Type II DCS Caused by..SWINE FLU??

[ModulationMan]

Alright Rick - You got me to register...

I'm the one that went on a chamber ride that Rick is talking about. My name is Chris.

I'm 26, in excellent health, 5'9", and 160 lbs. I run for 30-60 minutes each day if I'm not diving.
I had the flu at it's peak of the symptoms exactly two weeks prior to the dive. I'm not sure if it was H1N1, however, the symptoms were by far more severe than I have ever experienced with the flu. I also happen to know I was exposed to people that had H1N1. I do have asthma, but haven't had any trouble for five years. If and when it flares up, it is very bad news. During this flu I actually had to panic and locate one of my long lost rescue inhalers. Luckily the inhaler worked. I went to a clinic, and got some drugs to help reduce the length of the infection along with a new inhaler.
One of the worst symptoms I had was extremely sore back and joints. They were still sore at the dive last Saturday. At the time I didn't feel that was enough to stop me from diving on my birthday!
During the dive I got really cold hands and feet. We surfaced after the dive and all seemed just fine. I drove back to Spokane and got all my gear inside. I still felt sore, but it really didn't feel any different from before the dive.
Tuesday came and I went back out to Idaho for another dive in the evening. I was still a little sore in my joints and back. It also felt a little different from the aches from the flu. More localized, and hurt even when I didn't move. I assumed since I hadn't lifted all that equipment in a few weeks, that that may be the cause. We executed a 74 foot dive on EAN32 for 37 minutes. Nothing unusual about this dive, and I would guess the average depth was probably around 50 feet.
As soon as I got out of the water and in my car my right foot had a loss of sensation. I dismissed it as numbness from the cold. When I got home, nothing had changed. I was warmed up, so it had me a little concerned. I went through Wednesday with no change. Pain in my joints remained the same. It still felt different from the pain I experienced with the flu. Finally yesterday (Thursday) I called DAN in the morning. After describing the dive profiles, deco, and symptoms, the guy told me he couldn't rule out DCS. I was referred to Deaconess for further evaluation. I talked to the doctor on the phone, and described the symptoms. He immediately told me I need to get over there and run through a table 6.
At the maximum depth, they extended my time an additional 20 minutes along with a 5 minute air break. The rest of the recompression schedule was right out of the Navy table.
Before I entered the chamber, I felt extremely tired (I always do from my work), so I was expecting to take a 6 hour nap. As soon as I reached max depth, I felt like I got a shot of caffeine. This exposed an additional symptom that I hadn't noticed before. The loss of sensation in a large part of my foot shrunk down to about the size of a golf ball. It improved even more after I got out of the chamber and walked a bit. There is no pain in my joints or back now. I feel no less than awesome today!
Some things I have learned:
-Sickness or pain prior to a dive can possibly mask DCS symptoms post-dive. Pre-dive you should be at 100% so after a dive, you can immediately detect any changes. In this situation, it caused a lengthy delay in treatment. A mistake on my part. Swine flu, regular flu, or any other virus or WHATEVER, just call the dive. You can always dive another day.
-P-Valve. 'Nuff said.
-Hydrate - Your hydration level is usually closely related to whether you have a p-valve or not.
-If there is any question of DCS, just call DAN. I began questioning on Tuesday night. That should have been when I called. It doesn't hurt to ask them.



I can't say with 100% certainty that any one of the above actually caused the DCS. Even if all things are perfect, there is still a chance of the bends in all dives. My best advice from this experience is to take all symptoms seriously. Yes... it can happen to anyone. If I had followed my own advice, I would probably not be benched for the next 29 days 9 hours 35 minutes and 37 seconds.

Now... if you DO go for a chamber ride, make sure you ask for a free water bottle and T-shirt!

 

[ModulationMan]

tgsmith:

I use a Vyper2 in gauge mode only. It does log the profile at 1 second intervals. My ascent rates were as planned (within reason of course). 140-70 at 30 feet per minute. 70-20 at 10 feet per minute while including deco stops. 20-0 at 6 feet per minute after completion of deco.

We use V-planner to create our plans. My plan included 140 feet for 25 minutes, lost gas, and +5+5. The plan was based off of the VPM-B model with a +2 conservatism level. A very reasonable dive that doesn't push anything to the extreme.

The dive on Tuesday wasn't a deco dive, so I went by standard no-stop table limits.

It seems that if you go diving with even mild symptoms of DCS, you can come back even more bent.

 

[LeadTurn_SD]

ModulationMan (and Rick),

Thank you very much for sharing your experience with us. I'm very glad you are doing well, and are on your way back to diving!

Best wishes.

 

[dadediver]

Less than 100 dives with diving with 10 plus years and going to 250 feet?

 

[Bubbletrubble]

It's been hypothesized that there's an inflammatory component to the pathogenesis of DCS. Perhaps that's why the doctor thought that the viral infection was a predisposing factor -- ModulationMan's immune system was probably still pretty revved up at the time of the DCS hit. At least one human clinical study has shown that non-steroidal anti-inflammatory meds can ameliorate DCS symptoms. Here's a link to another older study. Some research in rats has shown that drugs blocking the lipoxygenase pathway (zafirleukast and zileuton) can decrease the severity of DCS symptoms. If inflammation is part of the disease mechanism in DCS, then block inflammation. Seems reasonable to me. Perhaps at some point in the future, we'll all be loading up on NSAIDs before a dive. I'm open to the idea.

Of course, dehydration and presence of a PFO may have also contributed.

 

[Rick Inman]

Less than 100 dives with diving with 10 plus years and going to 250 feet?

NO! Gosh, either I don't write clearly or people don't read. I said, that my other buddy and I did a 250' prior to this dive. He did a 140' dive.

 

[Rick Inman]

Other's may not know what your "Standard Gases" are. There may be club/agency/regional standardized gases, but there is not a worldwide, industry standard. For future references to gases you and others may find it helpful to just name the gases outright in the presence of mixed company.

We enjoy (usually) 21/35 at 140' on OC.

If I were this diver, I'd get a PFO test, especially with neuro symptoms on a dive where no one else had any problems.

FWIW, myself and his other buddy were on CCR's and I was clear before Chris began his 20' stop.

 

[dadediver]

NO! Gosh, either I don't write clearly or people don't read. I said, that my other buddy and I did a 250' prior to this dive. He did a 140' dive.

this is what I read:

I was on the dive with him. We were a 3-man team. This was the second dive for myself and one buddy (first dive to 250' with 2 hour SI), and the first dive of the day for the buddy who took the hit. He is a "new" deco diver with only a few deco dives to date. No one else on the team suffered any symptoms.


This is what I did not read so well:


He followed a VPM cut deco plan, fresh water, conservative 2, set for 2200 feet altitude, 140' for 25 mins using standard bottom & deco gasses. He spent a couple extra mins under the boat at about 12' before ascending.

 

[LeadTurn_SD]

...Perhaps at some point in the future, we'll all be loading up on NSAIDs before a dive. I'm open to the idea.

Of course, dehydration and presence of a PFO may have also contributed.

Hi Bubbletrubble,

I had read about this before (using apspirin or NSAID's), and at first glance it seems to make sense, but....One of the cardiologist / divers on the board weighed in on the preventative NSAID-use idea, and said it was not a good idea; if I remember his responce correctly the potential for increased bleeding caused by NSAID's would not be a good thing.

His recommendation was adequate pre-dive hydration.

I'm sure one of the MD's can answer this more completely / accurately.

Best wishes.

 

[Bubbletrubble]

I had read about this before (using apspirin or NSAID's), and at first glance it seems to make sense, but....One of the cardiologist / divers on the board weighed in on the preventative NSAID-use idea, and said it was not a good idea; if I remember his responce correctly the potential for increased bleeding caused by NSAID's would not be a good thing.

@LeadTurn_SD:
Whoa! I want to be clear about this. I did not recommend taking NSAIDs pre-dive. NSAID usage does entail certain risks to the lining of the stomach and the kidneys. I merely suggested that in the future pre-dive short-term NSAID dosing might be adopted by the dive community -- after the proper controlled studies are done AND once the benefits vs. risks of NSAIDs are assessed. We clearly aren't there yet.

The reason I brought up the issue of inflammation is that it could explain the reasoning behind the treating physician's comments.

Hope this clarifies my previous post. Sorry if there was any confusion.

P.S. FYI, mechanistically speaking, aspirin is not as specific as NSAIDs in the way that it blocks inflammatory pathways. On account of this, it might make aspirin less desirable in the treatment/prevention of DCS.