Nausea on First Dive After Long Non-Diving Period

[azathoth]

I seem to have an odd problem, searched but didn't find anything similar. If I don't dive for a couple of weeks, after my dive I get really nauseous. So far if I'm on a boat it's after the second dive and the fish get a meal. On shore dives it's usually after the first dive, I don't feed the fish but feel bad enough to thumb a second dive. Seems to be about 2-3 weeks to start feeling it. Yesterday had been a month, felt OK after first dive but we had to surface after a couple minutes on the second dive and as soon as I surfaced I was done. Fish didn't get a tip, but I was in no shape to go back down. The really odd thing is it is only the first day, after that I'm fine. Went to Jamaica last month, first day, second dive fed the fish, fine the rest of the week.
I'm 43 and not in shape. Shore dives are in the Puget Sound wet, lots of weight and some fairly long walks in gear. Boat dives are all tropical, no wetsuit. I generally don't get motionsickness, although I have gotten a little under just the right circumstances. Conditions that make normal people hurl don't bother me in the least.
Any body else experience this?

 

[cutlass]

Yes, odd. However, there seems to be a correlation to exertion (including boat v.s. shore) and so the first concern is for a cardiovascular cause*. Thus, it seems appropriate to start with a complete physical exam including stress/treadmill and lung function tests. This probably should be done at least 3 weeks after diving or equivalent activity when it's likely for the symptoms to appear.

*A CV cause typically appears during workload and abates post-activity. This case seems to have a delay where the symptoms appear post-activity and resolves long after; reportedly next day and persisting as long as the activity is regular. Then cessation of activity apparently begins a 2-3 week interval of some kind of decompensation which resets the cycle. Release from psychologic first-dive stress might fit the pattern. Sudden forceful vomiting would raise some important digestive tract or central neurologic questions. More zebras may be in parasympathetic, immune, or endocrine factors.