OP
DCS after two shallow dives - struggling with anxiety and worried
- Thread starter MarcusMansson
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- dcs dcs recovery dcs risk pfo
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OP
MarcusMansson
Registered
There were some leakage issues with some of the bottles before the dive.
First, I am not a doctor and I'm not qualified to give out medical advice but getting a PFO test is going to be absolutely essential here. There is noted higher prevalence of PFOs in people that experience migraines with an aura so you definitely want to get checked. It doesnt mean you have one but until you have more information and have spoken with a cardiologist it's hard to really say. You need to figure this part out first.
I'm going to go against the grain here and tell you Divers Alert Network (DAN) is often going to be completely useless in this situation (my own personal experience). They're just going to regurgitate facts to you and then refer you to a hospital / emergency room if you're experiencing current DCS symptoms. I'm not saying don't call them but you should try to find a cardiologist who understands diving, maybe they can help you with that.
The statistics say that approximately 1 out of 4 people have a PFO but they never realize it because they don't experience any symptoms. You may not even have one at all and this discussion is all a moot point.
Without knowing your actual dive profiles, gases (nitrox/air), ascent rate/safety stop, gradient factors/conservation factors it is also hard to make a recommendation.
I dealt with this a little bit after my wife had a couple DCS incidents so I can understand your questions and hesitation. Part of it came down to the fact that my gradient factors (conservative factor) I use are far too aggressive for her. Ultimately it comes down to some people are more sensitive to this than others but there are of course many factors.
If you do continue diving and are found not to have a PFO, some very basic recommendations I can give are to dive a lot more conservatively. For example: Dive nitrox as opposed to air, limit yourself to one dive a day or skip the afternoon dive or even taking a day off between dives, stay well hydrated.
Lastly, slow your ascent and pad your "safety stop" extending them to 5+ minutes. I would give this advice to anyone. This is the really important bit. Do not simply rocket / rush to the surface from 20f/6m. Do at least a ~5 minute safety stop and then take a few extra minutes to surface from this depth.
It also sounds like you were using the dive shop's computer. You may want to invest in your own computer so you can keep track / download your dive profiles. Many computers allow you to set a conservatism factor and pad your safety stops.
I'm going to go against the grain here and tell you Divers Alert Network (DAN) is often going to be completely useless in this situation (my own personal experience). They're just going to regurgitate facts to you and then refer you to a hospital / emergency room if you're experiencing current DCS symptoms. I'm not saying don't call them but you should try to find a cardiologist who understands diving, maybe they can help you with that.
The statistics say that approximately 1 out of 4 people have a PFO but they never realize it because they don't experience any symptoms. You may not even have one at all and this discussion is all a moot point.
Without knowing your actual dive profiles, gases (nitrox/air), ascent rate/safety stop, gradient factors/conservation factors it is also hard to make a recommendation.
I dealt with this a little bit after my wife had a couple DCS incidents so I can understand your questions and hesitation. Part of it came down to the fact that my gradient factors (conservative factor) I use are far too aggressive for her. Ultimately it comes down to some people are more sensitive to this than others but there are of course many factors.
If you do continue diving and are found not to have a PFO, some very basic recommendations I can give are to dive a lot more conservatively. For example: Dive nitrox as opposed to air, limit yourself to one dive a day or skip the afternoon dive or even taking a day off between dives, stay well hydrated.
Lastly, slow your ascent and pad your "safety stop" extending them to 5+ minutes. I would give this advice to anyone. This is the really important bit. Do not simply rocket / rush to the surface from 20f/6m. Do at least a ~5 minute safety stop and then take a few extra minutes to surface from this depth.
It also sounds like you were using the dive shop's computer. You may want to invest in your own computer so you can keep track / download your dive profiles. Many computers allow you to set a conservatism factor and pad your safety stops.
coldwaterglutton
Contributor
Get your pfo screening done, and then use that to inform what is next for you.
indepthmag.com
Everything You wanted To Know About PFOs and Decompression Illness, But Were Too Busy Decompressing to Ask
Though your chances of getting bent are relatively low, your risk increases five to 13-fold in the presence of a patent foramen ovale (PFO), which may enlarge and become problematic with age. Skin bends anyone? Here cardiologist and rebreather instructor Doug Ebersole explains the latest...
indepthmag.com
SteveCapnK
Registered
Hi @MarcusMansson,
I had a similar experience earlier this year, and I'm back in the water.
My case
I experienced mild joint pain DCS after a 12meter, 25 minute dive. This was the final dive of a 6 day liveaboard tour, where I followed all my safety stops, and was careful with my ascent rate. 4 dives per day, all on Nitrox, max 32m depth. I was keeping hydrated and avoided alcohol. The first dive that day was 23m for 59min, with a 3 hour surface interval. I had no prior symptoms.
Returning to the boat I realised I had abnormal joint pain and asked for oxygen, which temporarily relieved the pain. When the pain came back I called DAN and the crew took me to hospital. Thankfully we were in port and it was literally a 5 minute car ride.
Over the next two days I had two chamber treatments.
But your question really is about anxiety.
I'm not usually an anxious person, but I was in a foreign country, due to fly out two days later.
After treatment, speaking to DAN multiple times and being cleared to fly by the doctors, I still spent the next few days second guessing every twitch and feeling in my body. It became a vicious circle of worry, creating headaches and bad sleep which I worried were more DCS symptoms! They weren't, I was just stuck in my own head.
In the end I went to the hotel pool and forced myself to focus on the moment, the sensations of the water, and the world around me.
Since arriving home I got a full dive medical from a doctor who had seen DCS patients (not just a suburban doctor who can give basic dive medicals). I also saw a cardiologist and had myself checked for a PFO. No PFO in my case, I was cleared to dive by my cardiologist and the dive physician. Hooray!
In the end, my DCS was put down to cumulative nitrogen loading after doing 4 dives per day for 5 days. I can live with that explanation.
For my first dive back in the water I arranged a dive with a buddy I trusted, who knew about my incident. It was a nice easy dive, and in the first few minutes I again forced myself to focus on being in the moment. Enjoy the sensations and sealife, don't get stuck in your head.
Now I just dive a little more conservatively, slower ascents, less dives per day, and I've adjusted my computer to a more conservative setting. Over the past few months I've slowly been increasing my max depth, and ticked off my Rescue level cert.
Your case
Firstly, I'm not a doctor. I think @macado's post is spot on. Given what you describe, a PFO would not be surprising to me. Nor does it mean you have to give up diving if you get the PFO closed.
But once you fix your body you will probably want to address the anxiety.
Are you a member of a local club at home?
I do most of my diving at home, and it's very useful to have consistent buddies. This was important when I got back in the water first time.
Discussing the situation with mental health professional may give you some techniques for addressing the anxiety. You could also look into FIT TO DIVE Home Page
I found that diving was a great motivation to keep fit, and that helped the mental state. Keep fit to dive, don't dive to keep fit.
I would also second the recommendation to have your own computer and digital log. Better control over your conservatism, better tracking of your gas consumption, more information to help improve your diving.
Hope that helps, cause you're definitely not alone.
I had a similar experience earlier this year, and I'm back in the water.
My case
I experienced mild joint pain DCS after a 12meter, 25 minute dive. This was the final dive of a 6 day liveaboard tour, where I followed all my safety stops, and was careful with my ascent rate. 4 dives per day, all on Nitrox, max 32m depth. I was keeping hydrated and avoided alcohol. The first dive that day was 23m for 59min, with a 3 hour surface interval. I had no prior symptoms.
Returning to the boat I realised I had abnormal joint pain and asked for oxygen, which temporarily relieved the pain. When the pain came back I called DAN and the crew took me to hospital. Thankfully we were in port and it was literally a 5 minute car ride.
Over the next two days I had two chamber treatments.
But your question really is about anxiety.
I'm not usually an anxious person, but I was in a foreign country, due to fly out two days later.
After treatment, speaking to DAN multiple times and being cleared to fly by the doctors, I still spent the next few days second guessing every twitch and feeling in my body. It became a vicious circle of worry, creating headaches and bad sleep which I worried were more DCS symptoms! They weren't, I was just stuck in my own head.
In the end I went to the hotel pool and forced myself to focus on the moment, the sensations of the water, and the world around me.
Since arriving home I got a full dive medical from a doctor who had seen DCS patients (not just a suburban doctor who can give basic dive medicals). I also saw a cardiologist and had myself checked for a PFO. No PFO in my case, I was cleared to dive by my cardiologist and the dive physician. Hooray!
In the end, my DCS was put down to cumulative nitrogen loading after doing 4 dives per day for 5 days. I can live with that explanation.
For my first dive back in the water I arranged a dive with a buddy I trusted, who knew about my incident. It was a nice easy dive, and in the first few minutes I again forced myself to focus on being in the moment. Enjoy the sensations and sealife, don't get stuck in your head.
Now I just dive a little more conservatively, slower ascents, less dives per day, and I've adjusted my computer to a more conservative setting. Over the past few months I've slowly been increasing my max depth, and ticked off my Rescue level cert.
Your case
Firstly, I'm not a doctor. I think @macado's post is spot on. Given what you describe, a PFO would not be surprising to me. Nor does it mean you have to give up diving if you get the PFO closed.
But once you fix your body you will probably want to address the anxiety.
Are you a member of a local club at home?
I do most of my diving at home, and it's very useful to have consistent buddies. This was important when I got back in the water first time.
Discussing the situation with mental health professional may give you some techniques for addressing the anxiety. You could also look into FIT TO DIVE Home Page
I found that diving was a great motivation to keep fit, and that helped the mental state. Keep fit to dive, don't dive to keep fit.
I would also second the recommendation to have your own computer and digital log. Better control over your conservatism, better tracking of your gas consumption, more information to help improve your diving.
Hope that helps, cause you're definitely not alone.
Disclaimer: No professional, no experience or knowledge to give an advise.
However I would second to get tested for a PFO. As mentioned migrane with aura is some effect of it.
If you do a stronger valsalva maneuver you may open it with higher probability. So you said you had a bit of a cold, and aome sea sickness ofer first dive. That might link to a bad equalization, as motion sickness is also connected to an uneven pressure in both ears. Second with maybe a higher ascend rate and 50min surfsce interval you may still have bubbles and that would be the issue with non proper equalization on the second dive (symptoms started there...).
So if tested yes for a pfo, a dive medical specialised in heart related issues should be consulted. See www.gtuem.org for a list, as you said you are german.
If you continue divong knowing this, Inwould be more conservative. I.e. adjust gradient factors, slowet ascent, extend safety stop to 5-6min. Extend surface interval to 1.5h and maybe breath nitrox. Dive with nitrox. No strong effort like 30 to 45min after a dive, and also watch your pressure/effort when equalizing.
Regarding anxiety: It may be because ofnthe unknown. Speak to specialists to get information, how to behave and how to listen to your body. Speak maybe to a specialist medicial related to anxiety, or if its just slight consider meditation/hypno therapy, in order to rationalize that.
However I would second to get tested for a PFO. As mentioned migrane with aura is some effect of it.
If you do a stronger valsalva maneuver you may open it with higher probability. So you said you had a bit of a cold, and aome sea sickness ofer first dive. That might link to a bad equalization, as motion sickness is also connected to an uneven pressure in both ears. Second with maybe a higher ascend rate and 50min surfsce interval you may still have bubbles and that would be the issue with non proper equalization on the second dive (symptoms started there...).
So if tested yes for a pfo, a dive medical specialised in heart related issues should be consulted. See www.gtuem.org for a list, as you said you are german.
If you continue divong knowing this, Inwould be more conservative. I.e. adjust gradient factors, slowet ascent, extend safety stop to 5-6min. Extend surface interval to 1.5h and maybe breath nitrox. Dive with nitrox. No strong effort like 30 to 45min after a dive, and also watch your pressure/effort when equalizing.
Regarding anxiety: It may be because ofnthe unknown. Speak to specialists to get information, how to behave and how to listen to your body. Speak maybe to a specialist medicial related to anxiety, or if its just slight consider meditation/hypno therapy, in order to rationalize that.
Hi @MarcusMansson ,
You mentioned that you experienced symptoms during and after your second dive. You also mentioned having a slight cold. Did you have difficulty equalizing during either dive? At what point during your second dive did you notice the symptoms? Descent, bottom, ascent?
Best regards,
DDM
[emphasis added]
It's close to physiologically impossible for someone to experience DCS symptoms mid-dive given your stated profile. I strongly suspect that what you experienced was vertigo/inner ear equalization issue or some sort of general discomfort (perhaps related to seasickness) which was magnified by anxiety.
Edit - Looks like DDM is thinking along the same lines. I should have read the second page before posting
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