Denisegg's incident and near miss at Jackson Blue

[denisegg]

@denisegg: Glad to hear that you're doing OK now.

While it's good that this incident has raised awareness regarding IPE and how little the medical community knows about the various factors in divers which can cause such a condition, I think the involvement of a potential hyperthyroid state should not be discounted. denisegg, what were your thyroid hormone levels at the time of most recent testing (post-incident)?

[Warning: the following section contains medical mumbo-jumbo]
When it comes to circulating thyroid hormone levels, it's very much a "Goldilocks' porridge just right" phenomenon -- bad things can happen when thyroid levels are outside normal limits (too low or too high). It's well-documented in the medical literature that thyroid hormone has significant effects on the heart and blood vessels (via molecular mechanisms involving nitric oxide and endothelium-derived hyperpolarizing factor). Interestingly, thyroid hormone administered in animal tests can cause relaxation of peripheral vessels, which would seem to work in an opposite direction on systemic blood pressure (BP), i.e., drive BP down. However, we know that, if anything, hyperthyroid patients have elevated BP. Cardiologists will tell you that hyperthyroid patients have increased preload to the heart and an elevated heart rate, too. The cause of this is complicated and likely related to shifting blood from the arterial to venous compartment of the vascular system, effectively off-loading the arterial system. At the same time, I believe that the BP sensors (juxtoglomerular cells located on the arterial side) of the renin-angiotensin-aldosterone system will "see" a decreased renal perfusion pressure and respond by trying to increase BP -- thus, creating/exacerbating the hypertensive state. (By the way, this is an oversimplification of how the kidneys control blood pressure and doesn't even mention ADH.) All of this leads to an increase in blood volume and an increase in venous return to the heart.

Perhaps before diving was even attempted, blood volume had expanded. This state, combined with systemic hypertension and the central fluid shifts that occur normally during diving, could have driven excessive fluid to the lungs, leading to IPE. Just reasoning out loud here based on my limited knowledge of medical and dive-specific physiology...

denisegg, I hope that you can hook up with a caring, competent endocrinologist soon. Thank you for sharing your story. Best wishes on your recovery.

This would actually be a relief to know that this is what caused it. I would actually have an answer and it can also be preventable in the future with proper monitoring and medication if needed. My cardiologist did not give me specific levels. He just said it was high. I was later seen by the endocrinologist which suggests it was high enough that he felt I should see a specialist about it. I have a follow up visit with this doctor in 6 weeks. He told me not to take the medicine I had been given any longer and he would recheck my levels at that time. He even told me I probably did not need the medicine to begin with. In retrospect, I didn't understand the significance of this and I did not ask alot of questions.
Unfortunately for me, the doctor prescribing the medicine was not a specialist in the field and he was not rechecking me to see if the new dosage was adequate or excessive. I will not be seeing this doctor again.

 

[BabyDuck]

jeez, denise - that sounds super scary. i'm so glad the cave family was out in force for you.

next time could you just dance nekkid on a picnic table when you want some attention??

 

[Cave Diver]

next time could you just dance nekkid on a picnic table when you want some attention??

I'm pretty sure she just saves that for Vortoberfest.

 

[denisegg]

If you are talking nasal prongs CD.. they can't deliver enough O2 and esp since people in respiratory distress tend to be gasping with their mouths and not breathing through their noses at all.

We always have an O2 system on shore that can deliver 100% on demand with the button so we can do positive pressure vents of 100% if needed. I consider it a necessity to carry this to every dive site!

I must admit I prefer A Soft Bag so you can "feel" any resistance and bubbling but it takes too much air flow to deliver 100% (15 lpm with reservoir bag) I just can't fit enough 02 in our vehicle unlike when I was in the Ambulance. Fish gives me a rough time about buying a light bar to put on the car because I also have a AED and significant First aid kit... only used the stuff a few times (diving related) but sure nice to have them!

This is very true. I was not only gasping for breath with my mouth but coughing constantly. A soft bag was put on my face at the hospital and strapped to the back of my head with a tiny release on the side in case you felt like you needed to vomit. I was breathing so hard I was sucking the bag into my face as I inhaled. They increased the pressure of the air coming in. I was not given nasal prongs until many hours later.

I must say however, the stage bottle with a regulator was helpful even with only 40% mix in it. O2 would have been better of course but this can certainly be helpful until an ambulance arrives. If someone has lost consciousness that would be another scenario entirely.

 

[denisegg]

jeez, denise - that sounds super scary. i'm so glad the cave family was out in force for you.

next time could you just dance nekkid on a picnic table when you want some attention??

I'm pretty sure she just saves that for Vortoberfest.

LOL. BabyDuck you can appreciate this little fact. Even under the duress I was in I had enough state of mind to stop them as they were pulling my drysuit off to inform my male dive buddy to release the quick release valve on my she-p. He not being a drysuit wearer had no clue and started trying to unscrew the outside valve. Here I am breathing through the reg on the stage bottle coughing every breath saving "quick release" "quick relase" I can't imagine what part of the system would have "released" first.
I guess this should be added to the familiarize your buddy with your gear list in the future.

 

[Jax]

Glad to see you back, Denise!

 

[denisegg]

Glad to see you back, Denise!

Thank you Jax. I must add the other part of the drysuit disrobing. My dive buddy was practicing with 2 stage bottles so he had 4 bottles attached to him and didn't have the time to take them off as he was getting me out of my gear. When he got my sidemount bottles and rig off we were in about chest deep water beside a block wall. Some men above me pulled me up onto the ground when I was finally released from my gear. Dave told them to get my drysuit off. They did fine until they got to the latex neck seal. They were pulling it off like you would a shirt and it flatly stuck to my mouth and nose. I had to wedge my hand in to uncover my mouth and nose. I'm sitting there thinking damn, I already can't breathe!! So then about three of them pulled and raised me off the ground as they released my head from the latex seal.
You have to find the humor in these things. Dave also told some children to guard our gear as we left for the hospital until our other dive buddies finished their dive. Kevin said those children were gathered around that gear like little soldiers not letting anyone near it. Kevin saw us leaving in the ambulance and he took off with us while Andre managed to get mine, Dave's, Kevin's and his gear to the vehicles.
The lifeguards, the swimmers and the divers were all fantastic as they did everything they could to help me get the help I needed.

 

[Jax]

Thank you Jax. I must add the other part of the drysuit disrobing. My dive buddy was practicing with 2 stage bottles so he had 4 bottles attached to him and didn't have the time to take them off as he was getting me out of my gear. When he got my sidemount bottles and rig off we were in about chest deep water beside a block wall. Some men above me pulled me up onto the ground when I was finally released from my gear. Dave told them to get my drysuit off. They did fine until they got to the latex neck seal. They were pulling it off like you would a shirt and it flatly stuck to my mouth and nose. I had to wedge my hand in to uncover my mouth and nose. I'm sitting there thinking damn, I already can't breathe!! So then about three of them pulled and raised me off the ground as they released my head from the latex seal.
You have to find the humor in these things. Dave also told some children to guard our gear as we left for the hospital until our other dive buddies finished their dive. Kevin said those children were gathered around that gear like little soldiers not letting anyone near it. Kevin saw us leaving in the ambulance and he took off with us while Andre managed to get mine, Dave's, Kevin's and his gear to the vehicles.
The lifeguards, the swimmers and the divers were all fantastic as they did everything they could to help me get the help I needed.

So incredible how people step up to the plate when the chips are down!

Gotta wonder -- how are your seals after all that? :chuckle:

Your nasty experience has led me to complete one thing - I'm going to bring a large "E" bottle of O2 on the dive boat when we're in Mexico -- an emergency last year had the boat run out of O2 shortly before they got to the dock. I'm thinking I want O2 available for the whole hour trip back.

 

[denisegg]

I was very fortunate. I want to thank everyone who has participated in this thread with their care, concern and wisdom. It was a very traumatic event and it continues to be. I am still very weak and I have alot of recovering, tests, doctor visits and treatment ahead of me.
One thing that does comfort me is in sharing this it has helped to make those of you who were like me and had never heard of it aware of it and already plan to take precautions by having 02 on hand.

 

[Cave Diver]

LOL. BabyDuck you can appreciate this little fact. Even under the duress I was in I had enough state of mind to stop them as they were pulling my drysuit off to inform my male dive buddy to release the quick release valve on my she-p. He not being a drysuit wearer had no clue and started trying to unscrew the outside valve. Here I am breathing through the reg on the stage bottle coughing every breath saving "quick release" "quick relase" I can't imagine what part of the system would have "released" first.
I guess this should be added to the familiarize your buddy with your gear list in the future.