Incident on the Spiegel

[openmindOW]

I met with my gp yesterday, who admittedly does not know much about diving, but talking with him, I mentioned DAN, and he is going to try and get me in with a neurologist specializing in dive medicine.

That's good, Tommy. I am glad that you are doing better.

Thank you very much for your post. By posting here, you are helping others to learn and to make diving just a bit safer. Thanks.

Godspeed. Please let us know what is concluded. Hang in there.

 

[DandyDon]

I've not dived the SG in a few years, only once since the hurricane turned it upright, but it didn't seem like a big challenge - no. Better to do it with an Instructor in an AOW class I think than just as a diver with a few dozen dives logged like I was I think - or maybe it was with my AOW card that I got from diving a boring NM spring I'd been diving before, when I learned nothing? I do appreciate that Tommy did not feel comfortable, not belittling his feelings at all, but it's really a nice wreck dive - if you can find your own ascent line to your boat at the end.

I certainly might have a view more like Tommy's if I'd gone thru what he went thru tho. Thank goodness it happened in Key Largo waters and not Roatan or the Exumas. I did a 100 ft dive on my Resort course in the Lessor Antilles before I was certified, knew better, was insured by DAN or anything. Who knows what could have happened it I'd taken a hard hit then. :shocked2:

The neurologist in Key Largo recommended the PFO test, as well as a second MRI when I got home. I met with my gp yesterday, who admittedly does not know much about diving, but talking with him, I mentioned DAN, and he is going to try and get me in with a neurologist specializing in dive medicine. As it is referred by him, hopefully it will still be in network, and if not, I do have DAN insurance along with my normal insurance.

Great. Getting that from the Attending Specialist is a much better reference. The DAN article I linked above it still good background reading, but this puts the idea in all new light. Like others here, I hope you will update us as you learn more. Posting on this thread will bring it back to the top of our UserCPs and we'll see it.

So, if you were a new diver, and on your first deep dive, got a rather serious and dangerous hit, would you:

a. Lets just try this again, and see what happens, or
b. See if there is a known medical cause for this.

B of course. I've certainly agreed with that feeling from my first post, hence my linking to DAN contact numbers and my suggestion that he work with those physicians. If he prefers to work thru his local doctors instead, okee dokee - but I've been all for pursuing professional advice from the Get-go here.

 

[Thalassamania]

I'd vote for a echo cardiogram too.

 

[vshearer]

This week has really sucked. Thanks Tommy, just for sharing something that turned out good. Be careful, but as always, sh*t happens.

 

[TSandM]

Tommy, I'm very glad things have come out well for you, and thank you so much for posting your story. We rarely have good first-hand information on incidents like this!

The people who have evaluated you have the advantage of a great deal more information than we have. We don't know your age, your general health history, or even your gender (although I'm presuming you're male). We don't know your family history, or whether there are any other things in your history that would raise your risk of seizures. Given the scant information we do have, I think AGE has to be very high in the differential diagnosis -- the time of onset during the dive, on ascent, would not be atypical, and the severity would go along with that diagnosis. But if you are in your 60's, or have high blood pressure, this could be other things (like TIA). I think making a diagnosis in a strange case like this over the internet is fraught with hazard.

That said, if the neurologist also concurs that this was likely AGE, then the big question is why it happened. The profile isn't overly aggressive, but we don't have the ascent profile, just the safety stop information. There was apparently enough current to have to hang onto the acent line; was there enough to cause Valsava maneuvers from exertion?

Testing for a PFO certainly sounds reasonable, but if one is found, you have a difficult decision to make. As the correlation between PFO and DCS is far from perfect, you may elect to stop diving when it isn't required. On the other hand, if you do have a PFO and elect to have it closed, you don't know that this will absolutely prevent another event. It's a good idea to think over what you would want to do, or can do, if you have the test, because you will have to make decisions once it is done.

 

[elmer fudd]

Tommy, I'm very glad things have come out well for you, and thank you so much for posting your story. We rarely have good first-hand information on incidents like this!

The people who have evaluated you have the advantage of a great deal more information than we have. We don't know your age, your general health history, or even your gender (although I'm presuming you're male). We don't know your family history, or whether there are any other things in your history that would raise your risk of seizures. Given the scant information we do have, I think AGE has to be very high in the differential diagnosis -- the time of onset during the dive, on ascent, would not be atypical, and the severity would go along with that diagnosis. But if you are in your 60's, or have high blood pressure, this could be other things (like TIA). I think making a diagnosis in a strange case like this over the internet is fraught with hazard.

That said, if the neurologist also concurs that this was likely AGE, then the big question is why it happened. The profile isn't overly aggressive, but we don't have the ascent profile, just the safety stop information. There was apparently enough current to have to hang onto the acent line; was there enough to cause Valsava maneuvers from exertion?

Testing for a PFO certainly sounds reasonable, but if one is found, you have a difficult decision to make. As the correlation between PFO and DCS is far from perfect, you may elect to stop diving when it isn't required. On the other hand, if you do have a PFO and elect to have it closed, you don't know that this will absolutely prevent another event. It's a good idea to think over what you would want to do, or can do, if you have the test, because you will have to make decisions once it is done.

Being that you're both a diver and a doctor, I have a question for you. My understanding is that paralysis is a rather severe symptom of DCS. I've heard of minor cases of the bends involving skin rash and joint pain that people just walked away from, but never paralysis. Generally it seems that when people take hits like that they are seriously bent and in for a long and painful recovery or death. I've also never heard of it coming on like that. Usually I've heard of of divers coming to the surface and then losing their mobility shortly thereafter. In this case though, he was partially paralyzed on his safety stop, passed out upon surfacing and then appeared fine afterward.

Have you heard of anything like this before?

And for the OP, take everything I've said with a grain of salt. I'm interested in this from a dive safety standpoint and that's why I'm speculating. Your doctors are the ones with the info and the expertise and I wouldn't begin to second guess them.

 

[ianr33]

Tommy, how big were the swells on the safety stop? Any chance this was caused by a lung overexpansion injury/embolism due to holding your breath while the depth was changing with rough seas ?

Something similar may have happened to Denton Byers.
The Deco Stop

EDIT: How likely/common is it to get DCS symptoms at 15 feet after a 90 foot NDL dive. That seems very odd to me.

 

[deepair]

GREAT Post!

 

[Puffer Fish]

In principle, it should never happen. Over the years, there have been people that fall way outside the normal curve with regard to DCS.

I've known a few, heard stories of maybe a dozen over the years.

There have been two theories I've been told:

1. There is just something about that person's circulation system that causes bubbles to form.

2. They have some sort of an air leak, that when exposed to the pressure change, leaks air into the closed system with rather tragic effects.

Given the 15ft onset of symptoms, the second is the most likely issue.

As a PFO "could" be the cause...but lots of people have PFO's with no issues (this is the "it's not the PFO, but the location and size" issue). It could be several other things.

All of the people that I have known personally, only one ever found a cause and that was way too late.

One continued diving, but never went deep (over 45 ft).. the rest stopped diving.

It would be nice to actually know the cause, but finding it might be fatal to the test subject, and would cost a lot of money to ID...so for now we just guess and assume we know all the answers.

Tommy, how big were the swells on the safety stop? Any chance this was caused by a lung overexpansion injury/embolism due to holding your breath while the depth was changing with rough seas ?

Something similar may have happened to Denton Byers.
The Deco Stop

EDIT: How likely/common is it to get DCS symptoms at 15 feet after a 90 foot NDL dive. That seems very odd to me.

 

[The Chairman]

Tommy, how big were the swells on the safety stop?

It was pretty flat that day..Everyone on the boat kept commenting on how gorgeous it was.