Bizarre effects after diving - reasons?

[Amazz]

I just received my official response from a DAN medic, and it looks good. I have copied and pasted their email below. I am not including my original message because it essentially parallels what I have posted here.



Dear Greg,

Thank you for your e-mail and membership support. We cannot rule out the possibility of DCS entirely but in reference to the thorough information you provided DCS seems unlikely. The most compelling information that reduces suspicion is the fact that you dove the very next day without any return of symptoms. Historically this is not consistent with what is experienced with DCS. Divers have had symptoms that resolved without intervention but had worse symptoms when they dove within 24 to 48 hours after the initial onset of symptoms. Also the fact that your symptoms resolved without intervention further reduces the suspicion for DCS.

All oral motion sickness medications are classed as antihistamines. The symptoms you experienced can be attributed to the antihistamine. Although you had not to that point had any side effects from Bonine our susceptibility to side effects can vary with each use and is affected by many variables. All of the cognitive problems you had can be attributed to antihistamine side effects. Your hand being numb after napping is most likely due to the position of your hand while you slept. Your dive profiles are not particularly provocative especially with breathing 31% EAN. Again we cannot rule out DCS entirely but it seems very unlikely. If we can be any further assistance do not hesitate to contact DAN.



Divers Alert Network

And I am one who has been bent many times due to the existence of a PFO, which has been repaired. Your blurry vision is a big red flag to me. The fact you went diving the next day means absolutely nothing in doubting the fact you may have been bent. I have done the same without any return of symptoms. DAN also told me it was unlikely I was bent. I even commented on my skin rash that felt like bruising and the medic told me it was likely sea lice. I was also told my fatigue was too non-specific to be considered as a dive related injury and that diving can be tiring in itself because of exertion. The fatigue that accompanied my other symptoms was unique in that I was too exhausted to even throw my gear into the pool for rinsing. I had to lie down for about an hour to gather the strength to do anything. That's not normal for me. If it happens to you again, see a doctor. DAN is a great organization and I pay my membership yearly. However, on a given day, they are only as good as the person who takes your phone call.

 

[gcs118]

Amazz...Thank you for sharing. If I experience anything similar again I think I'll try to set up a more involved consultation as well as try to get some medical attention/evaluation while experiencing the symptoms.

 

[iztok]

Are you taking any other prescription, OTC, or homeopathic meds? T

Seriously? homeopathic meds?!?

How can water be an issue? They do not have any active ingredient.

 

[Bubbletrubble]

Seriously? homeopathic meds?!?

@iztok: Seriously. If you don't ask the patient this, then you'll never know. Ignorance leads many to think that homeopathic meds aren't "dangerous."
Some homeopathic meds have a truly active ingredient that can work as a sympathomimetic or can affect metabolism of another med being taken simultaneously via induction or inhibition of the cytochrome P450 system.
Another thing to keep in mind is that if any medication (OTC, prescription, homeopathic, etc.) is truly efficacious on its own, there will be a toxicity threshold.

How can water be an issue? They do not have any active ingredient.

I'm not sure to whom you were addressing this question. I'll answer it anyway. Water intoxication can affect electrolyte levels (particularly sodium and potassium levels). This is seen in various patient populations, e.g., people with certain medical issues, psych patients, athletes, military recruits...and I wouldn't be surprised to see it in divers trying to avoid DCS.

 

[tracydr]

Generally, homeopathic means tiny, tiny doses of something that normally causes the sxs being treated. It's pretty benign. Herbal treatments, on the other hand can have the side effects you described and many more. They can be wickedly powerful. Many of our drugs today are either derived from herbs or are synthetic copies. Opium is the precursor of morphine and is considered an herb, as is marijuana and even aspirin. (salicylic acid in willow bark).
Asking about meeds, including herbals is very important.
Is anyone else disturbed about long it took DAN to return an answer to possible DCS sxs? I too, thought of PFO problems and would order an echo if I had a patient describe this episode.

 

[iztok]

@iztok: Seriously. If you don't ask the patient this, then you'll never know. Ignorance leads many to think that homeopathic meds aren't "dangerous."
Some homeopathic meds have a truly active ingredient that can work as a sympathomimetic or can affect metabolism of another med being taken simultaneously via induction or inhibition of the cytochrome P450 system.
Another thing to keep in mind is that if any medication (OTC, prescription, homeopathic, etc.) is truly efficacious on its own, there will be a toxicity threshold.

I'm not sure to whom you were addressing this question. I'll answer it anyway. Water intoxication can affect electrolyte levels (particularly sodium and potassium levels). This is seen in various patient populations, e.g., people with certain medical issues, psych patients, athletes, military recruits...and I wouldn't be surprised to see it in divers trying to avoid DCS.

You would have to seriously overdose on the homeopathic medicine. You would have to drink entire world oceans to get an active molecule.

Sure water overdose would kick in first. But you need to seriously overdose on it too. And it wouldn't be called homeopathic medicine overdose

 

[iztok]

Generally, homeopathic means tiny, tiny doses of something that normally causes the sxs being treated. It's pretty benign. Herbal treatments, on the other hand can have the side effects you described and many more. They can be wickedly powerful.

Homeopathic "medicine" is pretty much water. One would have to drink whole oceans of that to get a single active molecule. It is a sham not a medicine.

 

[iztok]

Common dosage is 30C, which means means that the original medicine is diluted in one hundred parts water, not ten parts water, and this is repeated thirty times.

The resulting ratio will be one molecule of "medicine" for every 10^90 molecules of water - that is a 1 followed by 90 zeroes. But the number of atoms in the entire universe is about 10^80, or a 1 followed by 80 zeroes. This means that such "remedies" being suggested go beyond the dilution limit of the entire universe.

Basically quackery.

 

[gcs118]

Back to the original matter...

I stopped by the health clinic on campus today (free consultations) and spoke with a doctor (not a dive expert, but still a medical expert). He said that the antihistamine effects from Bonine would almost certainly be an every time or never occurrence. He did not feel that this was the culprit of my incident as the DAN expert had believed.

The doctor felt that my condition would either have been a result of sun/exhaustion/rather pronounced dehydration OR effects from the nitrogen. Not being an expert and without an evaluation from the time of occurrence, the doctor did not have other conclusions. He felt no further neurological/heart tests were required at the time mostly since 1) No symptoms have returned, 2) I dove the next day without incident, and 3) My symptoms pretty much cleared up within a few hours with no medical attention nor oxygen.

I do have 2 dives planned off the coast again tomorrow. Since neither the DAN medic nor the doctor believed I should refrain from diving, I will do the dives (weather permitting, etc.). The profiles are more conservative and I will extend my safety stops as well as hydrate extra today and tomorrow. Should anything similar happen I'll request medical attention immediately.

 

[Bubbletrubble]

I stopped by the health clinic on campus today (free consultations) and spoke with a doctor (not a dive expert, but still a medical expert). He said that the antihistamine effects from Bonine would almost certainly be an every time or never occurrence. He did not feel that this was the culprit of my incident as the DAN expert had believed.

I'm not sure whether I agree with this. However, I do understand his point. In light of all the discussion regarding PFO in this thread, I think it's important to understand that for recreational scuba divers PFO closure is still not considered standard of care. I believe that debersole is a cardiologist involved in a prospective study that seeks to evaluate whether PFO closure decreases the incidence of DCI in divers.

The doctor felt that my condition would either have been a result of sun/exhaustion/rather pronounced dehydration OR effects from the nitrogen. Not being an expert and without an evaluation from the time of occurrence, the doctor did not have other conclusions. He felt no further neurological/heart tests were required at the time mostly since 1) No symptoms have returned, 2) I dove the next day without incident, and 3) My symptoms pretty much cleared up within a few hours with no medical attention nor oxygen.

This sounds reasonable, though. It might be useful for you and your dive buddies to learn how to do a quick-and-dirty neurological exam. At the very least, it would be helpful for y'all to appreciate "normal" so that if this happens again you can be on top of it.

I do have 2 dives planned off the coast again tomorrow. Since neither the DAN medic nor the doctor believed I should refrain from diving, I will do the dives (weather permitting, etc.). The profiles are more conservative and I will extend my safety stops as well as hydrate extra today and tomorrow. Should anything similar happen I'll request medical attention immediately.

I'd recommend against hydrating "extra." Hydrate enough to ensure against dehydration. That's hydrating appropriately.

Good luck.