Post Dive Nausea

[hogued]

Perhaps someone can give me a hint about what may be causing very random post dive (at the surface) nausea. A while back, upon surfacing from a dive to about sixty feet for about thirty minutes, I felt extreme nausea as soon as I reached the surface. I attributed it to some combination of seasickness or something I ate. I skipped the second dive of the day, and had no further problems, nor did I experience any symptoms in subsequent dives that week.

Last week, I arrived in Cozumel, Mexico with a friend on Monday afternoon. On Tuesday, my friend began the first day of certification dives, and having not been in the water for a while, I had planned to go down on these dives as well. The first day and the first two dives were no problem. During the first certification dive of the second day, I once again experienced severe nausea upon reaching the surface. A few minutes after exiting the water, I once again felt fine. All of these dives were made from the shore, so there was no boat to factor in seasickness, and I had eaten only a club sandwich for dinner the night before, and some fruit for breakfast the morning of the dive, so I don't think it was due to anything I had eaten. I once again skipped the next dive, and felt fine the rest of the day.

After the C dives we made three days of boat dives, during which time I took one over the counter Dramamine Non-Drowsy pill each morning as a precaution. I had no occurences of nausea during any of these days. Boats normally do not upset my stomach, nor does diving, but every once in a while, I experience nausea at the surface. This last experience ruled out the boat, so I'm wondering if I have some undiagnosed dilemma?

Any suggestions would be greatly appreciated, since I am completely puzzled.

Thanks.

 

[Maggie]

I wonder whether you are swallowing air on occasions and when this expands as you reach the surface it is making you feel unwell? Just a thought - probably wrong!

 

[BillP]

Hi hogued:

Your symptoms are a head scratcher for me. My first thought was what Maggie said. If a diver swallows air at depth it will expand as they surface and could cause nausea. Your thought of "something you ate" or an event unrelated to the diving is still a possibility. You don't describe any dizziness, but vertigo on ascent can cause nausea. So can CO2 retention or even carbon monoxide poisoning (the latter seems very unlikely). A wetsuit, hood, or drysuit neck seal that puts pressure on your neck when it expands at the surface or with the upright posture at the surface could cause nausea. Even though you weren't on a boat, wave action at the surface nauseates some people.

These are just a few guesses. Hopefully someone will be along with more specific suggestions.

HTH,

Bill

 

[John Reinertson]

I'm stumped like Bill P.
Are there any other things you noticed at all-- particularly a spinning sensation, feeling of disorientation, or difficulty equalizing?

One of the more common causes is called alternobaric vertigo but it usually has a spinning or dizzy sensation with it and is associated with pressure differences when one ear equalizes and the other doesn't. Alternobaric vertigo can occur on ascent with a little bit of reverse squeeze, not necessarily to a painful degree.

If none of these symptoms fit, then I'm not sure and would suggest calling DAN.

May all your chumming be intentional.
John Reinertson

 

[larry_foo]

I'm into diving only recently. I had the same problem too, recently. And it happened a couple of times with no apparent pattern I could identify. Except everytime the symptom come, the condition at sea was very rough and the current strong. So I thought it may be due to exhuastion from fighting current. But the nausea problem sets in only upon surfaced. So I find it rather strange.
If there any medication? or should I just try get my body get use to this symptom. Drank lots of water and did help a bit.
Did thought of stopping diving, but just can't give up the sea...
Wonder if nitrox will help in such aspect?

 

[DocVikingo]

Hi hogued/larry_foo,

I think Drs. BillP & Reinertson have raised a number of possibilities you will want to rule out.

In the meantime, there are actions some divers find helpful in preventing mal de mer, such as avoiding fatigue, getting adequate rest, and eating modestly, avoiding greasy, fatty, acidic and spicy foods. Don't skip breakfast, but stick to bland foods like toast, rolls and cereal. Go easy on tea and coffee, and very, very easy on alcoholic beverages. When on the boat, don't get overheated--stay under a sunshade, don't put on your protective suit until necessary, and get in the water as soon as possible. Search out a spot low and in the center where motion is minimized, face forward, focus your eyes on a fixed object on the horizon or elsewhere, avoid unnecessary neck movements and stay out of exhaust fumes. Do not go below, read anything or look through binoculars. If you must vomit, do so freely, but not anywhere on the boat, and especially not in the marine toilet.

If precautions fail, there are plenty of medications available if you feel you must go this route. BillP recommends avoiding medications if at all possible, and so do I, but the fact remains some divers seem unable to scuba without them. You will want to discuss this with your physician. Among drugs reported to be the most effective are meclizine and scopolamine. Prescription strength meclizine commonly comes as Antivert. Scopolamine can be delivered through a transdermal patch, Transderm Scop, orally, and as a gel applied to the wrists. The gel reportedly works faster, but not as long as the patch. Scopolamine is the US Navy's first line sea sickness drug, including for divers, and DAN approves it with a trial run. Occasionally Phenergan, whose primary indication is as a sedative, is recommended. It can cause serious drowsiness, however, and is sometimes prescribed in combination with a stimulant to counteract this. I personally am very leery of such a cocktail, but some professional divers use it, and I know several pilots of private planes who swear by it.

The above drugs are prescription only and have reported side effects, most commonly dryness of the mouth and drowsiness. They may also cause blurred vision, dizziness and even confusion in some users, and it is recommended to carefully discuss their use with your physician, give them a trial run well prior to use in conjunction with diving, and take them only according to instructions.

Over the counter (OTC) preparations include Bonine, Dramamine, Dramamine II (advertised as a "less drowsy" formula. As this implies, be aware that some individuals still do experience some degree of drowsiness.) and Triptone. A British drug, Sturgeron (cinnarizine), has been mentioned by several sources as an effective treatment, but it is not yet available in the US. Those diving in such places as the British Virgin Islands can find it. Many report these OTC medications most effective if taken at bedtime the night prior to diving, with a second dose about an hour before diving, although recommended dosage amounts should of course not be exceeded. These medications often cause significant dryness of the mouth. Stay very well hydrated.

Considering more "natural" remedies, ginger is frequently mentioned, which can be taken in powdered, crystallized or root form, or as ginger snaps, ginger ale (but only some ales still use real ginger), or tea. As heartburn with the use of ginger has been reported, also pack an antacid. Others swear by wrist straps, such as 'Sea Bands,' usually wooden or plastic balls on elastic bands which are placed so as to exert pressure on an acupressure point on the inside of the wrist. There are also 'artificial-horizon' glasses. Even aromatherapy has been tried, with a combination of mandarin, peppermint, spearmint and lavender oil being recomended.

In the final analysis, you will need to discover what works best for you with the least risk, side effect, cost and inconvenience. If you take any medications, you should understand their adverse effects and carefully follow directions for use. And remember, there is one safe, sure cure: "Sleep under a tree all day."

BTW larry_foo, I can discern no reason that diving nitrox would have any material effect on your complaint.

This information is for general educational purposes only, and no doctor-patient relationship exists or is implied. It is not medical advice to you or any other individual, and should not be construed as such. Discuss any concerns with your physician.

Hope this gets you started.

DocVikingo

 

[got4boyz]

Hi,

Everytime I dive I get nauseated as soon as I surface. I'm fine on the boat, but inevitably I feel it as soon as I surface. So does my husband. After a couple hours rest I'm fine again.

I just got back from Cozumel and my first dive the seas were about as rough as I've ever experienced but I didn't get nauseated until I surfaced!!! My husband was very nauseated.

My husband also got nauseated in our cenote dive after surfacing and of course there was no boat or ocean swells involved there.

So on our dives in Cozumel we bought some dramamine and felt GREAT after our dives. So unless someone tells me otherwise I'm packing Dramimine on all my dive trips!

 

[Marine801]

If you guys ever come up with an answer for this please be sure and post it. These kinds of gremlins can ruin days and need to be understood.

Thanks

 

[scubadoc]

Originally posted by got4boyz
Hi,



So on our dives in Cozumel we bought some dramamine and felt GREAT after our dives. So unless someone tells me otherwise I'm packing Dramimine on all my dive trips!

You might want to rethink your medication for motion sickness. Dramamine (dimenhydrinate) is one of the few drugs that has been shown by a fairly good study to adversely affect mental flexibility. This effect, when added to the adverse effect of depth on memory, may
contribute to the dangers of diving.

An abstract of the article reporting this study is located at here.

We have removed dimenhydrinate from our web page about motion sickness medications at http://www.scuba-doc.com/mald.htm

Probably the best medication for seasickness is scopolamine in the dermal patch form.

 

[got4boyz]

Originally posted by scubadoc

You might want to rethink your medication for motion sickness. Dramamine (dimenhydrinate) is one of the few drugs that has been shown by a fairly good study to adversely affect mental flexibility. . . . We have removed dimenhydrinate from our web page about motion sickness medications at http://www.scuba-doc.com/mald.htm

Probably the best medication for seasickness is scopolamine in the dermal patch form.

Hey scubadoc, I really appreciate you sharing those study results with me. That's why I wrote in saying that I take Dramamine so that if for some reason I shouldn't someone would tell me!

However, I must admit I am a little confused about why scopolamine would be the better medication. I quote from the article:

"Side effects

Scopolamine must be used with caution in people with glaucoma and prostatic hypertrpphy and can cause hallucinations, confusion, disorientation and memory disturbance."

Yikes, this doesn't sound any better than dimenhydrinate!

(I don't know why it is putting all of this as a quote from scubadoc. The quote command is right after "patch form."! Weird.)