Ocular disturbance after decompression diving, that is now my norm even though I’ve had 15yrs of tech diving, interested to hear from Medics.

[Alex Ouroboros]

I’m curious to have thoughts from Dive medics, tech instructors etc with regard my current personal situation after mid depth deco dives (50-80m)
I’m wanting to be completely open about my situation so hopefully I may gain from it but also hoping it helps others,
I shall start with a brief overview of myself and my diving, then we can get stuck in to the diagnosed Bend, my self diagnosed bend, and my up to date situation,
It could go on a bit, but purely so all the facts are laid bare so there are few questions left for myself to fill gaps later, I will try to add a little humour where I definitely shouldn’t (as I’m British) indeed if any diving medic or pro want to use this whole saga as a talking point with students etc I’m more than happy as I’d like to feel it is helping somebody somewhere.

OFF WE GO.

So I’m in the UK now 44, active job, no medical issues, weight is what the Dr,s want to see, easily pass a HSE commercial diver medical and pretty much have dived ccr for 95% of the time since 2009, which is the same year I qualified as (what was at the time) full tec oc, my agencies have been varied with different very highly accomplished tec divers (one being an agencies national director) I was trained pretty damn hard and im thankful for that as I believe train hard fight easy, (all my diving is done in a drysuit with heating etc, now I sometimes use my DPV also) by mid 2010,s I was diving the mid deco depths on ccr (50-85m) I was fortunate enough to live at a dive centre although not be an instructor so plenty of water time although not worn out with it,
Next thing I know I’m full trimix and a year later I’m knocking out the 120m stuff with no problems in fact I did a year when I think my average wreck depth had been 75-80m

BEND 1 (coming up,, not like that)

After a uk dive in 40m of water after no deco issues and i was blessed with a bad one a neurological, it was the full bhuna in and out of the pot on multiple days I can’t remember much but it took me some weeks to recover to the stage of walking with the aid of a stick, after which came the consultations (at the time I was also a casual inshore commercial diver,,, yep that career was a bit of a dead end to a non ex military in the uk anyway,,,) and after PFO tests etc myself and the dive doctor were happy with the verdict of Bent by dehydration (had more beer than I should the night before, and not my normal 2ltr of water on the way out to dive) the deckhand was new so I did dive bitch job too as the poor soul spent half their time hanging over the gunwale,, not their fault, but It was rough and I was way over active pre and post dive..

I’ll also get in here that my normal routine was a maximum of 2 pints of beer with food the evening before and only if it is not an early start, and at least 2ltr of water on the way out with a sachet of rehydration powder put in for good measure, im pee valved up so not fighting any bodily urges in the water,
And that was that, after a few months taking it easy I’m back to the big stuff with no problems,

BEND 2 (imo)

And all is fine up until 18 months ago, I’d done a trip off the bottom of Ireland (geographically) and the second to last day of a week of 90m I’m fine for the 90min steam back to port and get to the bunk house (this was in the harbour so no elevation stuff to catch me out) in fairness I was darting around lugging and helping filling cylinders after a trouble free lovely dive no stress or issues etc I started to feel a bit off, a pain in my right knee, and then hip now I must confess as a pretty active and open minded tec diver it is way to easy to convince yourself you have got a bend when you haven’t and just as easy to convince yourself you haven’t when you have, so I made my excuses went to my room drank loads of water and watched a film lazed out, I skipped evening meal because my appetite wasn’t there and off I went to sleep,
I awoke at about 3am feeling like somebody had somehow starting poking metal rods in the centre of my hip joints (yes both thank you) and knees, the pain would have been delightful if one was depraved and my eyes watered, I also had a pathological urge to be on the cool tiles of the ensuit bathroom floor and so eased out of bed and promptly crashed on to the floor, I dragged myself like ironside with no wheels in to the ensuit and in tears of pain spent the rest of the night there until an hour I dare awake my room mates (I am so considerate) at which point they dragged an O2 cylinder in to bed with me and forced water in to me like a water boarding contest, by lunch time I was 100 times better and 24hrs later I was home, my wife was understandably upset and asked if I needed the pot,,,

I AM MAKING THIS ABSOLUTELY CLEAR. I’M NOT ADVOCATING WHAT I DID! IT GOES AGAINST ALL CURRENTLY ADVISED MEDICAL ADVICE AND IS ONLY INCLUDED TO KEEP EVERYTHING HONEST. (I’m not an instructor so I can’t be exterminated or expelled or whatever they can do by an agency)

But I had other ideas, so within a few days there was myself, wife, walking stick and dive gear at a well known uk inland dive site, and I listened to music on the 6m shelf for the next few hours on the ccr with a couple of capri-sun’s and jelly babies (candy) I emerged and felt completely fixed, my wife’s jaw was on the floor as she couldn’t believe the difference. Pain gone and walking as normal.

THIS YEAR,,,

Mainly trouble free, enjoyed this year around the uk, and really hammered the diving so far, the depths of winter at in land sites and started in Dover in march (one of the first trips out) and all is well until I did a 55m a few months ago, everything fine on the dive and boat, I’m well prepared plenty of hydration going on, unlikely to even have a beer the night before nowadays and running grandad gradient factors 30/70 I pad out the last stop by 10mins on a 2hr runtime, I’m now nobody’s dive bitch on the boat, hell I even consciously monitor my own breathing from time to time on the dive 5 seconds in, a pause 5 out, minimum loop, full suit heating etc etc, but 90 minutes post dive in the car park my vision goes odd, if I shut either eye my vision is fine but open both and I can’t quite focus perfectly, I do a quick neurological test on myself, my dive buddy checks my eyes look right and I’m fine,,, 3-5mins later I’m right again, how strange,
Which brings me to 2 days ago, by now you fully understand my position, I’m a sensible diver, well hydrated, not overweight or unfit, dived up, won’t over exert, can nail every stop depth in full control, I have confidence but not overly, high level of training, experience, temperature control, and I go and do a 55m 2hr runtime dive (30/70) but stick 10 whole minutes on the end slowly ascending from 6-3m and then after the shortest surface swim in history to the dive lift in millpond conditions and spending 12minutes sat on the boat motionless in the gear with the loop still in on 100%,, you’ve guessed it 90 minutes later the vision thing again and again same dive buddy “do my eyes look right?” Yep look fine the sight was fine after 10mins and all was well except a tingle in my right hip which disappeared within 30hrs, was it a bubble? Was it a nerve? Had I slept odd, or just sat too long who knows?

THINGS THAT HAVE CHANGED / NOTES

Deep stops, I now don’t do them but started in an era when we all did and had no problems, could I be better doing them? I might try.

Movement during deco. when diving with a trapeze I would always have my idive music player waiting for me,, and used to sort of punk rock my way through hours of deco (much to the bemusement of bored dive chums) but I was moving,,, could it really help jiggle the bubbles out? My experience maybe a hindrance here as I can just lay in the water on minimum loop like a tombstone, I’ve not been on a trapeze this year..

I’m older, yep 44 is not old and am fit , but now I do wear glasses for reading and do suffer a bit of numbness here and there,, a couple of decades of working welding and grinding.

Possibility of a shunt somewhere in my body? I have heard even a PFO can appear when you didn’t have one before.

Bad gas? Could this conceivably be a case of bad gas? Surely I’d feel effects at depth?

cells? Yep cells are all good and nope never old, yep I have a full trimix analyser, mix all my own gasses and due to my oc experience I still actually gas match for depths,
The dive 3 days ago was to 55m I used 20/31 in the dil and took 19/35 ali80 and a 55/5 Ali 80 so I’m not doing any of those outrageously stupid mixes,, I think also represents my attitude to kit config and care.

Can someone really become helium intolerant? Heard it as a rumour but sounds unlikely

Set point control, 0.7 until 20m down then 1.4, I do watch for spikes but I find as the dil is always keeping up as long as the ascent is steady it’s good, nope, I don’t change to 1.5 or 1.6 when leaving bottom, years ago I was reasonably heavily bollocked by my mentor for this as at the time it was thought to be a bit of a dangerous game to play.


THANKS FOR READING,
I’m sure some of you raised an eyebrow, a grimace and maybe even a chuckle, I do hope so, I also hope somebody somewhere can get something from it, but I would love to hear any feedback so I can improve my current possible bendiness, I’ve done my “Fizzy-Lizzy / Bendy Wendy quota and I’m quite keen for it to stop,,, and would hate to give up diving,,, well the deco stuff anyway, I’ve just got used to the scooter,,, and you want to hear some of those stories…

Dive safe.

 

[elmo]

Firstly, thank you for sharing your experiences. It is really helpful to have first hand descriptions of what someone experiences, as opposed to rumours of what might have happened to someone who knows someone who heard something.
Secondly, apologies for not being medically trained ir an instructor. I mere open-circuit technical diver with less experience than you. Value my opinion based on what you pay for it.
Visual disturbances sound far more like oxygen toxicity than bends. I suspect you might be over-compensation for decompression stress with extended time at high pO2 without breaks. I dare say you’re likely mildly overhydrating yourself. Probably not harmful (provided it’s only mild over hydration) but probably not doing yourself any favours either.

 

[Alex Ouroboros]

Thanks for reply Elmo, I’ll have a think about those points, I don’t think the O2 exposure is too high but I am completely open to suggestions so will re read what I have on that, I frequently used to shatter the oxygen clock with big dives of 4-5hrs so think it may have appeared sooner.
Cheers.

 

[Duke Dive Medicine]

The eye thing is interesting. My first thought was CNS O2 toxicity as @elmo mentioned, but it wouldn't happen on ambient air 90 minutes after a dive. If it's that transient, it's probably not DCS but it is strange that you experienced it at about the same point post-dive on two different dives. One thing that comes to mind (and this is strictly speculation) is that the cranial nerves that govern eye movement run very close to the sinuses. Some people have anatomic variants in their sinuses in which cranial nerves may not be protected by bone, in which case the nerves are subject to the pressure inside the sinuses. If there's a transient pressure buildup in the sinus it could affect the nerve. Of course it could be completely unrelated to diving as well.

You mentioned a PFO study - what type of test was done, and what were the results? PFO might explain your first serious DCS event but likely not the second. And yes, there are shunts outside the heart; the lungs are a common location. A properly done PFO study should pick up a significant intrapulmonary shunt, but some of them only open up with exercise. Even in the absence of a shunt, there are people who just experience more venous gas emboli than most. You may be one of those, in which case you'll have to make a decision about how much risk you're willing to accept doing long, deep dives, even with more conservative GF settings.

All that said, your case is quite complex and you can only get so far on the internet. The UKDMC site has a list of diving medical referees; I'd strongly recommend you contact one and get yourself evaluated in person.

Best regards,
DDM

 

[Alex Ouroboros]

After my first bend I was understandably worried but perplexed about it all, they did the full shabang test, echocardiogram? Whilst intravenously putting gas in to my body,,, if that doesn’t sound right I apologise but it was something like that, they were watching all sorts of stuff on the screen whilst chatting and basically said nope, no PFO, at the time one of the medics kept repeating “are you serious, your dives were in meters not feet?” Referring to previous dives,

Hope that helps.

 

[ginti]

Thanks for the post OP, especially for being so transparent, which is not always easy. A quick one: is 2ltr of water on the way out to dive a good idea? @Duke Dive Medicine I thought over hydration could be as much of a problem as dehydration

 

[JonG1]

Did you have to perform a valsalva during the pfo testing Alex and who did the testing?

I'm UK bases and had completed a lot of dives before mine showed up.

Even if you were at rest during and after deco a valsalva or similar could push through a small hole.

My worst symptoms were very mild, ocular disturbances but I was asymptomatic on arrival at the pot.

Have you had any skin bends.

 

[Duke Dive Medicine]

Thanks for the post OP, especially for being so transparent, which is not always easy. A quick one: is 2ltr of water on the way out to dive a good idea? @Duke Dive Medicine I thought over hydration could be as much of a problem as dehydration

That depends on how hydrated the individual is to begin with, how long the boat ride is, how quickly the water is consumed, and the rate at which the individual is losing water.

Best regards,
DDM

 

[LI-er]

Don't know what caused the vision problems but I can tell you one thing for sure, there's no way a buddy can look at your eyes and "tell you they're fine". There's a lot of stuff that goes on inside the eyeball and an untrained professional without an ophthalmoscope isn't going to be able to discern much of anything.

The fact that you can focus either eye independently but the problem occurs with both eyes open leads to a strong possibility that you're having problems with your binocular vision, more specifically there is probably difficulty converging the eyes, in other words the effort that it takes to maintain clear, single binocular vision is so great that the eyes are probably over focusing and driving excess convergence which causes the blur.

Next time it happens try looking at something far away, alternating covering each eye and then with both open. Then do it looking at an object at about arm's length. I'm going to wager a guess that your vision problem is worse close up. You can also do a "pen to nose" test where you slowly move a pointy object to your nose and see how close you can get without it becoming 2 images. Do this test under normal conditions and see if there's a noticable difference.

If so that means something is effecting the innervation to the medial rectus extraocular eye muscles and it could be a sinus pressure sort of thing but that's just one possibility of several, another is a momentary period of low blood circulation to the muscle which is a very mild version of sort of what happens to stroke victims who suddenly see double and one eye is pointed in the wrong direction. These poor folks usually need prism in their glasses, at least short term, sometimes forever if the problem doesn't resolve within 6 months it's probably never going to.

Obviously there is no way to say for sure without more tests being done at that particular moment. You could also check for subtle damage to an extra ocular muscle by doing a "pen rotation" where you view a sharp pointed object and rotate it in a large circle and see if there is a particular field of gaze where it breaks into 2 images. This test, and those above would be done by a competent vision care professional when you get yourself checked.

 

[Frogman82]

FWIW, I have had visual disturbances after dives on the edge of the NDL or light/medium decompression. Turned out to be a PFO that was the culprit, and after fixing it I have had no issues at all.