Bent on New Year

[Peter69_56]

A big thing with having a PFO is don't put yourself under physical stress at the end of and after a dive. In many people this is the time when you still have nitrogen loading, and being under physical stress increases the chance of the hole opening and nitrogen leaking past. Things like getting back on the boat with twin cylinders, moving heavy items after the dive is finished and washing up, walking up a hill or strenuous exercise after getting back to land.

That's what we found did it for my wife, lifting twin cylinders when washing etc, or getting onto the boat with twin cylinders and sling.

 

[maristu]

Peter and Greenjuice, thanks for all the info on PFO! I do still want to get tested, although the exam seems unpleasant (I've had endoscopies done in the past, and hate them). I don't think getting a referral will be much of an issue in Brazil. Finding a place where they actually do it there might be, though. However, if I do have a PFO, my choice is to quit diving rather than have it fixed. I have issues with any heart surgery, no matter how "simple" or "small" it might be... My stepfather died in a heart surgery (although that was a more complicated open heart surgery for a valve replacement), and I also have a friend who did a "simple" heart surgery - much like the description I read for PFO closure - to fix an arrhythmia, and she ended up having to put in a pacemaker at 23yo. But I'll worry about that when the time comes

beaverdivers, I was diving on air, as I have been during my entire course. We do have nitrox on the boat, but it's usually only used for divers who request it (and pay for it), and they do a nitrox profile. I'll see if it's possible for me to dive on nitrox for the remainder of my course (doing an air profile), but once I start working it's going to be a little harder. But there are other ways of reducing nitrogen exposure, and I've been thinking of not working liveaboards and doing daytrips instead (only two dives a day), and taking OW divers whenever possible. Taking a couple days off during the week as well. Pay won't be as good of course, but it's a (literal) price I'm willing to pay

markmud, thanks for the tips on staying hydrated! The water here in Thailand is fully distilled, which means there are NO minerals in it whatsoever. We mix in DChamp (powder "nature identical" electrolytes) into our water on the boat, but I've heard that you shouldn't take more than 4 packets a day or it could give you kidney stones. My water bottle is 750ml, and that's what I drank before the dive and in between dives. I'm working on drinking at least 8 bottles of water in day. I do pee a lot, though At least once in every si, sometimes more. One more thing I forgot to mention (and I'm sure most guys didn't think of ) - I was on the first day of my period, which tends to dehydrate you as well. Sucks being a woman sometimes

As for getting on O2 as soon as you feel symptoms, lesson learned. In my defense, I've never actually seen a case of DCS before, and the symptoms I had (sore rib and tenderness on my thighs) didn't fit any of the book descriptions, and fits my MO, as I have a tendency to bump into things and get bruised easily (especially on a boat). If I had pain on my shoulders or knees, or if I had a rash anywhere, it would've been a different story. As it was, I asked two instructors, who both told me they didn't think it was DCS. I think EVERYONE learned a valuable lesson with this episode.

One final question: what is considered a "mild" hit? Was this a mild case of DCS? As opposed to what? If I'd been on O2 earlier (and not done the second dive), would the symptoms have gone away? And if so, should I still have gone to the chamber? (Sorry, that was more like 5 questions )

Cheers, and thanks again for all the replies!

Mariana

 

[Peter69_56]

I can only speak of what happened to my wife. On the second time, with no help or O2 it was very painful for her and not something she would wish to repeat. The third time, within 30 min of being on 60% Nx the pain dropped off significantly and within 2 hours she had few symptoms. I think if she were on 100% O2 it would have been even better. I would call her's mild to medium. I would hate to see someone suffering a severe hit. My own personal opinion is that if the symptoms don't start to improve within say 1-1.5 hrs of O2 then the chamber it is. Just because they improve doesn't mean they wont come back though later. With my wife that didn't happen though.

Understand about your choice if PFO, for some surgery is not an option.

 

[Greenjuice]

'mild', 'moderate' or 'severe' (or does it matter)?
For a any particular case, I would say that you would get more agreement between dive medicine doctors (I would hope, close to 100%) than between doctors who don't specialise in dive medicine; who in turn would agree more than those who are interested in medicine but not formally trained; who in turn would agree with each other more than the average lay person.

Therefore, I would suggest, it's mild if your dive medicine doctor says it's mild!

This issue has come up before in many areas (not just DCS/DCI), because these words are shared in medicine as well as in common usage. Strictly for DCI/DCS the medical classification is Type 1 and Type 2.
However, the use of 'mild' or 'severe' can (and has) been loosely applied to various stages of the illness:
1. Speed on onset
2. Severity of symptoms
3. Range of organ systems involved
4. Response to treatment
5. Range of outcome and any long term disability

So, not a clear answer for you, unfortunately, 'it depends....' (and that could apply to all your questions!)

 

[Anna G]

'mild', 'moderate' or 'severe' (or does it matter)?

... Strictly for DCI/DCS the medical classification is Type 1 and Type 2.

The dive med field is actually getting away from TypeI/II, as it's often somewhat of an artificial divide. For ex, if you have an elbow bend, but at some point vaguely maybe felt some tingling or numbness in your hand, that would put it into Type II because of neuro symptoms, but...meh. Is it really that much more serious than if you didn't have that vague tingling?

It's moving more towards a descriptive scheme, so in the ex above would be "elbow pain x/10 severity, dull non-radiating, subjective feeling of numbness over *area* with no objective findings".

 

[Peter69_56]

I agree, I used the terms I did as a layman. It was a description of her feeling of uncomfortability (perhaps a new word?) with the symptoms, and that was relative to other things she has happened to her. What she might consider moderate, some might call severe or mild. In any regard as a simplistic term, I am sure there are much more painful levels than she experienced, however pain being only one part of the actual problem.

I also think pain in the neck, spine, head area might be more significant than say pain in a foot or hand? Anyway I am speaking generalist terms only as a layperson.

 

[TONY CHANEY]

Just a few extra thoughts / questions come to mind as well as what have been said by others. What is your age? Most PFO show themselves during childhood when children start to play sports. Could your lack of balance (falling of a stationary bike) might be due to lack of oxygen or an increase in CO2 during exercise? Have you been a sportsman throughout your life with hard exercise? If so it more than likely would have presented itself eariler.
The test echocardiography is really noninvasive. Did you know that you might decide to not dive anymore but there are other complications such as TIAs and CVAs that go hand in hand with untreated PFOs. I am not selling treatment but you really should get it checked out. I treat and care for a lot of stroke patients and it is one of the last things that I would want to happen to me.
Lastly...tell the shop to get some O2. No class I have seen ever allows an instructor not to have O2 handy while teaching diving. Please take care and I wish you the best.

 

[Greenjuice]

The dive med field is actually getting away from TypeI/II, as it's often somewhat of an artificial divide.

Agreed! I was just trying to explain to the OP why she might get differences of opinion even between so called experts. Perhaps I should have used the word, "Traditionally,...". The point being that medical classifications would try to avoid using lay or ambiguous terminology. Admittedly, one could argue that it hasn't helped in this instance!

To take this illustration a step further, what if, in the example above, the diver gave a very precise description of the numbness fitting a very clear dermatomal, say C5, distribution? Would that be an observation that all dive med specialists find just as easy to dismiss?


I think it is also worth commenting that issue of PFO (and related ASD) with Stroke still needs considerable work and is far from resolved. The association has really only been supported for a specific small subgroup of stroke called 'cryptogenic'. These are typically aged under 55 and often not atheromatous, unlike the vast majority of stroke cases who are over 65 and mostly considered to be due to atheromatous disease. Even within this subgroup, the treatment of PFO closure over conservative management remains unclear (at least, as of 2013).

I make this point to come back to something I said earlier, which is to be careful of focusing on the medical test as the solution. It is only the beginning and the decision to proceed should be guided by a physician. Know what your options are and where the results may lead. Be aware that every medical test has a chance that it might be wrong (this could happen in two ways: saying you have something when you have not; and saying you do not have something when you actually do). Just getting it checked out sounds simple, but is a potential hazard. Physicians who order these tests on their patients do develop feel for the 'meaning' of the results. Many lay people focus on, and trust, the test more then the physician when it should be the other way round.

 

[ajduplessis]

I have said it before and will repeat it again.

There is no such thing as an undeserved hit IMO.


Just because your dive profile is correct, does not mean you are safe. Age, physical health, hydration, immune systems, PFO/shunts, bruising of muscle/skin/ligaments/bones, medication, flu, drugs/alcohol, bumpy boat ride/bad posture, body fat, sleep, ambient temp, acclimatisation to name just a few can impact the outcome of a DCS hit, even within safe dive parameters.


Stay at ground level if you want to remove DCS, don't go up or down.

 

[scorpiofish]

Someone will be along shortly to say there is no such thing as "undeserved". Regardless of terminology, I would, however, call it unexpected based on your description of your dive week. It was kind of an oddball assortment of dives. I doubt a rapid ascent from 2.5 m after an 8 minute stop had much impact. I wouldn't be surprised, though, if a couple of bounce scenarios in rescue training might have contributed. Personally, I think the lack of sleep and hydration were likely the biggest factors.

My wife has gone through 3 bouts of skin bends, all after diving within NDLs. She was the perfect candidate for a PFO as the explanation. She was checked and she did not have a PFO. Based on this, the biggest factor was once again hydration and fatigue. It matters a lot. We have both been through chamber rides and you will be a bit paranoid and cautious upon your return. This is normal and this is good. You will find yourself doing all the little things to give you an edge. This includes drinking plenty of water all the time, skip the alcohol, dive a tad shallower than the rest of the group, stretch your safety stop a little longer, dive nitrox when available, set your computer at a lesser mix, keep breathing the nitrox after you hit the surface, don't stretch your tank out to unnecessary dive times.

Sometimes people just get bent. I, and some of my best dive buddies, believe some people are more bendable than others. It becomes a game of pushing your odds down as much as possible. I can count on one hand the number of dives I've done past 30 meters in the last 1000 dives. If there isn't something I'm specifically going to see, I stay relatively shallow, where there is more life and light any way.

Dive smart and it will likely be a one time event.