Christi with Blue XTSEA Takes a TypeII DCS Hit (+)

[Mossman]

So many divers are quick to mention PFO, but the most recent DAN magazine discounts a lot of common hype about that. Anyone even thinking about PFO studies really needs to read it. Alert Diver | PFO and Decompression Illness in Recreational Divers It does not suggest PFO testing for a hit or two, and does not necessarily suggest surgery even it the common feature is found.

I didn't suggest it for myself. Christi, however, may be within the parameters of those who might be PFO closure candidates according to 2 of 3 panelists quoted in your cited article, assuming she is tested and found to have the condition.

"Therefore, we recommend PFO closure only in specific cases: professional divers, who are required to dive with imposed dive profiles and cannot adapt their diving behavior; sport divers where no other contributing factors for DCS could be identified and who [experienced DCS after] a "low-risk" dive profile." -- Germonpre

"A commercial diver (e.g., offshore worker, dive instructor) who has experienced several DCS incidents of a type known to be associated with PFO (e.g., neurological), and who is not in a position to increase the oxygen percentage in his/her breathing gas or modify depth-time exposures [might consider PFO closure]." -- Moon

Even Bove concedes, "There have been several case reports of commercial divers who experienced repeated incidents of DCS following deep saturation dives, and the frequency of symptoms was reduced after PFO closure. So there are likely to be occasional cases where PFO closure would be warranted in a diver, but this would not apply to recreational divers."

The difference here between Christi and the rest of (most of) us is that she is a professional diver, not a recreational diver. While she often has the ability to increase the oxygen percentage in her breathing gas, we saw that this isn't always the case, and it's hard to modify dive profiles in Cozumel that are, literally, set in (reef) stone. Testing for the PFO condition, while not risk-free, is relatively benign. If results are positive, then a lot of consultation and hard thought may in order.

Yes, the article discounts routine testing for all divers, but, as Moon says, "Therefore, testing for a PFO is useful only in instances where there have been several DCS incidents of a type known to be PFO-associated, and the person cannot modify depth-time exposures or breathing gas."

Does two make "several" or should she wait until a third?

 

[firstdive2005]

Hi firstdive,

I find this comment potentially misleading.

"Nitrogen" (N) is a gas. It's the primary inert gas that builds up during SCUBA due to Dalton's law of partial pressures and the offending element in most cases of DCI.

Now, while indeed there is a relationship between a nitrogen compound in blood serum and frequency of voiding, this compound is urea nitrogen (NH2)2CO, which is molecular and not gaseous. It's very, very much different than nitrogen (N).

The amount of urea nitrogen in caffeinated beverages like coffee is zero. Moreover, to the best of my knowledge no meaningful relationship has been demonstrated between coffee consumption and blood urea nitrogen levels.

Regards,

DocVikingo

'
Hi DocVikingo,

Thanks for the input, I always enjoy your experience and knowledge. In my statement regarding 'nitrogen' I was referring to scuba nitrogen loading. In so many articles I read they say that nitrogen loading will promote a divers bladder to pee. Maybe it's only me. I'm wondering then why can't I hold my urine for more than a half hour or so underwater. Am I incontinent, gosh I'm only 52. I actually wear a diaper in my drysuit. Cant handle the pee valve deal. lol. thanks DocVikingo.

 

[Craig66]

'
Hi DocVikingo,

Thanks for the input, I always enjoy your experience and knowledge. In my statement regarding 'nitrogen' I was referring to scuba nitrogen loading. In so many articles I read they say that nitrogen loading will promote a divers bladder to pee. Maybe it's only me. I'm wondering then why can't I hold my urine for more than a half hour or so underwater. Am I incontinent, gosh I'm only 52. I actually wear a diaper in my drysuit. Cant handle the pee valve deal. lol. thanks DocVikingo.

My understanding is that the urge to pee underwater is multifactorial and is in part related to the effect that water has on the body as well as a component of peripheral constriction of blood vessels to conserve warmth and this inturn leads to an increase in blood pressure with a resulting pressure diuresis to lower BP and then more urine. There is also a component that is related to drinking more than enough to be well hydrated and almost over hydrated and the kidney doing what it is meant to do which is controlling fluid levels in the body by getting rid of the excess water. Needing to pee on a dive is not the effect of diuretics but is related to the two factors above. If this is in fact the case making sure you are warm on a dive also helps in preventing dehydration.

Craig

 

[DocVikingo]

Hi DocVikingo, ...in my statement regarding 'nitrogen' I was referring to scuba nitrogen loading. In so many articles I read they say that nitrogen loading will promote a divers bladder to pee.

Hey firstdive,

Thanks for your wilingness to enter into a respectful and polite discusion of the issue.

All I can say is that to the best of knowledge, while admittedly limited, in a healthy diver there is no relationship between frequency of voiding and tissue nitrogen loading per se.

I had to chuckle at your comment about holding your urine for more than a half hour or so underwater as I've got the warmest wetsuit is the west (the other directions, too).

Regards,

Doc

 

[1KWIK_69]

My understanding is that the urge to pee underwater is multifactorial and is in part related to the effect that water has on the body as well as a component of peripheral constriction of blood vessels to conserve warmth and this inturn leads to an increase in blood pressure with a resulting pressure diuresis to lower BP and then more urine. There is also a component that is related to drinking more than enough to be well hydrated and almost over hydrated and the kidney doing what it is meant to do which is controlling fluid levels in the body by getting rid of the excess water. Needing to pee on a dive is not the effect of diuretics but is related to the two factors above. If this is in fact the case making sure you are warm on a dive also helps in preventing dehydration.

Craig

This is good stuff! I've always wondered why I constantly need to go when I'm diving, even when I don't believe I've over hydrated myself. This explains a lot. It's also why I switched from using my farmer john jacket or a shorty, to only using a long sleeve 2.5 mil jacket that stops at the waist. At least in warm water that is. Some people like that warm fuzzy feeling they get from relieving themselves in a layer of neoprene. I'm not one of them! :shocked2:

Back to Christi. How ya doing girl???

 

[GrumpyOldGuy]

Staffybull's position is fully consistent with the published science on the topic.

In order to get into worrisome territory one needs a caffeine intake that is wildly beyond what even a very heavy drinker of caffeinated coffee, soft drinks, etc. is exposed to. With anything approaching moderate drinking of such beverages you still end up with a substantial net gain of fluid. Of course this is not say that it's not preferable to drink an equivalent amount of H20, instead.

Regards,

DocVikingo

Isn't this part of the issue. If you drink / sip coffee on your SI, you probably consume less liquid than if you drink straight water. Most coffee cups are what 6-10oz, while water drinkers probably double to triple the volume. This gets added to the mild diuretic effect.

FWIW: I really like my morning coffee and my diet coke with lunch, I just don't count on it for hydration.

 

[DocVikingo]

My understanding is that the urge to pee underwater is multifactorial and is in part related to the effect that water has on the body as well as a component of peripheral constriction of blood vessels to conserve warmth and this inturn leads to an increase in blood pressure with a resulting pressure diuresis to lower BP and then more urine. There is also a component that is related to drinking more than enough to be well hydrated and almost over hydrated and the kidney doing what it is meant to do which is controlling fluid levels in the body by getting rid of the excess water. Needing to pee on a dive is not the effect of diuretics but is related to the two factors above. If this is in fact the case making sure you are warm on a dive also helps in preventing dehydration.Craig

Hi Craig,

A bit of clarification is in order.

The stimulus to urinate whilst diving can in fact be a large function of a diuretic of sorts, and that would be atrial natriuretic hormone (ANH).

Please see --> Atrial natriuretic peptide - Wikipedia, the free encyclopedia

Regards,

DocVikingo

 

[Craig66]

Hi Craig,

A bit of clarification is in order.

The stimulus to urinate whilst diving can in fact be a large function of a diuretc of sorts, and that would be atrial natriuretic hormone (ANH).

Please see --> Atrial natriuretic peptide - Wikipedia, the free encyclopedia

Regards,

DocVikingo

Agreed 100%, ANH is a diuretic but it is not an EXOGENOUS one but rather an endogenous one and is infact one of the mechanisms the body uses to return homeostasis to the BP that has just risen due to vasocontriction.

Thanks for your input which as always is very helpful and logical

Craig

 

[vlkr]

Craig

Allow me please to throw in my 2 pesos worth of advice. I started drinking a liter of pedialyte the night before going diving years ago. Then I would follow that up with water and fruit on the boat the next day as usual. I have also been diving nitrox since 1995. So far so good. A side benefit of drinking the pedialyte is that it diminishes the hangover effect the next morning by at least 75%. ... Your mileage may vary.

i have noticed that football teams are now using pedialyte. i am not a big fan of gatoraid but i do have it every morning before diving on coz. your suggestion of pedialyte is probably better.

 

[DocVikingo]

Agreed 100%, ANH is a diuretic but it is not an EXOGENOUS one but rather an endogenous one and is infact one of the mechanisms the body uses to return homeostasis to the BP that has just risen due to vasocontriction.Craig

Absolutely.

Regards,

Doc