Denisegg's incident and near miss at Jackson Blue

[rongoodman]

There is a similar incident discussed over on Yorkshire Divers today. Lynn, can you think of any mechanism which might cause pulmonary hypertension in a diver? I understand that it plays a role in high altitude pulmonary edema, but the underlying reason for it there is hypoxia.

 

[Jax]

The Pulmonary specialist I am seeing Friday was recommended by DAN. I am sure he will want to get the results of the tests performed on me taken in the hospital before he is willing to even begin to make a diagnosis, but I will report on what he tells me.
The doctor I saw on Monday didn't seem to believe that the series of dives done over the weekend or the elevated thyroid had anything to do with what happened to me on July 4th.

Denise, what was their take on your recent hike in medication?

 

[Bubbletrubble]

There is a similar incident discussed over on Yorkshire Divers today. Lynn, can you think of any mechanism which might cause pulmonary hypertension in a diver? I understand that it plays a role in high altitude pulmonary edema, but the underlying reason for it there is hypoxia.

@rongoodman:
FWIW, hypoxic pulmonary vasoconstriction is a normal physiological process which facilitates proper ventilation-perfusion (V/Q) matching in the lungs -- redirecting blood to alveoli with higher oxygen content. In special circumstances such as high altitude exposure, with all alveoli containing low partial pressures of oxygen, you can see how this physiological mechanism might be a bad thing.

The list of potential causes of pulmonary hypertension in a diver is long. Clinically, the disorder is categorized into primary pulmonary hypertension (idiopathic) and secondary pulmonary hypertension (pulmonary embolism, COPD, CHF, etc.). I mention this because, as divers, we bring all of our medical conditions with us underwater.

A CHEST publication written by Slade et al. does a nice job of discussing pulmonary edema in the context of scuba diving. There is even a paragraph on how acute pulmonary edema in diving contrasts with high altitude pulmonary edema (HAPE).

If you were wondering whether there was some dive-related "thing" that might have caused denisegg's incident, exercise in and of itself may have been a precipitating factor. It's interesting to note that, even under normoxic conditions, exercise in humans can cause measurable permeability edema in the lungs (pulmonary capillary disruption due to mechanical causes). The aforementioned linked study demonstrates that this exercise-induced pulmonary edema is amplified under hypoxic conditions.

 

[wjefferis]

When I first read this thread last week I totally freaked out and ran to the phone to talk to Denise. I am so glad that everyhting worked out and that she is ok. I have done alot of thinking about this incident and have tried to extract some lessons that will help me or my dive buddies in the future. I have to agree with everyones take on the situation to ensure to have emergency O2 available. I have been DAN O2 certified for four or so years, but I never had an O2 bottle for that just in case moment. I think however that I just might buy a 40 cu ft bottle and fill it with some 100% for a just in case. I can always use it later on for my advanced NITROX and DECO procedures class. My cavern instructor made a point to tell me that if at any time to feel you need to turn the dive do so. I think we need to ensure that as a community we ensure that we encourage this type of attitude. When a diver thumbs a dive its time to get the H### outta dodge. The image of Denise pulling herself outta JB is unsettling to me, so I would like to replace that image with this one of Denise at JB taken by GlenFWB:

 

[D_B]

thank you, for your thoughts, and the pic ... that image is much better than the one I had in my mind after descriptions of the incident

 

[bowlofpetunias]

X 2... thanks

 

[Cave Diver]

thank you, for your thoughts, and the pic ... that image is much better than the one I had in my mind after descriptions of the incident

For those of you sharing this sentiment, I'd advise you not to click the spoiler tag.

Spoiler

Just to put things in perspective in the picture above, you can see the mouth of the cavern where Denise crawled to before making her ascent straight up as detailed below.

During the exit I was coughing violently and was purging the reg to try and get more air. Coming out of the cavern zone I was literally crawling on the ground to exit.

I watch my dive buddy swim her butt off from the breakdown to the sandy floor of the mouth of the cave.

<snip>

I didn't know why she stopped swimming and began crawling at the very mouth of the cave. But knowing Denise like I do...it wouldnt surprise me to think she would gain composure at the last minute and do her 3 minute safety stop! (I did not know she had reach complete muscle fatigue and inability to swim or kick at that point.

<snip>

As I got up alongside her and into her mask to make eye contact, she shot to the surface. When Denise did an emergency accent from the floor of the mouth of the cave (17 feet straight up) I watched her purge and I kept my fingers crossed thinking to myself "I hope she is exhaling as well as purching...but dang it looks like she did that textbook".

 

[D_B]

Not so bad
... that vivid mental image I already have ... I can feel it even though I have never been there.

Very thankful that the posts describing it are from Denise herself and also mos11b1p

 

[denisegg]

I promised to follow up. I spent all last night at a sleep apnea clinic hooked from head to toe with wires to access my brain, heart and lungs while I slept. I spent today at the 2nd Pulmornary's office referred by Dan with lung xrays, breathing in a chamber and walking exercises/tests to only reveal no problems with my heart or lungs and yet another blank stare. The second pulmonary specialist had never heard of IPE. He promised me he would research it and to follow up with him in two weeks.

 

[denisegg]

His prognosis...please don't dive anymore, especially in a cave, until we can figure out what happened to you...