Yeah, an echo isn't 100% sensitive, but he was worried about needles . . . better a bubble-less echo than no echo at all!
Record dive for me - 5 Hours. ...in the chamber.
- Thread starter Rick Inman
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Dr Deco
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Hello readers:
Unexpected DCS :06:
DAN has suggested that the term undeserved DCS should be replaced by unexpected DCS since this reflects the true nature of the problem. Decompression sickness is the result of dissolved nitrogen in the tissues and the growth of free-nitrogen bubbles when the pressure is reduced. Long-time readers of SCUBA BOARD should know that there are not any bends/no bends limits in physical reality. As the dose of nitrogen is reduced, the number of gas bubbles that can form is reduced to a point that is vanishingly small and DCS is not possible. It is a progression.
In addition, since tissue micronuclei are present [some generated by physical activity = hydrodynamic cavitation], their number are a factor as is their diameters. Diameter will influence the Laplace pressure (the contractive force of surface tension) and this will in turn influence what nuclei can grow under any pressure decrease.
Clearly, small nuclei (= large Laplace pressure), few nuclei, and a low nitrogen dose all will militate against the occurrence of DCS. Dive tables only calculate an approximation of nitrogen dose and contain nothing about variable nuclei number and change of surface tension.
Arterialization
[1.] Another factor is the pathways by which arterialization can occur. This is through the famous PFO or through pulmonary shunts. It is not currently something that can be calculated. How many bubbles get into the systemic circulation cannot be determined in advance for a random diver. Exercise will help generate/grow tissue nuclei. Certain types of activities can also mimic a Valsalva maneuver and lead to arterialization.
[2.] Flow segregation will determine where gas bubbles will travel if they reach the arterial system. While not as random as a roulette wheel, there is a degree of probability.
[3.] The lifetime of the bubbles is a function of the surface tension in the arterial system. Hydration will play a role in this part.
[4.] What degree of stoppage is determined by the volume of the gas bubbles in a vessel. Indeed, which vessel of the brain is somewhat random. The stoppage is determined by the adhesion pressure (volume and a molecular component). The resistance to move through the vessel is also a function of the thin fluid layer between the bubble and the endothelium ( = capillary lining). The thin film can breakdown by what is called the disjoining pressure.
PFO
There is always a possibility that the PFO played a role. If you have one, you should know. Since you experienced DCS already, possibly you have a hemodynamically significant PFO.
Dr Deco :doctor:
Unexpected DCS :06:
DAN has suggested that the term undeserved DCS should be replaced by unexpected DCS since this reflects the true nature of the problem. Decompression sickness is the result of dissolved nitrogen in the tissues and the growth of free-nitrogen bubbles when the pressure is reduced. Long-time readers of SCUBA BOARD should know that there are not any bends/no bends limits in physical reality. As the dose of nitrogen is reduced, the number of gas bubbles that can form is reduced to a point that is vanishingly small and DCS is not possible. It is a progression.
In addition, since tissue micronuclei are present [some generated by physical activity = hydrodynamic cavitation], their number are a factor as is their diameters. Diameter will influence the Laplace pressure (the contractive force of surface tension) and this will in turn influence what nuclei can grow under any pressure decrease.
Clearly, small nuclei (= large Laplace pressure), few nuclei, and a low nitrogen dose all will militate against the occurrence of DCS. Dive tables only calculate an approximation of nitrogen dose and contain nothing about variable nuclei number and change of surface tension.
Arterialization
[1.] Another factor is the pathways by which arterialization can occur. This is through the famous PFO or through pulmonary shunts. It is not currently something that can be calculated. How many bubbles get into the systemic circulation cannot be determined in advance for a random diver. Exercise will help generate/grow tissue nuclei. Certain types of activities can also mimic a Valsalva maneuver and lead to arterialization.
[2.] Flow segregation will determine where gas bubbles will travel if they reach the arterial system. While not as random as a roulette wheel, there is a degree of probability.
[3.] The lifetime of the bubbles is a function of the surface tension in the arterial system. Hydration will play a role in this part.
[4.] What degree of stoppage is determined by the volume of the gas bubbles in a vessel. Indeed, which vessel of the brain is somewhat random. The stoppage is determined by the adhesion pressure (volume and a molecular component). The resistance to move through the vessel is also a function of the thin fluid layer between the bubble and the endothelium ( = capillary lining). The thin film can breakdown by what is called the disjoining pressure.
PFO
There is always a possibility that the PFO played a role. If you have one, you should know. Since you experienced DCS already, possibly you have a hemodynamically significant PFO.
Dr Deco :doctor:
ScottZeagle
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Hey Rick...
Sorry to hear about your troubles, but I am glad everything seems to be ok now.
Funny how a nagging wife can get us to do some important things that we wouldn't normally be willing to do, eh???
2 weeks may seem like a long time, but your health is far more important!!
Best wishes,
Scott
Sorry to hear about your troubles, but I am glad everything seems to be ok now.
Funny how a nagging wife can get us to do some important things that we wouldn't normally be willing to do, eh???
2 weeks may seem like a long time, but your health is far more important!!
Best wishes,
Scott
miked
Contributor
Hi Rick,
As another member of the "unexpected/undeserved hit" club, I'm glad that you are feeling well.
Take care, and enjoy the "2 weeks dry" as best you can.
Good luck,
Mike
As another member of the "unexpected/undeserved hit" club, I'm glad that you are feeling well.
Take care, and enjoy the "2 weeks dry" as best you can.
Good luck,
Mike
Rick Inman:
Well, from that it definitely looks like an undeserved hit. Like I said before, I couldn't make a judgement either way because there just wasn't enough information and I also assumed you probably had diving experience even though your profile says not certified and no dives. I was just curious as to more specific details to the profiles. Like I said, I will never say I know all and am still learning a lot. That is part of why I wanted more details, seeing as I dive deep with nitrox.
As always, glad to know you are better now.
The problem I am learning on the boards here sometimes is that I have seen people say their hit was undeserved but they only give very simple information and then you get more details like "I was at 120' for only 15 minutes (on regular air) and didn't do a safety stop. So now I just like to get more information so that I can figure out the facts behind it so that I can learn from it.
gangrel441
Contributor
Hi Rick, hi Doc!
Good to hear that you caught this and got it treated! A story like this one has actually been a concern for me. I know typically with DCS we are looking for multiple symptoms off the laundry list I am sure we are all familiar with. If I read this right, your main (or only) symptom was fatigue.
My concern is, how do you catch a case like this. You wife sounded like she was on the ball, but in my case after an activity like diving (or for that matter, swimming, playing with the dogs outside in the afternoon, etc.), it would not be uncommon for me to get fatigued. I am not quite sure how I would look at symptoms like that and know that I should get checked out, in the absence of other symptoms.
As an example, last weekend I did some diving. A few hours afterwords, the large knuckle at the base of my thumb became really achey. No other symptoms, excepte the fatigue that is common for me after diving. I didn't sweat it, and I am fairly certain the joint was strained from putting on my 7mm suit. My profiles were shallow, too (above 30 ft accompanying a class of OW students), and no whacky ascents or blown safety stops...but had the profiles been deeper or more aggressive, how would I go about ruling this out? Based on what you described, I don't know that I would have given it much of a thought.
Good to hear that you caught this and got it treated! A story like this one has actually been a concern for me. I know typically with DCS we are looking for multiple symptoms off the laundry list I am sure we are all familiar with. If I read this right, your main (or only) symptom was fatigue.
My concern is, how do you catch a case like this. You wife sounded like she was on the ball, but in my case after an activity like diving (or for that matter, swimming, playing with the dogs outside in the afternoon, etc.), it would not be uncommon for me to get fatigued. I am not quite sure how I would look at symptoms like that and know that I should get checked out, in the absence of other symptoms.
As an example, last weekend I did some diving. A few hours afterwords, the large knuckle at the base of my thumb became really achey. No other symptoms, excepte the fatigue that is common for me after diving. I didn't sweat it, and I am fairly certain the joint was strained from putting on my 7mm suit. My profiles were shallow, too (above 30 ft accompanying a class of OW students), and no whacky ascents or blown safety stops...but had the profiles been deeper or more aggressive, how would I go about ruling this out? Based on what you described, I don't know that I would have given it much of a thought.
OP
Thanks Doc, Scott, and everyone else!
Also, I should have done the neurological exam on my self. Duh! That would have told me things were off kilter.
I was also nauseous. And we're not talking I've-been-working-hard-and-I'm-bushed fatigue. We're talkin', something is definitely wrong. For example, if you get a really bad flu and are puking everything up with a fever for three days, you're not just tired from chasing the dog. Your all drained all-out. This is closer to how I felt.gangrel441:
Also, I should have done the neurological exam on my self. Duh! That would have told me things were off kilter.
gangrel441
Contributor
Thanks Rick. That helps to clear it up. Just seems like we're always told, look for subtle symptoms and be vigilant, but I never know how subtle the symptoms could be. I have heard of sleepiness after diving possibly being subclinical DCS. I think that is taking it a bit far, but I am never quite sure where that line is drawn. Couple that with the fact that muscle and joint aches are not uncommon for me, because of my active lifestyle, and it can get pretty confusing sometimes...
Hey Rick,
So glad to hear you are ok - Good thing your wife cares isn't it?
Aloha, Tim
So glad to hear you are ok - Good thing your wife cares isn't it?
Aloha, Tim
Saturation
Medical Moderator
Divers seek help when abnormal symptoms worsen with time. Neurologic symptoms such as weakness or vertigo are striking unusual that divers clearly seek help when they occur. Fatigue, deafness, joint pain, or aches, etc., are often experienced for benign reasons that a diver will not consider it as potentially DCS until its severe enough to be noticeable different what is common in daily life. Since DCS worsens if left untreated, it will escalates symptoms to above 'daily life' levels. If the symptoms improve without treatment, its often considered not DCS, even if it could have been.
Its theoretically possible to get any disease that heals without treatment. Untreated DCS eventually resolves but how well it resolves depends on how big the injury: the body either heals, dies, scars or doesn't scar.
There is no proof that such 'quiet DCS' events are truly a reason why some divers get severe dive related diseases like dysbaric osteonecrosis, and others don't, but its more logical.
Its theoretically possible to get any disease that heals without treatment. Untreated DCS eventually resolves but how well it resolves depends on how big the injury: the body either heals, dies, scars or doesn't scar.
There is no proof that such 'quiet DCS' events are truly a reason why some divers get severe dive related diseases like dysbaric osteonecrosis, and others don't, but its more logical.
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