Seasick immediately after surfacing?

[Pearlman]

I recently did a dive last month - as soon as I got into the boat, I was queasy and nauseous even as I took my BCD off (to the point I could barely sit up after bracing my arm for support) then some 20 mins later I threw up thrice, once with projectile force. The trip to the dive site was a roller-coaster in 1.5mtr waves maybe even 2 mtr ones at times for the last 20 mins. We were in a fairly 4-5m tiny boat that was maxed out with 7-8 divers and 2 boat crew. I wasn't sick while gearing up and getting into the water. When we surfaced the conditions were a little calmer and the boat wasn't rocking much, while it did start bouncing a bit on the way back.

However I am suspicious because my dive profile wasn't the best - I was at 34 mtr for 4 mins with an average depth of 22mtr for the entire dive lasting 29mins. Then I skipped the safety stop after 1min because I was at 20bar and I didn't want to surface with no air with 2mtr waves crashing around me - I prefer breathing from the reg at the surface at times like these after experiencing forceful waves slap into my face just as I turned my head and gulping seawater on previous occasions.

Could this be a mild symptom of DC or just delayed onset of seasickness? I had no other symptoms just a mild headache with a slowly receding nausea that cleared before the next dive after a surface interval of +1h. I dived uneventfully that same day and the next, and even touched 40m the next day (due to a creeping downcurrent) without further issue. Normally - jumping into the water relieves symptoms of seasickness so I am curious why I was sick immediately after surfacing?

Thanks for your insights on this episode.

P

 

[Duke Dive Medicine]

I recently did a dive last month - as soon as I got into the boat, I was queasy and nauseous even as I took my BCD off (to the point I could barely sit up after bracing my arm for support) then some 20 mins later I threw up thrice, once with projectile force. The trip to the dive site was a roller-coaster in 1.5mtr waves maybe even 2 mtr ones at times for the last 20 mins. We were in a fairly tiny boat that was maxed out with 7-8 divers and 2 boat crew. I wasn't sick while gearing up and getting into the water. When we surfaced the conditions were a little calmer and the boat wasn't rocking much, while it did start bouncing a bit on the way back.

However I am suspicious because my dive profile wasn't the best - I was at 34 mtr for 4 mins with an average depth of 22mtr for the entire dive lasting 29mins. Then I skipped the safety stop after 1min because I was at 20bar and I didn't want to surface with no air with 2mtr waves crashing around me - I prefer breathing from the reg at the surface at times like these after experiencing forceful waves slap into my face just as I turned my head and gulping seawater on previous occasions.

Could this be a mild symptom of DC or just delayed onset of seasickness? I had no other symptoms just a mild headache with a slowly receding nausea that cleared before the next dive after a surface interval of +1h. I dived uneventfully the next day and even touched 40m (due to a creeping downcurrent) without further issue. Normally - jumping into the water relieves symptoms of seasickness so I am curious why I was sick immediately after surfacing?

Thanks for your insights on this episode.

P

Hi @Pearlman ,

Do you remember any difficulty equalizing on this dive?

Best regards,
DDM

 

[Pearlman]

Hi DDM
Yes, as a matter of fact I developed ear problems just the day before my 1st dive of the vacation 5 days back - for the first time I needed 5 mins equalizing beyond 10mtr on all my dives for the next 3 days (this was the 4th day). On this day I was unable to do the negative entry efficiently and took i minute to go from 19mtr to 23mtr and reached 34m at 6mins. The next day was the first day my ears behaved slightly better but I still struggled with ear pain and inflammation for another week until I started taking Diclofenac. If I remember correctly this was the first dive when I experienced one ear finally equalize and then to my surprise the other good ear had a problem equalizing - I had few issues with the other (left) ear up till then.

Thanks!
P

 

[Duke Dive Medicine]

Hi DDM
Yes, as a matter of fact I developed ear problems just the day before my 1st dive of the vacation 5 days back - for the first time I needed 5 mins equalizing beyond 10mtr on all my dives for the next 3 days (this was the 4th day). On this day I was unable to do the negative entry efficiently and took i minute to go from 19mtr to 23mtr and reached 34m at 6mins. The next day was the first day my ears behaved slightly better but I still struggled with ear pain and inflammation for another week until I started taking Diclofenac. If I remember correctly this was the first dive when I experienced one ear finally equalize and then to my surprise the other good ear had a problem equalizing - I had few issues with the other (left) ear up till then.

Thanks!
P

There are a few things that can cause vertigo with diving. Decompression sickness and inner ear barotrauma are the most serious, but from your description of your recovery time, I think both of these are unlikely. Of course seasickness is not out of the question, but given that you weren't sick on the way out despite the choppiness of the water, along with your description of one ear equalizing but the other not, it sounds like you could have had alternobaric vertigo. If one middle ear space equalizes before the other, the different pressures in the middle ears can affect the vestibular system in the inner ear and cause symptoms like you described. It usually happens on ascent from a dive and is transient, though I've seen it last for several hours. If it happens again, try a Toynbee maneuver - pinch your nose and swallow. This often clears it right up. Of course if the vertigo is persistent, seek medical attention. Interesting that this topic should come up twice in less than a week - there's a similar thread here.

Best regards,
DDM

 

[Pearlman]

If it happens again, try a Toynbee maneuver - pinch your nose and swallow. This often clears it right up. Of course if the vertigo is persistent, seek medical attention. Interesting that this topic should come up twice in less than a week - there's a similar thread here.

Best regards,
DDM

Interesting ... by "if it happens again" - do you mean at the moment of equalizing problems at descent along with the Valsalva maneuver or the moment of the vertigo symptoms?

P

 

[Duke Dive Medicine]

Interesting ... by "if it happens again" - do you mean at the moment of equalizing problems at descent along with the Valsalva maneuver or the moment of the vertigo symptoms?

P

I was thinking more if you experience the vertigo again, but the Toynbee maneuver can also be used to equalize on descent. It's a little more difficult to pull off but it's also more gentle than a Valsalva maneuver.

Best regards,
DDM

 

[Pearlman]

ok - reading again your posts - the event is likely to occur on ascent hence at the time of vertigo... doesn't that imply that ears can remain un-equalized even after surfacing? I guess its the same (reason) as ear pain on descent from an aircraft ... ?

P

 

[Duke Dive Medicine]

ok - reading again your posts - the event is likely to occur on ascent hence at the time of vertigo... doesn't that imply that ears can remain un-equalized even after surfacing? I guess its the same (reason) as ear pain on descent from an aircraft ... ?

P

Yes it does. Symptoms of alternobaric vertigo can persist until the ear clears, which may happen on the surface. The analogy would be to an aircraft that is climbing. Descent in an aircraft is similar to a diver descending, that is, the pressure in the cabin increases as the aircraft moves toward the ground.

Best regards,
DDM

 

[IT.]

Was it drift diving with a "live" boat?

Surfacing into a lungful of diesel fumes can get anyone heaving over the side, it's happened to me.

 

[outofofficebrb]

I have also had issues where I have had air in my stomach that I couldn't burp out upon ascent and that has caused me to feel nauseated and/or to throw up. Diesel, as @IT. mentioned, doesn't help, especially with bad viz during the dive, lots of current, some surge, while I'm wearing a hood, and some knocking surface or safety stop conditions.