know, recirculate that.
[00:32:00] Mike Fields, MD: That's a lot of waste.
[00:32:01] Eric Knight: But what they can do, Mike, is they can reclaim heat. They can pull energy out of that exhaust They can take that heat and they can heat the pool with it on a closed loop and that's very effective. You had a second question though.
[00:32:13] Mike Fields, MD: Yeah. My second question is so the big source of the amines is the pee from the swimmers. And I know it also is stuff that comes off the body. So if we had our swimmers shower before they got in the pool, and had them not pee in the pool, that would solve a lot of this problems. That's really truly source containment.
[00:32:32] Eric Knight: You would definitely reduce it, but, um, glad you brought that up. You're still sweating. You're not going to get rid of all of it. But there's other things too. One of the main contributors is deck cleaning products. What do you clean your floors with? If you're using dimethyl benzyl ammonium chloride, or you're using quaternary ammonia, or you're using.
[00:32:51] Um, Okay. Uh, something like simple green, great disinfection products. No doubt. But wet swimmers walking on that create chloramines on the deck and then they take it into the pool. So it's not just the pool deck, it's the locker rooms. It's wherever bare feet walk. And this is a massive problem. And one of the things we tell our clients is go through all the chemicals you use in this building and anything that has a nitrogen compound, get rid of it. Don't use them. And thatactually makes a huge difference
[00:33:20] Mike Fields, MD: Wow that makes sense.
[00:33:21] Eric Knight: Yeah, as to the pee, I was a swimmer and I'll tell you, there's a massive cultural shift that's going to have to happen, especially during swim meets. Because these tech suits are very hard to get on and off. Guys, we really don't have the excuse that females do their suits much harder to take on and off, but it's a cultural thing.
[00:33:37] Yes. evaporative cooling is a thing. You know how like if it's a windy day and you get your hands wet, they freeze really fast, right? If they're dry, they're, yeah, they're fine, but you get them wet. Well, evaporative cooling means air moves over water and the temperature drops dramatically. My teeth will chatter if I'm dripping wet and it's 82 degrees if I'm under an air vent.
[00:33:58] So why would I get out of the pool that is say 80 degrees Fahrenheit? It took me a while to warm up in that pool because it's cold, right? I got to get my, my blood pumping. I got to get my muscles warm, to walk out and start shivering to use an air conditioned locker room, lose my warmup and potentially pull a muscle. I've done it several times in my career. It is not pleasant. I'd rather pee in pool than pull that muscle.
[00:34:24] And that's where we've gotten to. I think one of the good solutions is you can put deck showers on with like a privacy wall. So that you're in the same conditioned space, that would be a really good solution.
[00:34:35] But you're right. If we take showers beforehand, if we take urine out of the equation, the problem goes down dramatically. Yeah, you probably didn't expect to learn all this.
[00:34:44] Mike Fields, MD: No it's awesome
[00:34:45] Eric Knight: You're the doctor. I was thinking I was going to learn all this stuff from you and I'm ready to learn from you now. Is there anything else on the air quality that you want to talk about before we get into blood chemistry?
[00:34:54] Mike Fields, MD: Don't think so.
[00:34:56] Eric Knight: Well, one of the things, one of the themes that we have had on the Rule Your Pool podcast is we try to take the perspective of water. Water doesn't have a voice. But water is governed by laws of nature. , like everything in nature, it seeks equilibrium. It seeks its natural state.
[00:35:13] And what we've discovered Mike, as we've learned the physics of water more and more is the pH will move based on the concentration of carbon dioxide in that water.
[00:35:28] And as I was learning this, sources kept popping up about blood. I'm trying to learn carbonic acid. I'm trying to learn bicarbonate. I'm trying to learn buffering chemistry. It just keeps going back to medical stuff. They're talking about blood. They're talking about lungs. They're talking about kidneys. They're talking about all this stuff. And I realized, wait a second. Mike, what is over 80 percent of our body made of?
[00:35:49] Mike Fields, MD: Water.
[00:35:50] Eric Knight: Water. You heard it from him. He's the doctor, not me. I'm not, I've not been making this up. So could you briefly explain how the lungs interact with blood? You said they carry oxygen and stuff, but what is this buffering system? Why is it that CO2 is so important in our bodies?
[00:36:08] Mike Fields, MD: Everything is all interrelated, of course. And so in order to talk about it in any way that makes sense, you have to simplify it down so there's certainly going to be other complicating factors, other real world factors that make this discussion more difficult.
[00:36:25] But for the simple purpose of our discussion, and for the way that most of us kind of think about how our bodies are working every day, you're breathing oxygen in. That's our fuel. Our body uses oxygen to make energy and to, to do the things that our body needs to do. And a waste product of that process in our body is carbon dioxide. So the carbon dioxide has to escape. It has to get out somewhere.
[00:36:54] Well, we've developed these really cool organs called lungs where we breathe in air and the air has oxygen in it. And our hemoglobin in the red blood cell that binds oxygen is a very aggressive binder. It wants oxygen. It's got a big affinity for it. So that you breathe in the air and the red cells are there next to it in the capillary inside your air sac. And the oxygen goes zooming from the air into that red blood cell.
[00:37:19] At the same time, we have not a lot of carbon dioxide in the air that we're breathing. So that carbon dioxide that's also in the blood jumps out into the air, and so then you can breathe it out. So you're breathing oxygen in and blowing carbon dioxide out.
[00:37:35] Plants are doing the opposite, right? They're taking in carbon dioxide, using that with sunlight to make sugar, and by the way, oxygen, and then they give us back some oxygen. So it's, it's a, a loop.
[00:37:46] Your body has a lot of buffering systems to keep things in balance. And just like it's easier to drive a car with a gas and a brake pedal, it's easier to balance your body if you've got a couple different systems and a couple of different places where you can apply a little pressure, a little bit of a push.
[00:38:03] So in our body, you've got the carbonic acid, which is formed by the joining of carbon dioxide and water. And then when it breaks apart, it makes bicarbonate ions and protons, which is acid. And so the balance there is you've got that chemical equation. And if you have more of one compound, well, then that's going to react and drive it until it's kind of in a balance.
[00:38:32] So it's kind of, those reactions are happening all the time spontaneously, and it's going to get to some kind of equilibrium. And so, if you drop a bunch of carbon dioxide into your blood, yeah, you're going to keep breathing it out, but that bicarbonate buffer is going to then take a role of absorbing some of that CO2, which is good, but it makes some acid as part of that process which can be bad if there's too much of it.
[00:38:58] And so, you breathe, you regulate your carbon dioxide level to also regulate the acidity of your blood when your carbon dioxide level goes up, you become more acidic. Your blood pH goes down and you are much, much sicker.
[00:39:11] Eric Knight: Now, timeout, just one second. I don't mean to interrupt a pulmonologist.
[00:39:15] Mike Fields, MD: No, please interrupt any time.
[00:39:16] Eric Knight: This is to the audience. Did you hear what he just said? Does that not sound familiar? Dissolved CO2 creates carbonic acid, H2CO3, which is in equilibrium with bicarbonate? Sound familiar? Like bicarbonate alkalinity? And a proton, which is a hydrogen ion (H+). That's the acid.
[00:39:40] This is the buffering system that dictates water chemistry in swimming pools. If you have carbonate alkalinity in your pools, which we all do. If you have that, the amount of CO2 is determining the pH of your pool, just like Dr. Fields just said, the amount of CO2 in your body determines the pH of your blood. Am I correct in that?
[00:40:01] Mike Fields, MD: That's part of it. Yeah. So a big part of the, the pH of your blood is the CO2. If you just look solely at that part of it and what the lungs are doing, that controls the CO2 level. What the kidneys work on is the bicarbonate side of that, those bicarbonate ions. And your kidneys make you pee out more or less of it, or hold on to more or less of it, depending on what your body's acid base needs are.
[00:40:28] And so there's a few different places in your body where your body senses the pH of your blood and senses the levels of these things. And it's evolved over time to have these systems in place that keep things in check.
[00:40:42] And, we check labs on people all the time. Why are we checking labs? Well, we're checking labs, not so we have something to do, but we're doing it so we can make sure that those parameters are where they need to be. Just like my pool has to have the parameters in the right balance in order for it to function properly and stay clear, and not feed algae and not destroy the plaster or whatever other problems are going on.
[00:41:04] My body has to have those things in the right balance because my brain really likes things to be in a certain range. It really likes those parameters to be locked in. My kidneys, my heart, my muscles, my bones, everybody. And so, your body has a lot of systems in place to keep everything where it should be. Because when things get off, other things don't work well.
[00:41:25] Eric Knight: Pools don't have kidneys. So we don't have that mechanism of automatically correcting on that high end, which is why we manually add acid if we want to lower our total alkalinity. The kidneys basically do that by removing some of the bicarbonate.
[00:41:39] That's just so amazing to me that water chemistry is pretty much identical in your blood as it is in a swimming pool. Obviously there's enzymes and things in the kidneys that do things differently, but primarily that is identical chemistry to what we're dealing with.
[00:41:56] And one of the things that we talk about a lot, Mike, is if you open up a beer, it's going to go flat because of the equilibrium from Henry's Law of the pressure of this gas dissolved in a liquid, compared to the gas above the liquid.
[00:42:09] Mike Fields, MD: Not if you drink it fast enough.
[00:42:11] Eric Knight: Well, that's true. I would never let a beer go flat.
[00:42:12] Mike Fields, MD: That's just an important point, yeah, a very important point.
[00:42:15] Eric Knight: An esteemed scholar like yourself would never let that happen.
[00:42:18] Mike Fields, MD: Oh yeah, right, right.
[00:42:19] Eric Knight: Me neither. Me neither. Right. but but that said,
[00:42:22] Mike Fields, MD: But theoretically!
[00:42:23] Eric Knight: Yeah, but theoretically, yes. So swimming pools go flat too. Because they have this carbonate alkalinity, there's more dissolved CO2 in that pool relative to the CO2 in the air.
[00:42:32] And therefore the CO2 leaves. And when the CO2 leaves, the pH goes up. And this is where it gets to the point where the beer goes flat or where the pool goes flat. You can't lose any more naturally because they're in equilibrium. And that's what we call in our app, the pH Ceiling.
[00:42:49] Funny story about the app, unless there's something else you want to add about blood, I think we tackled it.
[00:42:54] Mike Fields, MD: No I'm good on blood right now, yeah.
[00:42:55] Eric Knight: We just talked yesterday prior to this. And come to find out your pool guy who's doing a startup on your pool right now just gave you the Orenda App the day before we talked. How ironic is that? Very small world.
[00:43:09] Mike Fields, MD: Yeah. My worlds are kind of colliding here as I professionally have been pursuing this pool, um, air quality kind of idea. And now we're just coming off of a big renovation of our pool and, I'm getting a lot of lessons in pool chemistry and, and things like that. So fun bringing it all together.
[00:43:27] Eric Knight: I live in Charlotte. I'd be happy to come down there and help you with your pool since you're in Greenville.
[00:43:32] Mike Fields, MD: Anytime. I'm right down the road.
[00:43:33] Eric Knight: It sounds great. Uh, do you have any questions or anything you want to address to swimming pool owners all around the world? I just had a call literally today from Trent down in New Zealand. Which is awesome. Trent, thank you for listening to this podcast.
[00:43:47] Mike Fields, MD: Hi Trent! Hi New Zealand!
[00:43:49] Eric Knight: Yeah, I know that's not just him. I had someone from Perth, Australia call. I have people from all over the world. People in Cyprus, you guys know who you are. It's a global audience. It's a pretty amazing thing that people have swimming pools and they want to know water.
[00:44:02] They don't want to be told, Hey, buy this product, do this stuff. They want to understand why water keeps doing this to them. And that's our audience, pool professionals, pool owners, pool operators, anything that you want to say to them?
[00:44:15] Mike Fields, MD: I think that one of the things I've been learning from, my guys is just that the pool, the water is kind of a living being and it's going to try to do what it wants to do. And we're trying to keep it in a different state than what its natural state would be. As you said, the natural state would be a pond. And not to let our pools turn into ponds.
[00:44:34] And so I think my request to pool folks out there would be to not dumb it down for their customers and understand the chemistry as best as they can. Because all the chemistry ties back to how long all those pumps last, and how long the plaster is going to last, and how long all these other components are going to last.
[00:44:51] And pools are a very expensive beast, but if we can do stuff that makes it better for them, then that really pays off. And so I think that's for a lot of folks out there that might not be so worried about the indoor natatorium air quality.
[00:45:05] Certainly keeping that chemistry balanced and learning the best way to do that. Uh, that's the stuff that I'm finding very interesting as a, uh, I won't say a novice pool owner, because I've been at it for a few years, but I'm getting a really nice education right now. So I'm excited to have a new outlook.
[00:45:22] Eric Knight: Well I'm very happy to help you with your indoctrination journey, Mike. It's going to be a lot of fun for me.
[00:45:28] So anyway, this has been episode 149 of the Rule Your Pool podcast with another phenomenal guest, Dr. Mike Fields. A pulmonologist. So a true expert. And I'm so glad you were on this show. You're really helping us up our game because normally it's just Jarred and I bantering back and forth and teaching pool chemistry and that gets old. We've been trying to bring in some subject matter experts to up our game and you have done that very, very well. So Thank you so much for being on the show.
[00:45:56] Mike Fields, MD: Thank you so much for having me. I appreciate everything you've taught me, so we'll keep at it.
[00:46:00] Eric Knight: All right. Very good. If you have any questions or suggestions for guests or podcast topics, you know the email, it's podcast@orendatech.Com, and if you have any product questions or chemistry questions or app questions, you know the help center is ask, that's ASK.orendatech.com. I'm your host, Eric Knight with Orenda and HASA. You're the best. And we've got a very cool guest on the next one too, talking about Olympic swimming.
[00:46:23] It's not Rowdy, but it is another Olympian. And we're looking forward to having him as well. Thank you all for being here. Take care.