1.DCS symptoms and 2. MK25/S600 and Nitrox ?

[Duke Dive Medicine]

I would think sinus issues would present with pain, pressure, and mucus, possibly but not necessarily bloody....

Not necessarily. There are case reports of strange neurological symptoms with pressure changes that end up being related to anatomic anomalies in the sinuses. We published one in UHM a few years back on a diver who experienced sudden, painless vision loss at depth that resolved spontaneously on ascent, and another group published a similar case in the very next issue. We concluded that ours was related to a bony dehiscence in the sphenoid sinus after ruling out other potential causes and based on similar case reports in mountaineers and other ascents to altitude; their guy had CT scans showing it.

Best regards,
DDM

 

[fmerkel]

And I thought I had sinus issues.

 

[Sea Green Dreams]

Hey thought I would update.

I got an appointment for an echocardiogram..in March 2017. Our health care is free-ish after all; I can pay and get in faster if needed. My Dr says my 'murmur' is very small. I will be adjusting my depths and adding a deep stop for my 4 dives over the next week. Still considering taking the Nitrox cert..

Approaching the sinus possibility over the next week with care and attention by being gentle and more frequent with my clearing and see if that helps. If not I will be calling the Dive Drs around town.

Happy Diving!

 

[Shotmaster]

Yes, get your Nitrox training, it will lower your nitrogen saturation which will reduce the odds compared to using air for the same bottom time. Personally, I think Nitrox should be part of AOW since it almost covers any depth you would do strictly as a recreational diver. We know a lot more about what occurs with the body in relation to using different dive gases now, than when I began diving in the early 70's. You can use air, but the benefits of Nitrox are worth the extra cost if you dive deeper than 40-50 feet (personal opinion). I hope you get resolution on your symptoms with clearing more often and the doctor doesn't find anything that will affect your diving!

 

[fmerkel]

There is some controversy about the value of deep stops. For 'average' recreational use it probably doesn't make much difference. As indicated, Nitrox is your friend here. Since it's very doubtful at this stage that N2 is the problem, I'd focus on the sinuses.

You have to pay close attention to sinus issues. They can be subtle, pressure under your eyes like pushing with your fingers, pin prick sensation right above the inside of the eyes, even low grade tooth ache. Since you really can't clear sinuses voluntarily, you simply have to wait until they clear themselves...if they can. You could try a shot of Afrin (oxymetazoline) about 30" before diving, even add psuedofedrine (Sudafed) to the mix. They will not conflict with one another.

Nitrox will be of no benefit to sinus or any other clearing issue.

Murmur? Did I miss you bringing that up before?

 

[Sea Green Dreams]

fmerkel ~ I didn't use the word murmur but referenced remembering as a kid being told I have a small hole in my heart..fast forward years later as a young adult being told I have a murmur, not a big deal forgot about it...fast forward to now, remembering it again and realizing after all the reading I've been doing with these symptoms that it is definitely something to be considered. So until I have anything confirmed it would be prudent to act as if I do have PFO and dive accordingly. But! Everyone seems to think my current symptoms are sinus related but it doesn't hurt to be on the safe side.

 

[fmerkel]

Murmur generally means a leaky valve. I don't think you can detect a PFO by listening with a stethoscope.

Clots (and bubbles) tend to form on the venous side of the system circulatory system. All that blood has to go through the lungs before entering back into systemic circulation. The pulmonary (lungs) system is quite effective at screening out normal amounts of this kind of problem without incurring issues. Of course it can be overwhelmed in extreme circumstances.

A valve murmur would have no effect on this. A PFO or atrial septal defect (ASD) allow the blood to 'cross over' back into the systemic side and then potentially go lodge in somewhere critical causing problems. Generally any kind of clotting issue is treated with anit-clotting medication (can be as simple as aspirin). For DCS is simply don't form bubbles, which means being more conservative about how you dive. IMO the diving you have done does not get into suspicious territory at all.

 

[diver0008]

I do have to clear my ears quite forcefully

That is dangerous.

 

[chillyinCanada]

Equalize early equalize often. I suggest you start before you ever get near the water. Clear your ears as you would on a plane during landing or take off. Breathe in through your nose as you move your bottom jaw forward (mouth closed). Feel the stretch and you should hear the slight pop as your ears clear. This is like exercise for the eustachion tubes.

Equalize just before you descend, then continue equalizing early and often during descent. You should never have to really be forceful. If you feel the need to that, remember from your lessons, ascend slightly and try again. Forceful equalizing will cause any number of other problems including infection.

Best of luck.

 

[Duke Dive Medicine]

Hey thought I would update.

I got an appointment for an echocardiogram..in March 2017. Our health care is free-ish after all; I can pay and get in faster if needed. My Dr says my 'murmur' is very small. I will be adjusting my depths and adding a deep stop for my 4 dives over the next week. Still considering taking the Nitrox cert..

Approaching the sinus possibility over the next week with care and attention by being gentle and more frequent with my clearing and see if that helps. If not I will be calling the Dive Drs around town.

Happy Diving!

Do not add a deep stop by default. I'll go further than fmerkel and say that doing so may well do more harm than good. The definition of "deep stops" varies depending who you ask and where you look. Some decompression algorithms incorporate "deeper" stops as part of a planned decompression profile. "Pyle stops" arose out of one individual's experience and have been, IMO, inappropriately and unscientifically generalized.

Best regards,
DDM