SB Member Littlejohn in critical condition

[FritzCat66]

One detail that may or may not be significant that I left out of my report on the well-wishing discussion (because I thought it would generate inappropriate discussion for that thread): Apparently, the scans showed John had a massive undiagnosed cancerous mass in his liver*. However, all the immediate damage was caused by a pulmonary embolism (and the resulting clots interfering with blood flow to the brain), most likely triggered by a mild DCS hit.

Now, I'm not sure what role the liver plays vis-a-vis DCS and bubbles (even sub-clinical bubbles). But from another thread here I did read an interesting study very recently regarding liver function tests in a group of divers on an extended dive vacation, diving every day. Some divers were drinking in the evenings, and some were not. Yet tests showed that ALL of them had signs of highly elevated liver function, especially the women (whose levels were so severe as to be similar to mild hepatitis!).

Maybe some of the physicians here can elaborate, but to my layman's ears that seems to indicate that the liver may play more of a role in processing heavily nitrogenated blood (or some other effect of diving) than we currently understand. And for a diver with reduced liver functionality - like this situation - that may have made the difference between taking a DCS hit or not, since like I mentioned before, John did not violate his computer, and his profiles were no different than practically everyone else diving Jupiter that day or any other day.

Those computers are based on algorithms, which in turn are based on empirical data, probably gained from healthy Navy divers. I'll bet you anything those algorithms don't take into account reduced liver function, but presume 100% functionality from the diver's physiology.

Dunno, just speculating - but that's part of what this thread is for. If diving itself was part of the problem here, it should be alarming for us divers, because John was diving within accepted parameters. Therefore, it would be nice to find something here that made the difference.

I also can't help but think that John would like to have known that his incident served some positive function within the dive community he loved so much, that we all learned something from it, maybe something to help prevent another diver from going through what he did.

>*< Fritz

*CORRECTION/AMPLIFICATION: I just met with his family as they came to pick up John's car. Apparently the mass was located on his kidneys and there is evidence that it spread to his liver. The local M.E. is deciding whether or not to autopsy; we'll know more if he does, but of course the family would prefer they don't.

 

[shoredivr]

Thanks, Fritz, that was interesting.

 

[TSandM]

One comment . . . One of the predisposing factors for forming clots is having cancer.

With respect to the study showing elevated liver enzymes, it makes sense. Like the lung, the circulation through the liver is venous blood sent through an extensive filter system. Venous blood is where the bubbles are, and even small bubbles can block tiny capillary vessels. The liver can't "process" nitrogen bubbles, but I would guess it traps them and is damaged in the process.

What the study really says is that it's quite likely that the people on those liveaboards are having significant bubbling after their dives. We should all regard that soberly, and think about whether there are any modifications in our dive technique that can minimize that bubbling.

 

[scubafool]

FritzCat, sorry if I missed it in any of your earlier posts, and I did read them all. But I was wondering, was the dive in any way or at any point strenuous?

 

[String]

What the study really says is that it's quite likely that the people on those liveaboards are having significant bubbling after their dives. We should all regard that soberly, and think about whether there are any modifications in our dive technique that can minimize that bubbling.

That's one thing that ive been wondering about for a while. Liveaboard diving typically turns into an endurance contest. Day after days of multiple repeat and deep diving. Everyone is exhausted after 2-3 days (sub-clinical etc?). You do have to wonder if that sort of sudden massive increase in diving is doing some lasting damage.

 

[SparticleBrane]

Remember that bubbling does not mean that one gets DCS -- it just means the diver is bubbling after the dive.

 

[FritzCat66]

You know, we may never really know precisely what happened to John physiologically.

However, following up on prior discussions, one very clear lesson that can be learned from this is that we divers should have some easily available identification and emergency contact information available.

After talking with John's family, it became clear that, because of delays of nearly 24 hours in being able to contact his family, and for them to travel down to the hospital, nobody in his family was able to speak to John before he slipped into unconsciousness from which he never awoke!

Technological solutions are not the answer: John had a cellphone with his family numbers in it. But it just so happens the battery was dead. So much for that idea!

Please, divers - get some sort of physical ID tag that stays on or near your body. Not in your gear bag, not in your car, but on you.

DAN Tags are one answer, MedicAlert bracelets or necklaces that you wear are another, military-style dog tags, or just a cheap and simple laminated info card like Catt99 suggested in his post earlier in this thread - any of these kinds of things should do.

Having such ID available might not have made any difference to John's medical outcome in this case. But what it probably would have done is allowed the family to be contacted early enough to get down there and talk to their beloved son and brother before he slipped away.

So please, seriously consider keeping some sort of physical ID and emergency contact information on you when you dive! It may make all the difference in the world to your family and loved ones.

>*< Fritz

 

[mike_s]

you know... I've been meaning to put my ICE info in my phone for a eyar or two... just never got around to it..... you know how it is.

well, after reading through this thread, I just did it.

Then after reading more like the different methods, like ICE Wife, ICE Brother, etc I went back and added those.



what info do they put on the DAN tag? I went and looked at their website, but it doesn't show you an example of what they put on the tag.

 

[DandyDon]

When you order the tag, it'll prompt you.

 

[Hetland]

Dive computers are not 100% effective in preventing dcs. Computers (or tables for that matter) should not be viewed as infallable. Tables and computers cannot adjust to the physical makeup of each individual diver, and do not factor several significant variables in their computations (exertion, stress, hydration, etc). Dive computers will also not prevent embolisms created by the diver simply holding their breath during ascent, which may have been a key factor in this incident. Computers are great, and I wouldn't dive without one (actually two), but they are simply tools to help us make (hopefully) better decisions about our dives. It's difficult sometimes, when you are wrapped in the beauty and mystery of the deep, to concentrate on such things as proper breathing, return points, half-stops and gas management, but those things should always be scrolling through our minds.