Microbubbles and Shore Diving

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MikeFerrara once bubbled...
<snip>

Doc Deco did a good paper on micro-nuclei life which should give some indication of the length of time one should rest before hard work after a dive.

<snip>

Can you reference that? I hope it isn't written to utterly confuse the mathematically challenged. It's amazing that I ever made it through several years of univeristy math to get my degree. It still gives me the "gag" reflex when I see it. Dr. Wienke's papers can be written in Sanscrit for all the sense I can make of them. I need "the Dancing Wu Li Masters" version to understand what the h*ell it's all about. Surely I can't be alone in this.

R..
 
Excellent thread. This might be a lot more important than we currently realize.

While there is no recommended time period suggested in the DAN quote below, I nonetheless thought it interesting that they had something to say about the issue. I also wonder if post-dive exertion is a possible contributing factor in DAN's ongoing study on "Unexpected Decompression Illness." I wrote them an email to inquire.

From DAN:
Diving Medicine FAQs
Exercise & DCS

Q: Is there a problem with working out before or after I go diving? I love to dive, but I'm in training and don't want to miss a workout.

A: Nitrogen absorption and elimination is largely a matter of temperature and circulation. Gas exchange works very well at constant temperature. After diving when body tissues have been loaded with nitrogen, activities such as running, weight lifting or a heavy workload can shake up the bottle of soda, so to speak. So exercise after diving requires that you give tissue nitrogen levels time to drop, making bubbling generation less likely in the tissues.
 
This IS an excellent thread, thanks for starting it Brian.

I wonder if long surface swims would be considered a form of "heavy lifting" also. If so, I'm guilty of that on a quite a few of my shore dives.
 
Dear Readers:

Post dive exercise

I might estimate the waiting time between a dive near the NDL limits and a climb up a big hill with gear as about 30 minutes to an hour. As with everything in diving (that concerns gas loading), conservative is better than liberal. Exercise and depress was studied as a part of NASA research concerning EVA (extravehicular activity), and the abstract is given at the bottom of this post.

How Much Exercise is Bad?

One problem with all of these “recommendations” is that they are “hazy.” In the laboratory, exercise is determined by oxygen uptake measurements. That is not possible in the field with the recreational diver. Additionally, every situation will be different. Gas loading and unloading is easy to estimate by calculation (Haldane did it one century ago). While the exact amount is not known for each diver, nitrogen loads can be “guesstimated” and a plan worked for maintaining safety in a multiplicity of dive scenarios. Stress-assisted nucleation (bubble formation) in supersaturated divers is difficult to judge. :confused:

Microbubbles must be kept in check or the gas exchange situation runs amuck. The two-phase systems (gaseous nitrogen in bubbles plus dissolved nitrogen in tissues) are only manageable when gaseous nitrogen is kept at a minimum. That is why profuse “bubbling” is bad in multidiving situations. Bubbles in tissue modify off gassing and bubbles in capillaries modify off gassing AND blood flow.

The situation given above by Uncle Pug indicates that he believes that his initial dive started the down hill slide towards bubble formation

Gentle Exercise

Braunbehrens commented that he thought he heard that gentle exercise was harmful. Actually, research indicates that gentle exercise during the deco stops is a good activity to promote blood flow and washout.

Dr Deco :doctor:

Please note the next class in Decompression Physiology :grad:
http://wrigley.usc.edu/hyperbaric/advdeco.htm



Dervay JP, Powell MR, Butler B, Fife CE. The effect of exercise and rest duration on the generation of venous gas bubbles at altitude. Aviat Space Environ Med 2002 Jan; 73(1):22-7
[Medical Operations Branch, NASA-Johnson Space Center, Houston, TX 77058, USA.]

BACKGROUND: Decompression, as occurs with aviators and astronauts undergoing high altitude operations or with deep-sea divers returning to surface, can cause gas bubbles to form within the organism. Pressure changes to evoke bubble formation in vivo during depressurization are several orders of magnitude less than those required for gas phase formation in vitro in quiescent liquids. Preformed micronuclei acting as "seeds" have been proposed, dating back to the 1940's. These tissue gas micronuclei have been attributed to a minute gas phase located in hydrophobic cavities, surfactant-stabilized microbubbles, or arising from musculoskeletal activity. The lifetimes of these micronuclei have been presumed to be from a few minutes to several weeks.

HYPOTHESIS: The greatest incidence of venous gas emboli (VGE) will be detected by precordial Doppler ultrasound with depressurization immediately following lower extremity exercise, with progressively reduced levels of VGE observed as the interval from exercise to depressurization lengthens.

METHODS: In a blinded cross-over design, 20 individuals (15 men, 5 women) at sea level exercised by performing knee-bend squats (150 knee flexes over 10 min, 235-kcal x h(-1)) either at the beginning, middle, or end of a 2-h chair-rest period without an oxygen prebreathe. Seated subjects were then depressurized to 6.2 psia (6,706 m or 22,000 ft altitude equivalent) for 120 min with no exercise performed at altitude.

RESULTS: Of the 20 subjects with VGE in the pulmonary artery, 10 demonstrated a greater incidence of bubbles with exercise performed just prior to depressurization, compared with decreasing bubble grades and incidence as the interval of rest increased prior to depressurization. No decompression illness was reported.

CONCLUSIONS: There is a significant increase in decompression-induced bubble formation at 6.2 psia when lower extremity exercise is performed just prior to depressurization as compared with longer rest intervals. Analysis indicated that micronuclei half-life is on the order of an hour under these hypobaric conditions.
 
It's definitely one to think about - I certainly will! The one incidence of DCI I witnessed was also (probably) due to exertion.

I'm going on a 2 day dive trip in north west Ireland tomorrow and I reckon it could be strenuous. Am going to be ultra careful - thanks for all the tips everyone - especially the one about sleeping after diving - I didn't know that was bad.
 
Dr Deco once bubbled...
Dear Readers:

Post dive exercise

Gentle Exercise

Braunbehrens commented that he thought he heard that gentle exercise was harmful. Actually, research indicates that gentle exercise during the deco stops is a good activity to promote blood flow and washout.


I don't mean to be a pest, but I think this is not in line with the latest findings. Unfortuntely I can't seem to find the actual data, and I don't have time to look right now.

Apparently there was a paper submitted at the recent NAUI workshop, recommending NOT exercising at deco.

Maybe it would be easier for you to track it down than for me...

thanks.
 
Dear Braunbehrens:

Exercise and Deco

You’re not being a pest; you just want to make sure you are getting the real skinny. (“I trust my mother, but I cut the cards.”) There was a paper at the NAUI conference on “Deep Stops and New Decompression Techniques” (something like that for a title) and it did recommend moderate exercise – I gave the paper.

There is evidence that increased blood flow will washout nitrogen faster than if the diver is resting. It is important that the exercise is not too vigorous of tissue microbubbles will be formed. Moving arms and legs while seated is a good exercise, weight lifting and beach volleyball are bad exercises. :lifter:

Dr Deco :doctor:

Please note the next class in Decompression Physiology :grad:
http://wrigley.usc.edu/hyperbaric/advdeco.htm

ABSTRACTS

[1.] Loftin KC, Conkin J, and Powell MR. Modeling the effects of exercise during 100% oxygen prebreathe on the risk of hypobaric decompression sickness. Aviat Space Environ Med 1997 Mar;68 (3):199-204

BACKGROUND: Several previous studies indicated that exercise during prebreathe with 100% O2 decreased the incidence of hypobaric decompression sickness (DCS). We report a meta-analysis of these investigations combined with a new study in our laboratory to develop a statistical model as a predictive tool for DCS. HYPOTHESIS: Exercise during prebreathe increases N2 elimination in a theoretical 360-min half-time compartment decreasing the incidence of DCS. METHODS: A dose-response probability tissue ratio (TR) model was created for two groups, prebreathe with exercise (n = 113) and resting prebreathe (n = 113). RESULTS: The model predicted that prebreathe exercise would reduce the residual N2 in a 360-min half-time compartment to a level analogous to that in a 180-min compartment. This finding supported the hypothesis. The incidence of DCS for the exercise prebreathe group was significantly decreased from the resting prebreathe group. CONCLUSIONS: The results suggested that exercise during prebreathe increases tissue perfusion and N2 elimination approximately 2-fold and markedly lowers the risk of DCS. Based on the model, the prebreathe duration may be reduced from 240 min to a predicted 91 min for the protocol in our study, but this remains to be verified. The model provides a useful planning tool to develop and test appropriate prebreathe exercise protocols and to predict DCS risks for astronauts.

[2.] Jankowski LW, Nishi RY, et al. Exercise during decompression reduces the amount of venous gas emboli. Undersea Hyperb Med 1997 Jun;24(2):59-65

To determine the effects of moderate, intermittent exercise during decompression on the Doppler detectable amount of venous gas emboli (VGE), 29 healthy male volunteers performed 44 wet (8 degrees +/- 2 degrees C) dives to 45 msw (450 kPa) for 30 min with standard air decompression. During compression and the bottom period, all subjects were inactive; during decompression, 28 remained inactive, 11 performed leg exercise, and 5 did arm exercise. Intermittent exercise was controlled at approximately 50% of each subject's arm or leg aerobic capacity. At 30-min intervals after surfacing, subjects were monitored with a Doppler ultrasonic bubble detector. The Doppler scores were used to
calculate the Kisman Integrated Severity Score (KISS). The mean pooled KISS after exercising during decompression were significantly lower than those of the inactive controls. Moderate, intermittent exercise during decompression apparently reduces the amount of Doppler-detectable VGE after diving. The incidence rate of decompression sickness in both groups was not significantly different (P < 0.05).
 
Can you expand on the sleep being bad after diving?

When I boat dive, after the last dive of the day, I break down my gear, have some liquid and a small snack, shoot the breeze some then go hit the sack while the boat is underway. If I was with the last group of divers to surface, I'd guess usually thats usually anywhere from 30 minutes to an hour after surfacing. Then it's usually an hour or two of sleep before docking and the exercsise of moving the gear to the car from the boat.
 
Dear runvus4:

This is misunderstood quite often because I do not write it out completely. By sleeping I refer to the period between the dives during the dive day. I do not mean when all diving for the day is over. Sleeping between dives will reduce the gas washout from the body.

The repetitive group is based on expected nitrogen elimination from a somewhat active individual. If you sleep, the blood flow is considerably reduced and the shift to the next repetitive group is not in synchrony with what is occurring in your body.

Dr Deco :doctor:

Please note the next class in Decompression Physiology :grad:
http://wrigley.usc.edu/hyperbaric/advdeco.htm
 
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