Saturation
Medical Moderator
Thanks for posting the profiles, Dr T!
A Nasty incident
- Thread starter The Iceni
- Start date
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Thanks for posting the profiles, Dr T!
mudfootpal
Guest
Hi Paul,
Nice to hear from you again. Prayers do work! The positive of this is the appreciation of a second chance brings a new perspective to life.
Our best to you and your family.
Nice to hear from you again. Prayers do work! The positive of this is the appreciation of a second chance brings a new perspective to life.
Our best to you and your family.
Aquamaniac
Contributor
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That flat line sent shivers down my spine...............
I have been O/S for the last 4 weeks, and only just noted your return.
Welcome back......Glad your well into recovery.
Dr Paul, to see you alive and recovering. I also travel frequently, and had not been aware earlier of your recovery status. You have been in my prayers.
I have enjoyed, and continue, thankfully, to enjoy reading your posts. I am not perhaps as curious as you are to determine what, precisely, occurred, however the fact that what happened to you could occur to myself, or indeed many of us, keeps me wondering. You are in a much better position than many others on this board to examine the mystery with a penetrating analysis. I hope you discover some answers.
It is good to see posts from you on the board again. We were not sure we would. Welcome back. Thank you for sharing such a life altering event with us.
We each have only one life to live. I respect your decisions. I've learned, however, to avoid words like 'never'. May your decisions bring you satisfaction, serenity, and happiness.
My regards to you and your family,
Doc Intrepid
I have enjoyed, and continue, thankfully, to enjoy reading your posts. I am not perhaps as curious as you are to determine what, precisely, occurred, however the fact that what happened to you could occur to myself, or indeed many of us, keeps me wondering. You are in a much better position than many others on this board to examine the mystery with a penetrating analysis. I hope you discover some answers.
It is good to see posts from you on the board again. We were not sure we would. Welcome back. Thank you for sharing such a life altering event with us.
We each have only one life to live. I respect your decisions. I've learned, however, to avoid words like 'never'. May your decisions bring you satisfaction, serenity, and happiness.
My regards to you and your family,
Doc Intrepid
OP
The Iceni
Medical Moderator
Had my TOE today confirming a PFO.
I should have realised I had one if you look at my posts on that subject prior to my accident. Somewhat prophetic if you look at the dates!
I had shallow water blackout during the ascent from the second dive of the day on 7/Nov/02. This was a simple, practice, shore dive to 22 M on 32% Nitrox for 17 minutes.
The possibilities
1) The migraine-like symptoms I experienced climbing the rocks after the very first dive of my renewed diving career five years ago were due to subclinical type II DCI due to a shower of bubbles crossing a PFO into my arterial tree, which was caused by the "Valsalva-like" manoeuvre of hauling heavy kit, followed by rebound increased venous return.
2) My first dive on the index day, after hundreds of incident-free boat dives, at 22 M on Nitrox 32 for 48 mins was within the no-stop limits with practice stops but, as all dives are decompression dives, my veins were showered with small bubbles and micronuclei during the ascent phase of that dive and during the early part of the surface interval.
3) Normally these bubbles are mopped up by the lungs but carrying my own and my buddy's heavy kit out of the Stoney Cove Quarry caused more micronuclei to from and a transient reversal of the normal left-to-right atrial shunt. A number of these bubbles therefore found their way into the left arium, to my arterial tree and then into the cerebral arteries, lodging in a number of cerebral capillaries.
4) Some of these were still in situ during the second dive and ongassed during a bottom phase of only 17 minutes at 22 M.
5) During the ascent phase these bubbles enlarged due to Boyle's Law causing both obstruction to cerebral blood flow and a transient increase in intracranial pressure.
6) This was sufficient to cause me to lose consciousness without warning.
Does this make sense?
I should have realised I had one if you look at my posts on that subject prior to my accident. Somewhat prophetic if you look at the dates!
I had shallow water blackout during the ascent from the second dive of the day on 7/Nov/02. This was a simple, practice, shore dive to 22 M on 32% Nitrox for 17 minutes.
The possibilities
1) The migraine-like symptoms I experienced climbing the rocks after the very first dive of my renewed diving career five years ago were due to subclinical type II DCI due to a shower of bubbles crossing a PFO into my arterial tree, which was caused by the "Valsalva-like" manoeuvre of hauling heavy kit, followed by rebound increased venous return.
2) My first dive on the index day, after hundreds of incident-free boat dives, at 22 M on Nitrox 32 for 48 mins was within the no-stop limits with practice stops but, as all dives are decompression dives, my veins were showered with small bubbles and micronuclei during the ascent phase of that dive and during the early part of the surface interval.
3) Normally these bubbles are mopped up by the lungs but carrying my own and my buddy's heavy kit out of the Stoney Cove Quarry caused more micronuclei to from and a transient reversal of the normal left-to-right atrial shunt. A number of these bubbles therefore found their way into the left arium, to my arterial tree and then into the cerebral arteries, lodging in a number of cerebral capillaries.
4) Some of these were still in situ during the second dive and ongassed during a bottom phase of only 17 minutes at 22 M.
5) During the ascent phase these bubbles enlarged due to Boyle's Law causing both obstruction to cerebral blood flow and a transient increase in intracranial pressure.
6) This was sufficient to cause me to lose consciousness without warning.
Does this make sense?
bwerb
Hoser/English Translator, eh
that you now have a definitive diagnosis. I don't think there is much worse than having had an incident like you did and not knowing the reasons why.
Thank-you for continuing to share all of your knowledge and on-going prognosis/diagnosis with us.
I'm just curious...is a PFO a 100% contraindication for diving or are their certain parameters you can work within to dive in the future? Can a PFO be repaired?
Thanks again,
Brian
Thank-you for continuing to share all of your knowledge and on-going prognosis/diagnosis with us.
I'm just curious...is a PFO a 100% contraindication for diving or are their certain parameters you can work within to dive in the future? Can a PFO be repaired?
Thanks again,
Brian
Dr Deco
Contributor
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Dear Dr Paul:
The natural history that you outlined appears to be very plausible.
Dr Deco :doctor:
The natural history that you outlined appears to be very plausible.
Dr Deco :doctor:
Scubaroo
Contributor
I just saw this profile. Scary stuff.
Glad you're back amongst us, Dr Paul!
OP
The Iceni
Medical Moderator
Hi Brian,
Well, before my incident I would have said that the fact that about 30% of the adult population have a PFO was academic and that it would only be a concern to technical divers and those who dive deep and often. I am no longer certain that this is the case and wonder if many of those unexplained diving fatalities were not simply "drowning" but were due to a similar cause.
As I am sure you will see from the profiles, my dives that day were hardly technical, or in any way demanding. What puzzled me was why this incident did not happen before on any one of my many ocean wreck dives, which would certainly be classed as "technical", even if I was not using Trimix. (lucky for me that it didn't!)
I think the answer appears to be due to the fact that these were shore dives. As I see it, this was the one factor that caused the generation of additional micronuclei and reversal of the shunt during the immediate post-dive phase due to climbing rocks and the carrying of heavy kit over an extended period of time.
In earlier dives I believe that I may have inadvertently protected myself from such an event because of my insistence of using 100% oxygen as my final deco gas, and when climbing the boat's ladder I always took it very, very easily while still breathing that same oxygen.
For this reason I would not wish for any of my children to take up scuba until a PFO has been excluded. If one is found it can easily be repaired and although I do not intend to dive any more I am having mine repaired because PFOs are associated with a fourfold increase in the incidence of cerebrovascular accidents in later life; (thromboembolic events or "strokes".)
Many believe the test can only be carried out by specialsists with an interest in diving medicine.
This is not the case.
All decent cardiologists can perform the necessary imaging echocardiogram as a day case. I personally feel that having such a test would be pretty good life insurance for any scuba diver.
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