Suffered DCS for the first time and terrified to dive again

[Duke Dive Medicine]

Sorry again for the bouncing posts, jbird. It's great that your symptoms resolved after your initial treatment. That's almost certainly a function of how quickly you got help.

Initially when I read that you'd omitted some decompression, I called your DCS incident "explained", but after I posted, I read the comments that had gone up while I'd been writing, which, if I followed them right, corrected that and said that you'd remained in no-D status according to your computer.

Looking at the data none of the flags indicated I was in deco. They were all for ascent. I wear my computer on my left-hand (I'm left handed) which means its prone to movement as I check my pressure gage/fight off man-eating sharks etc.

This makes things a little less clear. Your dive profile was sound, if a little cold, yet you suffered a fairly significant DCS hit. Your plan to see a diving physician sounds like a good one, and I'd recommend you follow through on it. There have been several mentions of patent foramen ovale (PFO) here. Among other things, it's correlated with severe neurological DCS and inner ear DCS, both of which it appears you had symptoms of. Without actually seeing you, I can't make a specific recommendation that you get tested, but your symptom presentation and dive profile do raise my index of suspicion for it a little.

Best regards,
DDM

 

[Crush]

I'd say that second dive was you're biggest problem. Max depth of over 80' with an ascent at the end from 45' to surface in just over a minute and no safety stop.

Ditto what Bubbletrubble said - Divernoob is pointing out one of the less conservative elements of your dive profile.

I would like to re-post a recent, relevant discussion on safety stops and their importance. The thread is http://www.scubaboard.com/forums/advanced-scuba-discussions/363783-why-hate-safety-devices.html , but that thread ended up being a train-wreck of fighting. The original comment that safety stops are more important than previously thought was made by boulderjohn here: http://www.scubaboard.com/forums/5648533-post234.html . My response to his thread, located here: http://www.scubaboard.com/forums/5648745-post235.html is reproduced below (with a bit of tidying up).

I found a relevant DAN article at DAN Divers Alert Network - you may have to be a member to access it (not sure). A few quotes from the article are http:/news/Article.aspx?newsid=514

What is interesting, and not necessarily intuitive, is that an in-water stop with a relatively rapid ascent rate appears to be more effective at eliminating inert gas than a very slow ascent rate. As can be seen from Table 2, a five-minute in-water stop is much more effective than simply slowing the ascent rate, even though the total ascent time is not much different (6.6 minutes vs. five minutes). That total ascent time also remains very short. We know the spinal cord has a 12.5-minute halftime. Thus, 6.6 minutes is an insufficient total ascent time for the spinal cord which is, by then, virtually fully saturated (as seen in Table 1).

At 30 feet per minute (which is the ascent rate more commonly used today with a five-minute safety stop at 20 feet), the time to surface from 100 feet will be some eight minutes. This is better, but still a lot shorter than the 12.5-minute halftime of the spinal cord (not considering that gas elimination is slower than uptake). A plausible alternative might therefore be to ascend at 30 feet per minute but to add an additional "Haldanian" stop at about half the depth (remember, the depth is 100 feet / 15 meters) at 50 feet for five minutes. This gives 13.3 minutes of total ascent time2.

With respect to deep stops:

International DAN research studies have recently clearly confirmed these hypotheses: 15 divers were enrolled in a study and each given eight possible combinations of ascent rates, and either a shallow stop, or a deep and a shallow stop. The repetitive dives were to 80 feet (25 meters) for 25 minutes; the surface interval was three hours, 30 minutes; and the final dive was to 80 feet for 20 minutes. Ascent rates were 60, 30 and 10 feet per minute. The matrix is shown in Table 3 and the results of 181 dives are shown in Table 4.

Clearly, the best decompression schedule is Profile 6 (see highlights in both tables). With an ascent rate of 33 feet (10 meters) per minute, and two stops at 45 feet (13.5 meters) and 9 feet (2.7 meters) respectively, this profile had the lowest bubble score of 1.76.

 

[Davemohio]

J bird,

Thanks for posting. I found some of the currents in Cozumel challenging. Sometimes I had to fight hard to accomplish my safety stops. At times it was a real PITA.

Your intial decision on the 3 mil was logical too. Many people in Coz are comfortable with the 3. Some people need a 5 or a 7 mil.

 

[jbird71]

As a totally unrelated note, Paul Allen's Octopus was docked at the harbor. Very cool.

 

[jbird71]

Among other things, it's correlated with severe neurological DCS and inner ear DCS, both of which it appears you had symptoms of.

Best regards,
DDM

Up until this point I had a mild case of DCS (the "sniffles" if you will) after reading about my symptoms and their meaning, I now know that this was no joking matter.

 

[vladimir]

Suffered DCS for the first time

I broke my DCS cherry with no serious effects, and learned many valuable lessons about my diving.

Thanks for a valuable thread--especially the profiles. We don't see those very often in DCS threads; they saved a lot of conjecture.

I realize you are being a bit flippant in some of your posts--and perhaps these--but I think it's important to point out that the overwhelming majority of divers never break their "DCS cherry."

 

[Bubbletrubble]

@jbird71: When you got to the hospital, did the docs ever analyze your blood glucose levels? Also, how often do you test your blood sugar levels on your own?
Type 2 diabetics with uncontrolled hyperglycemia can be hit with a serious condition called hyperglycemic hyperosmolar syndrome (HHS). This is a rare condition, but you may want to learn a little about it. Here's a link to a MedlinePlus article about it.

It's interesting to note that diabetes is a vascular disorder...and that blood vessels and bloodflow likely play a role in DCS pathogenesis. I'm unaware of any correlation between diabetes and DCS, but considering your recent experience, it might be prudent to increase the level of conservatism of your dives.

Have fun and be safe out there...

 

[Duke Dive Medicine]

Up until this point I had a mild case of DCS (the "sniffles" if you will) after reading about my symptoms and their meaning, I now know that this was no joking matter.

IMHO, it's fine to make a little light of it after the fact considering the good outcome. I'll emphasize again that I think you did far more right here than you did wrong. I'll be back in clinic on Wednesday. If you'd like, I can look in our database then and see if I can find a diving physician close to you, unless somebody here knows of one in Toronto and can provide the info.

 

[bleeb]

Fortunately, the healthy human body is able to excrete and tolerate a very large quantity of water without adverse affect provided it is imbibed at anything approaching a sensible rate. Considering the dehydrating effect of diving due to several mechanisms (e.g., elevated ambient temperatures, immersion diuresis, breathing extremely dry air), bringing on hyponatremia during active scuba would seem quite a feat.

While over-hydration may be more common than has generally been thought, it appears to remain a very low probability event. In adults it is most frequently seen in association with high–endurance activities like marathons, strenuous hiking or cycling and long military marches where there is excessive water intake within an inadequately long time span.

Being someone who partakes in some of the afore-mentioned endurance activities, I thought I'd add a little bit of the common folklore to what DocV said.

Under most quasi-normal conditions, the average person's digestive system can absorb a max of about 0.75-1.25 liters/hour. As a rough rule of thumb, assuming someone start's out with a reasonable electrolyte balance and don't have any special medical conditions, it takes roughly 4-6 liters of pure water to cause hyponatremia. It therefor tends to take at least several hours of non-stop drinking and sweating to cause problems. Drinking and urinating is even less of an issue, since the human body doesn't loose as many electrolytes that way.

So while over-hydration probably does happen a bit more often than most people would think, it is indeed generally a very low probability event that tends to require special conditions (continuous heavy exercise or certain medical conditions) for an extended period. Bottom line: Pay attention to your individual situation, but in general, you're far more likely to get in trouble from under-hydrating than over. (Unless maybe you're diving a dry suit without a p-valve.

 

[Crush]

Up until this point I had a mild case of DCS (the "sniffles" if you will) after reading about my symptoms and their meaning, I now know that this was no joking matter.

I believe that is is referred to as "niggles."