Completely normal nitrox dive to 25m gave me DCS

[SFJCody]

No matter; it's fascinating. ☺ Have returned to the gym today.

 

[Kevrumbo]

No matter; it's fascinating. ☺ Have returned to the gym today.

Well that's why we wanted know about your Table 6A -that's a very serious treatment protocol typically used for "Hyper-Acute" critical dive casualties suffering from Arterial (Air) Gas Embolism with occluded blood flow causing organ ischemia. . .

 

[Beau640]

Sounds like the original nausea might have not even been DCS but you actually sustained a DCS hit from the first chamber ride itself with low flow and a poorly fitting mask...all the other trips have been an attempt to fix the actual DCS symptoms you got after the first chamber ride...

 

[SFJCody]

I really really think it was DCS... I've had it before. I know what it feels like.

Another wave of nausea and shaking in the past hour, just when I thought I was over the worst.

I'm going to get checked for a PFO. It might explain my history of migraines as well as my unwarranted DCS hits.

 

[Duke Dive Medicine]

SFJCody, from the information you have provided, a PFO test is probably not indicated in your case. Your symptoms during your course of treatment could be explained by the circumstances we've already discussed here. Post-dive nausea that resolves spontaneously on ambient air is almost certainly not DCS-related. Testing for PFO should only be done after consultation with a diving medical specialist, and results should be interpreted with care. A PFO may well be a red herring in your case. Is there a way to return to the UK for evaluation earlier than you had planned?

Best regards,
DDM

 

[Rred]

DDM-
PMFJIH, but purely out of conservatism I had asked my cardiologist about doing an ultrasound (echocardiogram) to make sure I didn't have a PFO or any other heart condition that might affect my diving. (I'm an older diver getting back into things.) He seemed certain that simple non-invasive procedure could provide a 100% certain result, in this case "no problems, no pfo". Was he wrong to think it is that simple to find a PFO?
--Red

 

[Duke Dive Medicine]

DDM-
PMFJIH, but purely out of conservatism I had asked my cardiologist about doing an ultrasound (echocardiogram) to make sure I didn't have a PFO or any other heart condition that might affect my diving. (I'm an older diver getting back into things.) He seemed certain that simple non-invasive procedure could provide a 100% certain result, in this case "no problems, no pfo". Was he wrong to think it is that simple to find a PFO?
--Red

Hi Red,

No worries at all. Happy to answer questions. A transthoracic echocardiogram (TTE) with bubble contrast will detect a clinically significant PFO. It's a relatively benign procedure but does involve an IV. Some cardiologists prefer a transesophageal echocardiogram (TEE) but it's slightly more invasive.

It's also worthwhile to consider what you would do with the results of a PFO test. Would you dive more conservatively if you knew you had a PFO? Arguably, conservative diving is a good idea for anyone who's getting on in age; you could save yourself the bill and just dive conservatively, i.e. stay well away from the no-stop limits, learn to dive nitrox, stay warm on decompression, and don't exert yourself on the bottom.

Best regards,
DDM

 

[Bubblesong]

Wouldn't it be important to know about an existing FPO in the event of an accident requiring a decompression chamber? It might affect what treatment plan the doctors go with.

 

[Kevrumbo]

DDM-
PMFJIH, but purely out of conservatism I had asked my cardiologist about doing an ultrasound (echocardiogram) to make sure I didn't have a PFO or any other heart condition that might affect my diving. (I'm an older diver getting back into things.) He seemed certain that simple non-invasive procedure could provide a 100% certain result, in this case "no problems, no pfo". Was he wrong to think it is that simple to find a PFO?
--Red

I had a much simpler non-invasive pre-diagnostic screening procedure called a Transcranial Doppler (see links below) back in 2009 as part of a free experimental university study at the time, which fortunately showed no indication of a PFO.

Hi Red,

No worries at all. Happy to answer questions. A transthoracic echocardiogram (TTE) with bubble contrast will detect a clinically significant PFO. It's a relatively benign procedure but does involve an IV. Some cardiologists prefer a transesophageal echocardiogram (TEE) but it's slightly more invasive.

It's also worthwhile to consider what you would do with the results of a PFO test. Would you dive more conservatively if you knew you had a PFO? Arguably, conservative diving is a good idea for anyone who's getting on in age; you could save yourself the bill and just dive conservatively, i.e. stay well away from the no-stop limits, learn to dive nitrox, stay warm on decompression, and don't exert yourself on the bottom.

Best regards,
DDM

Wouldn't it be important to know about an existing FPO in the event of an accident requiring a decompression chamber? It might affect what treatment plan the doctors go with.

From Dr. Richard Moon, Dept of Anesthesiology, Duke University Medical Center (1998):
http://archive.rubicon-foundation.o...e/123456789/5949/SPUMS_V28N3_9.pdf?sequence=1

". . .For recreational divers I believe there is no need for a screening examination to look for a Patent Foramen Ovale (PFO). The only relationship we have found between PFO and DCI is for serious neurological bends, a rare disorder, and largely attributable to risk factors which are associated with the dive itself, such as depth, bottom time and rate of ascent. On the other hand, for a person who plans to perform dives that have a high risk of venous gas embolism for long periods of time, for example saturation diving [and especially with regard to modern day long runtime open circuit or CCR decompression dives now becoming common to sport recreational advanced technical diving -italics mine @Kevrumbo ], then I would recommend a PFO Study. . ."

The statement above IMHO, along with my comment in brackets, is less ambiguous than the current joint DAN/UHMS/SPUMS consensus position as of June 2015: https://www.diversalertnetwork.org/...Proceedings/2015-pfo-workshop-proceedings.pdf

The point to be aware of is this: There's a dilemma in considering the low statistical incidence of DCI in the general diver population versus the high morbid consequences of suffering a type II DCS/AGE in specialized technical decompression diving, with a PFO as a possible contributing -or "associated" condition. So you have a low probability event vs a severe health & welfare outcome if you unluckily suffered such an occurrence.

It may seem like a fallacy apples & oranges comparison, but it actually turns out to be a continuum of personal risk management: In other words, the chances are low of contracting DCI in regular NDL recreational diving, but on the other hand, would you do 3hr runtime, saw-tooth profile, decompression cave dives in hypothermic stress if you knew you had an underlying PFO condition to begin with?

Again, finding out you have a pre-existing PFO through suffering a type II DCS/AGE emergency is neither preferable from a personal health & welfare standpoint, nor medically ethical if you could have screened for it beforehand with at least a contrast TCD (Trans Cranial Doppler):
How to use contrast enhanced transcranial doppler toward detection and follow-up

Transcranial doppler ultrasonography should it be the first choice for persistent foramen ovale screening?

Finally, further frustrating and confounding the issue even more -how can you get your primary health insurance to cover a TCD, or TEE/TTE diagnostic test to Rule Out a PFO? Is it worth it to pay out-of-pocket?

 

[Rred]

DDM-
Thank you. Since the cardiologist just ordered the procedure without an IV, and he and the tech both knew that I wanted to check for a PFO, does that suggest I should find a sharper cardiologist? (Putting that diplomatically, I hope.) Who will order the procedure with contrast, at the least?
I'm not sure how finding one would affect my diving, since I'm already conservative. But confirming that I don't have to worry about one, would give me one less thing to be concerned with. There's enough FUD propagated by the diving industry, so when it comes to more objective medical issues that have more finite answers (i.e. there is or isn't a PFO) I like to make properly informed decisions.

With DCS these days...onceuponatime we had the USN tables, period. Now there's Bühlmann, RGBM, revised secret proprietary untested tables in every computer...as the joke goes, I'm sure there's a pony in that pile.(G)