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Denisegg's incident and near miss at Jackson Blue
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OP
Again I want to thank everyone for their well wishes. The information that is being provided is awesome and I appreciate all of the input.
OP
Pulmonary oedema and haemoptysis induced by strenuous swimming -- Weiler-Ravell et al. 311 (7001): 361 -- BMJ
While reading this article, two things come to mind. We talked a bit jokingly earlier about the she-p but one of the selling points of it was the ability to remain better hydrated during diving. This was my first weekend using it and I did drink alot more water than usual before drysuit diving. Also, it speaks of residual effect. During my dive on Saturday which lasted approx one hour I was exerting more than usual because my dump valve got pinched (typical setup for sidemount rig with inflator hose being rerouted to bottom exhaust valve and the top exhaust valve being fitted with a pull cord going down left shoulder to vent air from wing by pulling the cord)(although this is a good design for sidemount, it has been known to become pinched and not allow you to dump air efficiently. We made a modification on Saturday afternoon after this dive to prevent this from happening again hopefully) and I couldn't dump air from my wing so I was struggling with buoyancy.
From the article:
Water overload, the result of well intentioned but overzealous concern about dehydration, probably further increased pulmonary vascular pressure.
Haemoptysis and pulmonary oedema recurred in two of the patients without an increased fluid intake; recurrences gradually became less severe, gradually proceeding to complete spontaneous resolution. They may have been the result of residual damage to the alveolar-capillary unit, which finally healed
I am not sure at all if this had anything to do with it. The elevated thyroid level also effects your body's metabolism and would seemingly cause the effect of exertion on your body to be more profound? I know according to lab tests done 6 weeks ago that my thyroid level was lower than normal and that tests done in the hospital showed it was higher than normal. Sometime during that six weeks it went from lower than normal to higher than normal so that would be the first time I went diving with an elevated thyroid level.
Is it possible for all these negatives to align perfectly at one time to cause a very rare condition to occur?
While reading this article, two things come to mind. We talked a bit jokingly earlier about the she-p but one of the selling points of it was the ability to remain better hydrated during diving. This was my first weekend using it and I did drink alot more water than usual before drysuit diving. Also, it speaks of residual effect. During my dive on Saturday which lasted approx one hour I was exerting more than usual because my dump valve got pinched (typical setup for sidemount rig with inflator hose being rerouted to bottom exhaust valve and the top exhaust valve being fitted with a pull cord going down left shoulder to vent air from wing by pulling the cord)(although this is a good design for sidemount, it has been known to become pinched and not allow you to dump air efficiently. We made a modification on Saturday afternoon after this dive to prevent this from happening again hopefully) and I couldn't dump air from my wing so I was struggling with buoyancy.
From the article:
Water overload, the result of well intentioned but overzealous concern about dehydration, probably further increased pulmonary vascular pressure.
Haemoptysis and pulmonary oedema recurred in two of the patients without an increased fluid intake; recurrences gradually became less severe, gradually proceeding to complete spontaneous resolution. They may have been the result of residual damage to the alveolar-capillary unit, which finally healed
I am not sure at all if this had anything to do with it. The elevated thyroid level also effects your body's metabolism and would seemingly cause the effect of exertion on your body to be more profound? I know according to lab tests done 6 weeks ago that my thyroid level was lower than normal and that tests done in the hospital showed it was higher than normal. Sometime during that six weeks it went from lower than normal to higher than normal so that would be the first time I went diving with an elevated thyroid level.
Is it possible for all these negatives to align perfectly at one time to cause a very rare condition to occur?
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I checked DAN's systems before I bought mine but none were quite what I wanted. I also tried through my employer who sells medical equipment
and sell to me at price plus 10%
Last time I used it when the first ambulance crew turned up the obviously new paramedic didn't recognize the function of the system and kept asking if I had it set at 15 flow rate. This system delivers 100% 02 on inspiration or when the button on the head is pressed if you are assisting vents or resuscitating. That is how I can get away with the smaller tanks and still deliver the 100% required by diver emergencies. This delivery head system makes the system fairly expensive and the standards in Australia require that it must have the bleed back or safety release system so you don't over inflate lungs.
The problem we have in OZ is that most suppliers will tell you it is illegal to own your won O2 cylinders here. It isn't illegal but most places will refuse to fill cylinders they don't own and rent you. So if there are any Aussies reading this.. you need to make sure that if you purchase cylinders you have a way of getting them filled. I can't even get mine filled through my employer... I can get them filled by the company I bought the system from.
I think some of the concern here relates to heat and possible heat expansion damage. The Gas companies tell me they are concerned about liability issues if their staff are injured doing the fills.....I have a lot of staff from the companies who fill the cylinders come through my classes and I have discussed this topic with them in some length.
When it comes to the costs of First Aid supplies, O2 and other medical equipment I just don't worry about price that much. I figure we put out so much for dive gear without thinking twice... why would you not do the same for the equipment that will save your life or that of a loved one. I know people that wear jewelery worth more than these systems
. I guess it is all in perspective. I don't drink, smoke, go for fancy clothes or jewelry so buying this stuff doesn't seem unreasonable to me or to fish even if he does like to tease me a bit about puttling a light bar on the roof of the car when we go diving:blinking:Very interesting information Denise! I won't comment at this point tho because my opinion/interpretation is not based on the level of qualifications that TSandM and a few others here have. VERY valuable information exchange in this thread.. thanks to everyone.
I hope things are progressing well for you Denise!:blinking:
I guess I would like to finish with this comment. Please.. get the best O2 delivery system you can manage and the appropriate training to use it. Cut costs somewhere else.. go for one less dive trip/holiday.. whatever but don't stint on spending money on the thing that could mean saving a life, the quality of a life or the end of the ability to dive EVER!
Last edited:
ohmdiver
Contributor
Thoughts and well wishes...
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Denise, you will most likely never know the exact combination of events that caused the episode. Probably drive you half crazy, but it looks like this is the way it is. Where to go from here? You can either stop diving (highly unlikely) or use vigilance, educated buddies, and O2. I am not a doctor and I wouldn't have the least problem getting the AMA to verify this. That being said, everything that I read ends with administed O2. You had an issue the day before. [-]If[/-] When anything happens again, get on O2. Take advanced nitrox and buy your very own 40 cuft sling. Hose length? -with the bottle on the passenger seat you should be able to comfortably turn heads all the way home. 
BTDT.
stay well,
lowviz
BTDT.stay well,
lowviz
OP
LOL..Lowviz, sounds like the prognosis I am sure to hear from every medical doctor I have seen and will see.
I already had plans to take advanced nitrox this summer and have already bought the AL40 filled with 100% and a brand new reg. I left it at home until I had my training.
I already had plans to take advanced nitrox this summer and have already bought the AL40 filled with 100% and a brand new reg. I left it at home until I had my training.
mos11b1p
Registered
Dave Selmo, Densie's dive buddy who was by her side. Thought I would share just a couple thoughts I had after reading the whole thread. I'm an "Old school EMT" trained from 1986. I watch my dive buddy swim her butt off from the breakdown to the sandy floor of the mouth of the cave. I knew I was dealing with a "panicked diver" but one at least fully in control of her faculties and heading in the right direction. So I kept up right on her heals, never guessing that a life threating medical condition was unfolding. 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. I only knew to get up in her mask, establish eyecontact and reassure her that she's gonna be ok...we "made it.")
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".
I did a "quick controlled accent" and met her on the surface about 15 seconds later. We physically swam to the ledge together (i had a hand on her and was verbally reassuring her at that point. I truly believed the "emergency is over now...we are on the surface.") But when we got to waist deep water and I pulled her hood off in the opening moments of the situation...I was absolutely shocked. When I say "blue as a smurf" I am not lieing. (Add to it aspiration all over her mouth region..it was frightfully awakening.) What is the FIRST thing they teach you in Rescue course? "shout Somebody dial 911!" Well when we all saw her face...nobody needed to be told...somebody did so immediately and announced it to the group.
In my mind I had NO IDEA that she was within minutes of death due to the almost COMPLETE failure of gas exchange going on her in lungs (I.e. acidonic levels tell them this from buildup of CO2 in her tissue due to the failure of gas exchange...she was within a coin toss of living...or crashing and dieing at that moment.) Rather I actually thought to myself "The damn neck seal on her drysuit is CHOKING HER!" She looked like a choking victem! My very first response was to leap forward and get my fingers under her seal and pull it entire away from her neck "so she can breath."
As she indicates, she remained alert enough to communicate with me for a couple of minutes or so as I was getting her out of her gear. But about the time her tanks and nomad were off her (all mine was still on) was the moment that she began to loose consciousness. (She doesnt recall this...her eyes rolled back and she began to waver and I said to myself "oh crap...she's about to drop in my arms and this is not good.") That is when I realized it was time to get bystanders involved (just like your PADI Rescue Diver training teaches you.)
I shouted up on shore to bystanders and they pulled her from the water at my direction. (You have to TELL them exactly what and how to do it..but they WILL respond... "You..grab her right under the shoulder there...you...grab the the other one... now DRAG her right up...there you go!") Next, we worked as a team to get her drysuit off. I leaned up on shore and unzipped and they pulled...and they pulled...and they pulled! I shouted to them... "You need to PULL HARD! Dont be shy..pull on that damn thing!" and they responded wonderfully. As I watched the neck seal go up over her nose and mouth and I watched her WHOLE BODY jerk in reaction. (if I was a drysuit owner, I'd have anticipated this! But Im not...and it caught me off guard.) I leaned forward over her body (lifting the weight of all four tanks still attached to me to do so) and got my right hand under the seal by her chin and pulled up (but i think her hand beat me to it as well...but babygirl..i was right there on that neck seal with you!)
Somebody asked later "why didn't you just cut her out of her drysuit?" Answer...Even if we DID carry that kind of implimentation in cave diving (which we dont) you don't "extricate" a conscious dive buddy from her $1600.00 suit without risk of being killed yourself later when she is able! And Denise remained conscious to give request and direction...right down to "Dave...my pee valve...ya gotta disconnect it..." (Im just glad she has the latest and greatest "quick release" cause I would have been in a world of hurt if it was the old style
After getting her completely out of all her gear...minutes into the topside response...her color was NOT getting much better...and I realized something was still very wrong. I had no idea what...but that color should have been flushing back in and it was not. That is when I scanned the entire JB park looking for an O2 bottle. We ALWAYS put a 100% 02 bottle down by the water's edge...ALWAYS...just as a response tool. But everybody in the cave family had gone on a "big dive" shortly before we left for our dive. My 02 was being used by somebody else and so was everybody elses. All the O2 bottles were down at the mouth of the cave and there wasn't a damn bottle lying around that whole park. (All i could think to myself in that moment was "all these tec divers comin and goin on the fourth of July...and the moment Denise and I are up here in trouble...there isnt a single diver to be seen nor a bottle of O2 anywhere! are you kidding me??!!")
I had a 40% "travel mix" bottle in the truck and realized it was all that was available. Figuring there is no way to direct the bystanders for THIS, I tried to get out of my gear (two LP112'S and two AL80 stage bottles) by "dumping" it at the waist and shoulder straps. Bad idea. I turtled and couldn't get out. Bystanders said "can we help?" I said Yes..jump in the water and grab these shoulder straps and lift! they did and I slid right out. (New skill to practice? maybe?!) I got out of the water and sprinted up the hill to the truck, grabbed the bottle, sprinted back, put my stage reg on it...and leaned over Denise and said "Baby girl, I got fourty mix here...can you take a reg in your mouth and breath from this?" She noded yes and took it and began breathing. Within 5 minutes of that, the ambulance arrived.
We always have O2 on hand and no, we dont carry non-rebreather type demand valve medical supplies. That's like asking roofers if they carry "backboards and C collers" in their truck for spine immobiliztion when one of them slips off the roof! NOBODY does. But we ALWAYS have 100% 02 around for this diving. (I take it with me on open water dive boats too) It was just "horse**** bad luck" (as my father would say) that not a dang bottle was topside. Somebody asked later "Why didn't you swim down back into the cave and grab one?" Well... the immediate and honest answer is...it never occured to me! The "hindsight" answer, however, is 1: removing somebody's O2 from a technical dive location in the State of FL is a felony. and 2: I really don't know how practical attempting such with all my gear on would have been, knowing I had 40% top side. Denise was conscious, out of her gear and did not appear to be worsening in those minutes. In my mind, at that moment, getting the 40 mix just seemed like the "right thing to do."
I truly believe the following: That had she been another 100 feet in the cave...had she been another five minutes bottom time...had she lost consciousness at the mouth of the cave before attempting an emergency accent...she would NOT be with us today. In "Rescue Diving" there is a "tiny window" where "doing everything RIGHT"...actually matters because the truth is..in the vast majority of scenario's.... the endangered diver either would have made it anyway...or they WEREN'T gonna make it no matter WHAT you do. That is just the reality of it all. In my heart of hearts... I believe God gave Denise that little warning saying.. "Not your time today, babygirl...you need to turn NOW." She listened and HAULED _SS out of that cave. (Nobody was gonna help her move faster...only keep up with her...which is what I did.)
Top side, there is no way to know the answer to the question "At what moment did gas exchange in her lungs cease to continue it's downward spiral towards death and stablize, and then slowly begin life sustaining exchange?" The ER doctor told Keven and me "she was within 1-3 minutes of complete failure and certain death. The PH level in her lung tissues tell us this." If that's true...then all i can say is... Denise is one of those "one in a million scenarios" where everything went "right" and she get's to retell the story. And THAT only happens because God's just not done with her yet. And amen to that, sister, neither are we.
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".
I did a "quick controlled accent" and met her on the surface about 15 seconds later. We physically swam to the ledge together (i had a hand on her and was verbally reassuring her at that point. I truly believed the "emergency is over now...we are on the surface.") But when we got to waist deep water and I pulled her hood off in the opening moments of the situation...I was absolutely shocked. When I say "blue as a smurf" I am not lieing. (Add to it aspiration all over her mouth region..it was frightfully awakening.) What is the FIRST thing they teach you in Rescue course? "shout Somebody dial 911!" Well when we all saw her face...nobody needed to be told...somebody did so immediately and announced it to the group.
In my mind I had NO IDEA that she was within minutes of death due to the almost COMPLETE failure of gas exchange going on her in lungs (I.e. acidonic levels tell them this from buildup of CO2 in her tissue due to the failure of gas exchange...she was within a coin toss of living...or crashing and dieing at that moment.) Rather I actually thought to myself "The damn neck seal on her drysuit is CHOKING HER!" She looked like a choking victem! My very first response was to leap forward and get my fingers under her seal and pull it entire away from her neck "so she can breath."
As she indicates, she remained alert enough to communicate with me for a couple of minutes or so as I was getting her out of her gear. But about the time her tanks and nomad were off her (all mine was still on) was the moment that she began to loose consciousness. (She doesnt recall this...her eyes rolled back and she began to waver and I said to myself "oh crap...she's about to drop in my arms and this is not good.") That is when I realized it was time to get bystanders involved (just like your PADI Rescue Diver training teaches you.)
I shouted up on shore to bystanders and they pulled her from the water at my direction. (You have to TELL them exactly what and how to do it..but they WILL respond... "You..grab her right under the shoulder there...you...grab the the other one... now DRAG her right up...there you go!") Next, we worked as a team to get her drysuit off. I leaned up on shore and unzipped and they pulled...and they pulled...and they pulled! I shouted to them... "You need to PULL HARD! Dont be shy..pull on that damn thing!" and they responded wonderfully. As I watched the neck seal go up over her nose and mouth and I watched her WHOLE BODY jerk in reaction. (if I was a drysuit owner, I'd have anticipated this! But Im not...and it caught me off guard.) I leaned forward over her body (lifting the weight of all four tanks still attached to me to do so) and got my right hand under the seal by her chin and pulled up (but i think her hand beat me to it as well...but babygirl..i was right there on that neck seal with you!)
Somebody asked later "why didn't you just cut her out of her drysuit?" Answer...Even if we DID carry that kind of implimentation in cave diving (which we dont) you don't "extricate" a conscious dive buddy from her $1600.00 suit without risk of being killed yourself later when she is able! And Denise remained conscious to give request and direction...right down to "Dave...my pee valve...ya gotta disconnect it..." (Im just glad she has the latest and greatest "quick release" cause I would have been in a world of hurt if it was the old style
After getting her completely out of all her gear...minutes into the topside response...her color was NOT getting much better...and I realized something was still very wrong. I had no idea what...but that color should have been flushing back in and it was not. That is when I scanned the entire JB park looking for an O2 bottle. We ALWAYS put a 100% 02 bottle down by the water's edge...ALWAYS...just as a response tool. But everybody in the cave family had gone on a "big dive" shortly before we left for our dive. My 02 was being used by somebody else and so was everybody elses. All the O2 bottles were down at the mouth of the cave and there wasn't a damn bottle lying around that whole park. (All i could think to myself in that moment was "all these tec divers comin and goin on the fourth of July...and the moment Denise and I are up here in trouble...there isnt a single diver to be seen nor a bottle of O2 anywhere! are you kidding me??!!")
I had a 40% "travel mix" bottle in the truck and realized it was all that was available. Figuring there is no way to direct the bystanders for THIS, I tried to get out of my gear (two LP112'S and two AL80 stage bottles) by "dumping" it at the waist and shoulder straps. Bad idea. I turtled and couldn't get out. Bystanders said "can we help?" I said Yes..jump in the water and grab these shoulder straps and lift! they did and I slid right out. (New skill to practice? maybe?!) I got out of the water and sprinted up the hill to the truck, grabbed the bottle, sprinted back, put my stage reg on it...and leaned over Denise and said "Baby girl, I got fourty mix here...can you take a reg in your mouth and breath from this?" She noded yes and took it and began breathing. Within 5 minutes of that, the ambulance arrived.
We always have O2 on hand and no, we dont carry non-rebreather type demand valve medical supplies. That's like asking roofers if they carry "backboards and C collers" in their truck for spine immobiliztion when one of them slips off the roof! NOBODY does. But we ALWAYS have 100% 02 around for this diving. (I take it with me on open water dive boats too) It was just "horse**** bad luck" (as my father would say) that not a dang bottle was topside. Somebody asked later "Why didn't you swim down back into the cave and grab one?" Well... the immediate and honest answer is...it never occured to me! The "hindsight" answer, however, is 1: removing somebody's O2 from a technical dive location in the State of FL is a felony. and 2: I really don't know how practical attempting such with all my gear on would have been, knowing I had 40% top side. Denise was conscious, out of her gear and did not appear to be worsening in those minutes. In my mind, at that moment, getting the 40 mix just seemed like the "right thing to do."
I truly believe the following: That had she been another 100 feet in the cave...had she been another five minutes bottom time...had she lost consciousness at the mouth of the cave before attempting an emergency accent...she would NOT be with us today. In "Rescue Diving" there is a "tiny window" where "doing everything RIGHT"...actually matters because the truth is..in the vast majority of scenario's.... the endangered diver either would have made it anyway...or they WEREN'T gonna make it no matter WHAT you do. That is just the reality of it all. In my heart of hearts... I believe God gave Denise that little warning saying.. "Not your time today, babygirl...you need to turn NOW." She listened and HAULED _SS out of that cave. (Nobody was gonna help her move faster...only keep up with her...which is what I did.)
Top side, there is no way to know the answer to the question "At what moment did gas exchange in her lungs cease to continue it's downward spiral towards death and stablize, and then slowly begin life sustaining exchange?" The ER doctor told Keven and me "she was within 1-3 minutes of complete failure and certain death. The PH level in her lung tissues tell us this." If that's true...then all i can say is... Denise is one of those "one in a million scenarios" where everything went "right" and she get's to retell the story. And THAT only happens because God's just not done with her yet.
And amen to that, sister, neither are we.
mos11b1p
Registered
one small note... when I said "panicked diver" i meant that is what i THOUGHT was happening at the time...but because she was going in the right direction i thought it best to to just let her keep haulin down the gold line on her own power... the TRUTH is there was NOTHING PANICKED about her...she was in complete controll and swimming for her life..make decisions that ultimately SAVED her life. I didn't mean to sound like I was slammin ya, girl!
Top side, there is no way to know the answer to the question "At what moment did gas exchange in her lungs cease to continue it's downward spiral towards death and stablize, and then slowly begin life sustaining exchange?" The ER doctor told Keven and me "she was within 1-3 minutes of complete failure and certain death. The PH level in her lung tissues tell us this." If that's true...then all i can say is... Denise is one of those "one in a million scenarios" where everything went "right" and she get's to retell the story. And THAT only happens because God's just not done with her yet.
Amen Dave!
I'm sure glad that this is a story that both people got to tell their sides of! A lot can be learned from this and I hope everyone takes notice.
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