cool_hardware52
Contributor
I got bent. Saturday February 4th 2012. No way to sugar coat that fact. It doesn't always happen to somebody else.
Ive long known that I live under a lucky star, and this incident is simply more proof.
I have recovered fully, and owe this to a long list of care providers starting with my teammates. Their prompt actions and follow though were key. I could not ask for a better group, these are the guys you want around when things go sideways.
Huge thanks to La County Life Guards, La County Sheriffs, Ambulance Crews, ER staffers, HBM Doctors and staff.
The circumstances:
Dive 1, max depth 159 fsw, Average depth ~150 fsw. Bottom gas 21/35, deco 50% and 100% BT 20 min, Ascent 1 min stops starting at 110 ft to 80 ft. 4 mins @70, 4 @60, 2 @50, 2 @40, 3 @30, 10 @20, 5@10 with a slow ascent to the surface. Gas switches at 70 ft and 20 ft. Water temps ~53F with adequate exposure protection. Dive went as planned, solid deco, no problems. Scooters were used by all 4 divers, no heavy exertions.
Dive 2, max depth 138 fsw, Average depth ~125 fsw. Same gases, BT 15 min, Ascent 1 min stops from 100 to 80, 2@70, 2@60, 2@50, 2@40, 2@30, 10@20, 5@10, slow ascent to the surface. Dive went as planned, solid deco, no problems. Scooters were used by all 4 divers, no heavy exertions.
Approximately 5 minutes after exiting the water and getting out of my gear I began to feel chest tightness and profound need to cough. This occurred as we were moving gear on the boat and recovering scooters/ deco bottles. Humm seems like "chokes" This is immediately troubling as chokes are quite rare, and are frequently fatal. (or at least that what I thought I knew about "pulmonary" DCS)
I recognized these symptoms as abnormal and immediately went on surface O2. Soon I found I could not sit up as I was becoming increasingly dizzy. Heart Attack? Probably not, as I have very recently been thoroughly worked up by a cardiologist and cleared to dive. More about that later.
My teammates helped me to a berth in the boat cabin, and I stayed on O2. The chest tightness and coughing subsided over about 15-20 minutes, but I remained dizzy if I was not lying down. Knee hurts too.
Decision is made to contact emergency responders / chamber. Boat ride back to port requires ~50 minutes from this point.
We were met at the berth by the local Los Angeles County Life Guards from Marina Del Rey Harbor. I was assessed, shaved, hooked up to a monitor and IV was started. The LA County Sheriffs also showed up shortly after the Life Guards. More big guys in that boat cabin than I had previously thought possible. (Getting "manscaped" by a big guy while lying on a boat bench is not the way to end a day of diving.)
I was able, with considerable assistance, to walk off the boat and onto the waiting dockside gurney, into the ambulance and off to the ER/Chamber. Still on O2. I don't recall if I was being given IV fluids or not.
I arrived ~20-30 minutes later at the ER. They had been alerted that a "Diving Accident" was inbound.
I spent the next 4-5 hours in the ER before going to the chamber. Hard to judge time well, no wrist watch. There was some question if the chamber on site would be used or if I was to be transported to another chamber on the mainland, or even flown out to the USC chamber on Catalina Island. They did eventually secure the necessary personal to run the chamber on site, very good news.
I've now been out of the water for about 6 1/2 hours, and have been on O2 for most of that time, and have been unable to get anything to drink after leaving the boat. Blood pressures are ~ 110 / 50 lying down. It's becoming evident that some in the ER think I've had a MI, as I did tell them about the chest tightness as the first symptom. This leads them to deny me liquids.
The chamber is now ready, the necessary blood work done, the chest films have been reviewed and it's time to leave the ER and go to the chamber.
Stand up and get into the wheel chair for the ride thought the labyrinth that is a large modern urban teaching hospital. Almost immediately I'm again dizzy, nauseous, and feeling profoundly unwell. I tell the staff that I'm either going to vomit or pass out.
I wake up on a gurney. As predicted I passed out on my way to chamber. (Avoid doing this if at all possible, as it starts a cascade of additional interventions.)
Soon I'm in the chamber, with two technicians, starting a TT6 or "Treatment Table 6" ride, down to 60 ft on pure 02, with occasional air breaks and a very slow ascent over the next 4:58.
My knee is definitely feeling better, but the Dizziness is hard to assess. I'm not dizzy if I'm lying down, but they are reluctant to have me sit up and will not let me try to stand, go figure.
After several hours I'm allowed to try sitting up, and the world is still moving on it's own, but at a reduced tempo. Some anti-nausea meds help. First chamber ride ends ~1:00 am. Back to the ER with orders to keep hydrating me. Knee still hurts a little. Still a bit unsteady, but much improved.
ER is convinced that I'm either a MI patient or possible stroke, reinforced by my apparent seizure. (Did I mention trying to avoid this is possible?)
They won't give me anything to drink, as they are concerned that my next stop will be an OR. Next is the CAT Scan. Good news, no problems found on the CAT SCAN.
Can I have something to drink now please? No, the doctor wants 18 hours of labs negative for MI before we will provide liquids. Really? I'm very dehydrated. Ill have your nurse ask your doctor.
Still no fluids, Me not too happy. Blood pressure is ~88/38 lying down! After a couple hours of this I'm getting concerned, and took steps to make my concerns known. Finally got some fluids!
Back to the chamber for a 2nd treatment. TT4. (Note: May Have been TT5) Shorter, about 3 hours IIRC. One tech in the pot this time and she pouring water into me, and encouraging me to try and urinate. Near the end of the ride success! Feeling *much* better. Balance near or at normal. Knee no longer hurts.
After this second ride Sunday Morning I'd sent not back to the ER, but to an Observation Unit in the Main Hospital. Way different. These folks have orders to rehydrate me and to run blood tests every few hours. *Gallons* of IV fluids are dumped into me along with gallons of water to drink. My kidneys start to work again. Lab tests trending back towards normal. Remarkably I gained 16 lbs. from Saturday morning predive to Monday night when I arrived home. slosh...slosh....
How do they judge when you had enough chamber rides? For me it was one ride past improvement. If you get better after one ride you need another. If a second ride results in further improvement you need a third etc. If the third has little / no additional benefit youre probably done. My last ride was on Monday with and I was with one other patient who was not a diver but was having wound care. I'm not sure of the treatment protocol, but the ride was about 2 hours, and the ascent was faster than the TT6 and TT4. The good news was I went in fine and came out fine, so no change.
Time to go home, well maybe not. Now they want a MRI due to my "seizure" (Did I mention trying to avoid losing consciousness if at all possible?)
Remarkably they were able to schedule a brain MRI in their 3 Tesla closed tube for that afternoon. Nothing like a large teaching hospital with a "Stroke Center" First Class hardware and world class eyeballs reading the films, I love modern medicine.
I sprung from the hospital Monday evening, just about 72 hours after arriving via ambulance. Feeling mostly OK, but still kinda hammered. If fatigue is a symptom of sub clinical DCS, it is certainly a symptom of full blown clinical DCS. Add to that the sleep depriving nature of any hospital stay and I was pooped.
I was back to see the neurologist the following Friday for the MRI results. All good news, no damage, no underlying seizure disorder, no cause for concern. The neurologist suspects I did not have a seizure, but in fact simply fainted. (Did I mention trying to avoid this if possible?)
Now, what went wrong? Why did conservative profiles, with well executed deco, with proper gas choices, on a low exertion dive not unlike dives that I have done many times before send me to the chamber?
PFO? No, been there done that, no PFO.
Cold? No, I've been in colder water longer, on deeper dives. Im pretty cold tolerant anyway.
Exertion? No, scooters rule.
Sloppy deco? No, not with these guys.
Post dive exertion? Maybe, lots of gear to shift and recover from the drop lines. Next time I'll wait an extra 10-15 minutes. Maybe spend it sucking on the remains of my 20 bottle.
Hydration? Probably. In the last year I've lost 50 lbs. and greatly increased my amount of exercise. Why? Because I needed to, and I had a Doctor tell me I had borderline high blood pressure that would need treatment if I didn't eat less and move more.
I did both and it worked. ~120 / 60 Resting heart rate ~45 bpm is pretty typical for me. Leap tall building in a single bound etc. etc.
Then I have another doctor tell me I have an irregular heart beat and I should see a heart specialist.
Humm, sounds like a good idea, I'm 53 and heart attacks underwater are seldom survivable. Not fair to my teammates if I'm a liability.
EKG's Stress test and Echo-cardiogram and Nuclear Stress Test. Everything looks good and the Irregular Heart Beat is found to be "PACs or premature atrial contractions. Essentially an extra beat every so often that disappears when I'm stressed. I'm told that PAC's such as mine are not a cause for concern, and no restrictions are placed on my activities including diving.
The Cardiologist does not find any hypertension either, but they do find slight hypertrophy in the heart wall, my heart is slightly thicker than they like. This leads the cardiologist to suspect that my blood pressure may at times be higher than what they see in the office.
He suggests a low dose of a BP med and a low sodium diet. I suggest a low sodium diet and more weight loss and more exercise. We compromise; low sodium diet, more weight loss, continued exercise and 80 mg daily of Diovan. I'm provided physician samples of the meds which I start taking.
Now I'm finding that I occasionally have BP of ~ 100 / 50 or less (Home monitor), and the idea of an afternoon nap has been quite appealing lately .. (My follow up appointment with the Cardiologist is tomorrow, as I started the Diovan ~5 weeks ago.)
I was profoundly dehydrated while I was in the hospital. Was this a cause or effect of the DCS? Or perhaps a bit of both? Hard to say. I had reduced kidney function too.
What I now know is plain Diovan, not just Diovan HCT, is in fact a diuretic.
From Baby Carriers | LIVESTRONG.COM
Diovan (valsartan) is a medication used primarily to control blood pressure (See References 1). Because of its mechanism of action, it also has diuretic properties. Diovan is also used cautiously in patients with congestive heart failure (See References 2). Diovan affects powerful hormones that control fluid balance in the body by altering kidney function. The National Institute of Health (NIH) advises caution when giving Diovan to patients with a history of kidney disease because of the potential to cause kidney failure (See References 1).
My primary complaint was dizziness, and I managed to pass out when I was taken from lying down to sitting up in a wheelchair.
Central Nervous System Side Effects
Diovan (valsartan) may cause headache and dizziness in some patients (See References 2). Other central nervous system (CNS) Diovan side effects include feelings of anxiety, difficulty sleeping, numbness and tingling, and in some cases, drowsiness (See References 1). Vertigo and syncope (passing out) have also been reported after post marketing studies (See References 1). These symptoms caused some patients to discontinue using Diovan (See References 1). CNS effects may be greater if Diovan is causing postural hypotension, which is a significant drop in blood pressure with position changes.
When I first exited the water I was having trouble getting a full breath.
Cardiovascular and Respiratory Side Effects
Diovan (valsartan) is reported to cause chest pain, dyspnea (difficulty breathing) and palpitations in some patients (See References 1). The occurrence of these side effects should be reported to a physician. Patients taking Diovan reported cough, upper respiratory tract infections, rhinitis, sinusitis and pharyngitis (swelling in the pharynx) (See References 1).
Were my problems caused by or exacerbated by Diovan? DAN doesnt think so.
I have my suspicions that my low sodium (under 1000mg daily) diet, and the Diovan combined to leave me dehydrated. This led to less efficient deco. That led to some sort of hit. The hit combined with low blood pressure produced a set of symptoms that looked far more ominous than they were.
Can I prove any of this? No. Many undeserved hits remain unexplained.
What will I change going forward?
No more Diovan. I can control my blood pressure easily with diet and exercise.
Better predive Hydration starting the night before and continuing up until I get in the water.
Pad the deco a bit. Already doing conservative profiles, but no harm in adding minutes.
Wait a bit after the dive to start humping gear. Suck down some O2 floating at the surface if conditions allow it. Dont climb the ladder with deco bottles still clipped on. Wait a bit to recover the scooters and stages from the drop line.
What will our Team do differently if we have another DCS incident?
Send a 2nd diver to the ER / Chamber with the casualty. I received wonderful care from great people in a world class hospital. The HMC crew was fantastic, the HBM doctors, the chamber Technicians and the nurses were all phenomenal. So was the ER, the problem is that the ER, even in an institution with a HBC on site, is not accustomed to seeing DCS cases. This is where a 2nd diver can help.
The next 5 weeks are dry for me. I plan to use them to catch up on cylinder hydros and reg service and drysuit repairs etc. Cant wait to get back in the water.
Tobin
Ive long known that I live under a lucky star, and this incident is simply more proof.
I have recovered fully, and owe this to a long list of care providers starting with my teammates. Their prompt actions and follow though were key. I could not ask for a better group, these are the guys you want around when things go sideways.
Huge thanks to La County Life Guards, La County Sheriffs, Ambulance Crews, ER staffers, HBM Doctors and staff.
The circumstances:
Dive 1, max depth 159 fsw, Average depth ~150 fsw. Bottom gas 21/35, deco 50% and 100% BT 20 min, Ascent 1 min stops starting at 110 ft to 80 ft. 4 mins @70, 4 @60, 2 @50, 2 @40, 3 @30, 10 @20, 5@10 with a slow ascent to the surface. Gas switches at 70 ft and 20 ft. Water temps ~53F with adequate exposure protection. Dive went as planned, solid deco, no problems. Scooters were used by all 4 divers, no heavy exertions.
Dive 2, max depth 138 fsw, Average depth ~125 fsw. Same gases, BT 15 min, Ascent 1 min stops from 100 to 80, 2@70, 2@60, 2@50, 2@40, 2@30, 10@20, 5@10, slow ascent to the surface. Dive went as planned, solid deco, no problems. Scooters were used by all 4 divers, no heavy exertions.
Approximately 5 minutes after exiting the water and getting out of my gear I began to feel chest tightness and profound need to cough. This occurred as we were moving gear on the boat and recovering scooters/ deco bottles. Humm seems like "chokes" This is immediately troubling as chokes are quite rare, and are frequently fatal. (or at least that what I thought I knew about "pulmonary" DCS)
I recognized these symptoms as abnormal and immediately went on surface O2. Soon I found I could not sit up as I was becoming increasingly dizzy. Heart Attack? Probably not, as I have very recently been thoroughly worked up by a cardiologist and cleared to dive. More about that later.
My teammates helped me to a berth in the boat cabin, and I stayed on O2. The chest tightness and coughing subsided over about 15-20 minutes, but I remained dizzy if I was not lying down. Knee hurts too.
Decision is made to contact emergency responders / chamber. Boat ride back to port requires ~50 minutes from this point.
We were met at the berth by the local Los Angeles County Life Guards from Marina Del Rey Harbor. I was assessed, shaved, hooked up to a monitor and IV was started. The LA County Sheriffs also showed up shortly after the Life Guards. More big guys in that boat cabin than I had previously thought possible. (Getting "manscaped" by a big guy while lying on a boat bench is not the way to end a day of diving.)
I was able, with considerable assistance, to walk off the boat and onto the waiting dockside gurney, into the ambulance and off to the ER/Chamber. Still on O2. I don't recall if I was being given IV fluids or not.
I arrived ~20-30 minutes later at the ER. They had been alerted that a "Diving Accident" was inbound.
I spent the next 4-5 hours in the ER before going to the chamber. Hard to judge time well, no wrist watch. There was some question if the chamber on site would be used or if I was to be transported to another chamber on the mainland, or even flown out to the USC chamber on Catalina Island. They did eventually secure the necessary personal to run the chamber on site, very good news.
I've now been out of the water for about 6 1/2 hours, and have been on O2 for most of that time, and have been unable to get anything to drink after leaving the boat. Blood pressures are ~ 110 / 50 lying down. It's becoming evident that some in the ER think I've had a MI, as I did tell them about the chest tightness as the first symptom. This leads them to deny me liquids.
The chamber is now ready, the necessary blood work done, the chest films have been reviewed and it's time to leave the ER and go to the chamber.
Stand up and get into the wheel chair for the ride thought the labyrinth that is a large modern urban teaching hospital. Almost immediately I'm again dizzy, nauseous, and feeling profoundly unwell. I tell the staff that I'm either going to vomit or pass out.
I wake up on a gurney. As predicted I passed out on my way to chamber. (Avoid doing this if at all possible, as it starts a cascade of additional interventions.)
Soon I'm in the chamber, with two technicians, starting a TT6 or "Treatment Table 6" ride, down to 60 ft on pure 02, with occasional air breaks and a very slow ascent over the next 4:58.
My knee is definitely feeling better, but the Dizziness is hard to assess. I'm not dizzy if I'm lying down, but they are reluctant to have me sit up and will not let me try to stand, go figure.
After several hours I'm allowed to try sitting up, and the world is still moving on it's own, but at a reduced tempo. Some anti-nausea meds help. First chamber ride ends ~1:00 am. Back to the ER with orders to keep hydrating me. Knee still hurts a little. Still a bit unsteady, but much improved.
ER is convinced that I'm either a MI patient or possible stroke, reinforced by my apparent seizure. (Did I mention trying to avoid this is possible?)
They won't give me anything to drink, as they are concerned that my next stop will be an OR. Next is the CAT Scan. Good news, no problems found on the CAT SCAN.
Can I have something to drink now please? No, the doctor wants 18 hours of labs negative for MI before we will provide liquids. Really? I'm very dehydrated. Ill have your nurse ask your doctor.
Still no fluids, Me not too happy. Blood pressure is ~88/38 lying down! After a couple hours of this I'm getting concerned, and took steps to make my concerns known. Finally got some fluids!
Back to the chamber for a 2nd treatment. TT4. (Note: May Have been TT5) Shorter, about 3 hours IIRC. One tech in the pot this time and she pouring water into me, and encouraging me to try and urinate. Near the end of the ride success! Feeling *much* better. Balance near or at normal. Knee no longer hurts.
After this second ride Sunday Morning I'd sent not back to the ER, but to an Observation Unit in the Main Hospital. Way different. These folks have orders to rehydrate me and to run blood tests every few hours. *Gallons* of IV fluids are dumped into me along with gallons of water to drink. My kidneys start to work again. Lab tests trending back towards normal. Remarkably I gained 16 lbs. from Saturday morning predive to Monday night when I arrived home. slosh...slosh....
How do they judge when you had enough chamber rides? For me it was one ride past improvement. If you get better after one ride you need another. If a second ride results in further improvement you need a third etc. If the third has little / no additional benefit youre probably done. My last ride was on Monday with and I was with one other patient who was not a diver but was having wound care. I'm not sure of the treatment protocol, but the ride was about 2 hours, and the ascent was faster than the TT6 and TT4. The good news was I went in fine and came out fine, so no change.
Time to go home, well maybe not. Now they want a MRI due to my "seizure" (Did I mention trying to avoid losing consciousness if at all possible?)
Remarkably they were able to schedule a brain MRI in their 3 Tesla closed tube for that afternoon. Nothing like a large teaching hospital with a "Stroke Center" First Class hardware and world class eyeballs reading the films, I love modern medicine.
I sprung from the hospital Monday evening, just about 72 hours after arriving via ambulance. Feeling mostly OK, but still kinda hammered. If fatigue is a symptom of sub clinical DCS, it is certainly a symptom of full blown clinical DCS. Add to that the sleep depriving nature of any hospital stay and I was pooped.
I was back to see the neurologist the following Friday for the MRI results. All good news, no damage, no underlying seizure disorder, no cause for concern. The neurologist suspects I did not have a seizure, but in fact simply fainted. (Did I mention trying to avoid this if possible?)
Now, what went wrong? Why did conservative profiles, with well executed deco, with proper gas choices, on a low exertion dive not unlike dives that I have done many times before send me to the chamber?
PFO? No, been there done that, no PFO.
Cold? No, I've been in colder water longer, on deeper dives. Im pretty cold tolerant anyway.
Exertion? No, scooters rule.
Sloppy deco? No, not with these guys.
Post dive exertion? Maybe, lots of gear to shift and recover from the drop lines. Next time I'll wait an extra 10-15 minutes. Maybe spend it sucking on the remains of my 20 bottle.
Hydration? Probably. In the last year I've lost 50 lbs. and greatly increased my amount of exercise. Why? Because I needed to, and I had a Doctor tell me I had borderline high blood pressure that would need treatment if I didn't eat less and move more.
I did both and it worked. ~120 / 60 Resting heart rate ~45 bpm is pretty typical for me. Leap tall building in a single bound etc. etc.
Then I have another doctor tell me I have an irregular heart beat and I should see a heart specialist.
Humm, sounds like a good idea, I'm 53 and heart attacks underwater are seldom survivable. Not fair to my teammates if I'm a liability.
EKG's Stress test and Echo-cardiogram and Nuclear Stress Test. Everything looks good and the Irregular Heart Beat is found to be "PACs or premature atrial contractions. Essentially an extra beat every so often that disappears when I'm stressed. I'm told that PAC's such as mine are not a cause for concern, and no restrictions are placed on my activities including diving.
The Cardiologist does not find any hypertension either, but they do find slight hypertrophy in the heart wall, my heart is slightly thicker than they like. This leads the cardiologist to suspect that my blood pressure may at times be higher than what they see in the office.
He suggests a low dose of a BP med and a low sodium diet. I suggest a low sodium diet and more weight loss and more exercise. We compromise; low sodium diet, more weight loss, continued exercise and 80 mg daily of Diovan. I'm provided physician samples of the meds which I start taking.
Now I'm finding that I occasionally have BP of ~ 100 / 50 or less (Home monitor), and the idea of an afternoon nap has been quite appealing lately .. (My follow up appointment with the Cardiologist is tomorrow, as I started the Diovan ~5 weeks ago.)
I was profoundly dehydrated while I was in the hospital. Was this a cause or effect of the DCS? Or perhaps a bit of both? Hard to say. I had reduced kidney function too.
What I now know is plain Diovan, not just Diovan HCT, is in fact a diuretic.
From Baby Carriers | LIVESTRONG.COM
Diovan (valsartan) is a medication used primarily to control blood pressure (See References 1). Because of its mechanism of action, it also has diuretic properties. Diovan is also used cautiously in patients with congestive heart failure (See References 2). Diovan affects powerful hormones that control fluid balance in the body by altering kidney function. The National Institute of Health (NIH) advises caution when giving Diovan to patients with a history of kidney disease because of the potential to cause kidney failure (See References 1).
My primary complaint was dizziness, and I managed to pass out when I was taken from lying down to sitting up in a wheelchair.
Central Nervous System Side Effects
Diovan (valsartan) may cause headache and dizziness in some patients (See References 2). Other central nervous system (CNS) Diovan side effects include feelings of anxiety, difficulty sleeping, numbness and tingling, and in some cases, drowsiness (See References 1). Vertigo and syncope (passing out) have also been reported after post marketing studies (See References 1). These symptoms caused some patients to discontinue using Diovan (See References 1). CNS effects may be greater if Diovan is causing postural hypotension, which is a significant drop in blood pressure with position changes.
When I first exited the water I was having trouble getting a full breath.
Cardiovascular and Respiratory Side Effects
Diovan (valsartan) is reported to cause chest pain, dyspnea (difficulty breathing) and palpitations in some patients (See References 1). The occurrence of these side effects should be reported to a physician. Patients taking Diovan reported cough, upper respiratory tract infections, rhinitis, sinusitis and pharyngitis (swelling in the pharynx) (See References 1).
Were my problems caused by or exacerbated by Diovan? DAN doesnt think so.
I have my suspicions that my low sodium (under 1000mg daily) diet, and the Diovan combined to leave me dehydrated. This led to less efficient deco. That led to some sort of hit. The hit combined with low blood pressure produced a set of symptoms that looked far more ominous than they were.
Can I prove any of this? No. Many undeserved hits remain unexplained.
What will I change going forward?
No more Diovan. I can control my blood pressure easily with diet and exercise.
Better predive Hydration starting the night before and continuing up until I get in the water.
Pad the deco a bit. Already doing conservative profiles, but no harm in adding minutes.
Wait a bit after the dive to start humping gear. Suck down some O2 floating at the surface if conditions allow it. Dont climb the ladder with deco bottles still clipped on. Wait a bit to recover the scooters and stages from the drop line.
What will our Team do differently if we have another DCS incident?
Send a 2nd diver to the ER / Chamber with the casualty. I received wonderful care from great people in a world class hospital. The HMC crew was fantastic, the HBM doctors, the chamber Technicians and the nurses were all phenomenal. So was the ER, the problem is that the ER, even in an institution with a HBC on site, is not accustomed to seeing DCS cases. This is where a 2nd diver can help.
The next 5 weeks are dry for me. I plan to use them to catch up on cylinder hydros and reg service and drysuit repairs etc. Cant wait to get back in the water.
Tobin
