Vomiting at end of dives

[DrWScott]

I am a relative newbie with around 45 dives under my belt and have completed Advanced Open Water certification. At about the 30th dive I started vomiting at depth, toward the end of my dives. I have tried every recommendation given to me, but even as late as last night I was spewing at the end of the 2nd tank. Here's what I have noticed and done to prevent this:
-Always post 45 minutes into dive on 2nd tank of a 2 tank dive. Never on 1st of a 2 tank dive.
-Never on a short dive - less than 40 minutes.
-I have vomited at depths between surface and 50 ft.
-Doesn't matter if the tank is steel or aluminum, air or Nitrox, personal or rented.
-Often worse at surface when waiting for the boat to pick me up.
-Never get sick on the boat, even in 5-6 ft waves.
-Doesn't matter if stomach is full or empty.
-Doesn't matter if I take my oral meds for diabetes or not.
-I drink a lot of water before dives and during surface interval.
-Tried taking and chewing ginger.
-I am now up to 75mg of meclizine before dive and still vomiting at end of 2nd dive.

Some other potentially contributing factors:
-I am an insulin dependent diabetic.
-I have a history of motion sickness in cars.
-I battled with an extreme case of vertigo about 7 years ago after a minor surgery, and only experience it now slightly when I lean backwards.

I have fallen in love with the sport and want to move on to my rescue diver cert, but until I can get this under control, I'm holding off. Can someone with some knowledge and experience please help me? Either I get some help or I'm likely to quit diving.

Wesley

 

[Duke Dive Medicine]

Hi Wesley, sorry to hear about this. A few questions:

When you say you have a history of motion sickness in cars, do you mean in the past?

Do you check your glucose pre and post-dive?

If so, does it differ significantly from your glucose readings on days when you're not diving?

Do you have reflux?

Do you notice whether you are in a particular position in the water when you get sick (horizontal, vertical)?

When you get sick, is your depth changing, or is it constant?

If I may ask, what was the surgery you had 7 years ago, and did anyone posit a cause of the
vertigo?

<edit> Is the vomiting preceded by nausea? Are any other symptoms present?

Best regards,
DDM

 

[Bubblesong]

Where are you getting your tanks air filled? Are you analising them for contaminants?

 

[DrWScott]

Hi Wesley, sorry to hear about this. A few questions:

When you say you have a history of motion sickness in cars, do you mean in the past? Yes, but haven't really experienced it lately.

Do you check your glucose pre and post-dive? Not particularly. I stay between 100 and 200 most of the time.

If so, does it differ significantly from your glucose readings on days when you're not diving?

Do you have reflux? Yes

Do you notice whether you are in a particular position in the water when you get sick (horizontal, vertical)? Both

When you get sick, is your depth changing, or is it constant? Sometimes when changing, but initial is constant.

If I may ask, what was the surgery you had 7 years ago, and did anyone posit a cause of the
vertigo? Heart Cath. They put me on BP meds to reduce the possibility of a clot until the cut healed and it caused my BP to drop too low and caused vertigo.

<edit> Is the vomiting preceded by nausea? Are any other symptoms present? I don't feel any nausea before or after vomiting.

Best regards,
DDM

I have threaded my answers above. Thanks so much for asking and trying to help.

 

[DrWScott]

Where are you getting your tanks air filled? Are you analising them for contaminants?

Good question. I have gotten tanks filled at two different local shops and same results. Also got rented two tanks in Roatan (air) and vomited there too.

 

[Duke Dive Medicine]

Thanks for the quick response. I have a couple of thoughts, which is about the best I can do over the internet. First, I would strongly recommend that you take pre and post-dive blood glucose readings. DAN and UHMS offer other recommendations for diving with diabetes:

DAN | News

I'm assuming from the lack of mention of other symptoms that you're not going hypoglycemic during your dives but it's worth exploring.

It's been demonstrated that when a diver is vertical in the water with the head up, pressure in the esophagus is less than pressure in the stomach, so the vomiting may be more of a hyper-refluxia, so to speak.

Another possibility is that you're experiencing some kind of transient vertigo under water, though you would probably feel actual vertigo if this was happening. Loss of visual reference can cause it, as can changes in ambient pressure, especially if one ear equalizes and the other does not. It can also be caused by a sudden influx of cold water into the ear canal, though from your description this sounds unlikely.

Another random question, this from one of our attendings: do you use marijuana?

Best regards,
DDM

 

[emoreira]

That also happened to my buddy. The reason why that was happening was the weight belt.
We are all taught to tighten the weight belt 3 times during the dive. When we don it, in the surface when we enter in the water, and finally at depth, but no one tell us to untighten it back in the surface, because it could become too tight when we uncompress back in the surface.
At least this was the reason why my buddy suffered end of dive vomiting.

 

[DrWScott]

Thanks for the quick response. I have a couple of thoughts, which is about the best I can do over the internet. First, I would strongly recommend that you take pre and post-dive blood glucose readings. DAN and UHMS offer other recommendations for diving with diabetes:

DAN | News

I'm assuming from the lack of mention of other symptoms that you're not going hypoglycemic during your dives but it's worth exploring.

It's been demonstrated that when a diver is vertical in the water with the head up, pressure in the esophagus is less than pressure in the stomach, so the vomiting may be more of a hyper-refluxia, so to speak.

Another possibility is that you're experiencing some kind of transient vertigo under water, though you would probably feel actual vertigo if this was happening. Loss of visual reference can cause it, as can changes in ambient pressure, especially if one ear equalizes and the other does not. It can also be caused by a sudden influx of cold water into the ear canal, though from your description this sounds unlikely.

Another random question, this from one of our attendings: do you use marijuana?

Best regards,
DDM

I'm pretty good at catching low BG before it gets there and I don't feel any of those symptoms on dives. Since I don't dive with my insulin pump, I'm more likely to go a little high while diving.

As for the vertigo, I don't feel any sensation of it before vomiting. I'm taking the meclizine just in case, but it is not helping at 75mg.

No, I haven't smoked weed in 35 years.

Wesley

 

[DrWScott]

That also happened to my buddy. The reason why that was happening was the weight belt.
We are all taught to tighten the weight belt 3 times during the dive. When we don it, in the surface when we enter in the water, and finally at depth, but no one tell us to untighten it back in the surface, because it could become too tight when we uncompress back in the surface.
At least this was the reason why my buddy suffered end of dive vomiting.

I do tighten the belt again when I get to depth, but haven't thought of loosening again at the surface. Thanks.

Wesley

 

[outofofficebrb]

Hi -

Do you happen to know if you swallow a lot of air while you are at depth? This might be in the form of swallowing saliva which seems innocent enough. The air expands and if you aren't able to burp it out, it becomes an issue. I have surfaced a few times where I have not been able to burp it out and I've been incredibly nauseated. I have to remember to not swallow any saliva while down there or else it tends to happen unless I stay ahead of it.